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IDENTITAS DUNIA USAHA / INDUSTRI

1. Nama Perusahaan/Instansi/Lembaga/Institusi Pasangan


:…………………………………………………………………………….
Alamat Lengkap :…………………………………………………………………………….
Desa :……………………………………………………………………………..
Kelurahan :…………………………………………………………………………….
Kecamatan :……………………………………………………………………………
Kota/Kab. :……………………………………………………………………………..
Provinsi :……………………………………………………………………………..
No. Tlp/Hp :…………………………………………………………………………….
No. Fax :……………………………………………………………………………..
E-Mail :………………………………………………………………………………
Website :……………………………………………………………………………….
2. Nama Pimpinan :………………………………………………………………………………
Contact Person :……………………………………………………………………………….
3. Pembimbing:……………………………………………………………………………….
Contact Person :……………………………………………………………………………

Harjomulyo jaya,01 maret 2023

Pimpinan / Pembimbing DU

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