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  • Rumah Sakit Umum Amanah Jalan Dr. Soetomo No 33 Malang Telp.1234567890 Kode Dok: Kode Revisi: 0.0 RSU"A"

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    Rumah Sakit Umum Amanah Jalan Dr. Soetomo No 33 Malang Telp.1234567890 Kode Dok: Kode Revisi: 0.0 RSU"A"

    Uploaded by

    Dinda Aulia
    Tugas makalah

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    RUMAH SAKIT UMUM AMANAH Kode Dok :

    RSU”A” Jalan Dr. Soetomo No 33 Malang


    Telp.1234567890 Kode Revisi : 0.0

    SURAT PERNYATAAN

    Yang bertanda tangan dibawah ini :

    Nama :

    Jabatan :

    Instansi/perusahaan :

    Dengan ini menyatakan tidak akan menggandakan dan menyalahgunakan dokumen/


    formulir yang kami terima dari …………….berupa :

    …………………………………………………………………………………………
    …………………………………………………………………………………………
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    …………………………………………………………………………………………
    …………………………………………………………………………………………
    …………………………………………………………………………………………
    …………………………………………………………………………………………
    …………………………………………………………………………………………
    …………………………………………………………………………………………
    …………………………………………………………………………………………
    …………………………………………………………………………………………
    .

    ----------------------------------
    Yang membuat pernyataan

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