PT.

Modena Indonesia

BERITA ACARA DISPOSAL

DISPOSAL REPORT
F.21/MI-BPI/R03/2019

DOKUMEN/ARSIP (DOCUMENT/ARCHIVE) LAIN-LAIN / OTHERS (E.g:

Business Card/Uniform)

A. DATA DISPOSAL (DISPOSAL DATA)

1 DIV./DEPT./CABANG :
(DIV./DEPT./BRANCH)
2 NAMA DOKUMEN/ARSIP/LAIN-
LAIN :
(DOCUMENT/ ARCHIVE/ OTHERS)
3 PERIODE DOKUMEN/ARSIP/LAIN-
LAIN :
(DOCUMENT/ARCHIVE/OTHERS)
4 METODE DISPOSAL :
(DISPOSAL METHOD)
5 JUMLAH :
(TOTAL AMOUNT)

B. URAIAN/KETERANGAN (REMARK)

C. DOKUMENTASI DISPOSAL / DISPOSAL DOCUMENT (Must attached

GAMBAR/PHOTO)

Jakarta, dd/mm/yy

Dibuat/Proposed Diperiksa/Disetujui/Approved Diketahui/Known*)

Staff/Pemohon Dept. Head/BM/Atasan ACC/Div. Head

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