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  • DPMTP Sipp

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    Merry Yuliani
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    This document is a request letter for a nurse practice license (SIPP) addressed to the Regent of Merauke. It includes the applicant's personal details and attachments required for the application: photocopy of ID card, legalized copy of nursing diploma, health certificate from a doctor, valid STR, original recommendations from the nursing association and Health Department, passport photo, photocopy of tax ID, maps, and stamp duty. The applicant expresses gratitude and hopes for consideration of this sincere request.

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    DPMTP SIPP

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    This document is a request letter for a nurse practice license (SIPP) addressed to the Regent of Merauke. It includes the applicant's personal details and attachments required for the application: photocopy of ID card, legalized copy of nursing diploma, health certificate from a doctor, valid STR, original recommendations from the nursing association and Health Department, passport photo, photocopy of tax ID, maps, and stamp duty. The applicant expresses gratitude and hopes for consideration of this sincere request.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    9 views1 page

    DPMTP Sipp

    Uploaded by

    Merry Yuliani
    This document is a request letter for a nurse practice license (SIPP) addressed to the Regent of Merauke. It includes the applicant's personal details and attachments required for the application: photocopy of ID card, legalized copy of nursing diploma, health certificate from a doctor, valid STR, original recommendations from the nursing association and Health Department, passport photo, photocopy of tax ID, maps, and stamp duty. The applicant expresses gratitude and hopes for consideration of this sincere request.

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

    PERMOHONAN SURAT IJIN PRAKTEK PERAWAT (SIPP)

    Kepada Yth :
    Bupati Merauke
    c.q Kepala Dinas Penanaman Modal dan
    Perizinan Terpadu Satu Pintu
    Kab. Merauke
    Di
    MERAUKE

    Yang bertanda tangan dibawah ini :


    1. Nama :
    2. Tempat , tanggal lahir :
    3. Jenis Kelamin :
    4. Lulusan :
    5. Tahun Lulusan :
    6. Tempat Bekerja :
    7. Alamat Rumah :
    8. Alamat Praktek :

    Dengan ini kami mengajukan permohonan Surat Izin Praktek Perawat (SIPP), Sebagai bahan
    pertimbangan bersama ini kami lampirkan :
    1. Fotocopy KTP sebanyak 1 lembar
    2. Fotocopy Ijazah Terakhir Pendidikan Perawat (dilegalisir)
    3. Surat Keterangan Sehat dari dokter yang mempunyai SIP
    4. Fotocopy STR yang masih berlaku
    5. Rekomendasi Asli dari organisasi profesi (PPNI)
    6. Rekomendasi Asli dari Dinas Kesehatan
    7. Pas photo 4x6 sebanyak 2 lembar
    8. Fotocopy NPWP sebanyak 1 lembar
    9. Map sebanyak 2 lembar
    10. Meterai 10.000 2 lembar
    Demikian permohonan ini kami buat dengan sebenarnya atas perhatian bapak/ibu kami
    ucapkan terima kasih.

    Merauke,
    Hormat Kami

    ( )

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