P E NG A J
U A N K E B E R A T A N A T A S P E R M O H O NA N I NF O R M A S I
A . I NF O R M A S I P E NG A J U A N K E B E R A T A N
Nom or R egi s t r a s i K eber a t a n * Na m a P em oh on In for m a s i T u j u a n P en ggu n a a n In for m a s i
Id en t i t a s P em oh on Na m a A l a m a t
Nom or T el ep on P ek er j a a n
Id en t i t a s K u a s a Pem oh on ** Na m a
A l a m a t
Nom or T el ep on P ek er j a a n
B . A L A S A N K E B E R A T A N ***
P er m oh on a n i n for m a s i d i t ol a k In for m a s i b er k a l a t i d a k d i s edi a k a n P er m i n t a a n i n for m a s i t i d a k di t a n gga p i P er m i n t a a n i n for m a s i
B i a y a y a n g d i k en a k a n t i d a k w a j a r
In for m a s i d i s a m p a i k a n m el ebi h i j a n gk a w a k t u y a n g d i b er i k a n
C . H A R I / T A NG G A L T A NG G A P A N A T A S K E B E R A T A N A K A N D I B E R I K A N D em i k i a n k eb er a t a n i n i S a y a s a m p a i k a n , a t a s per h a t i a n
k a s i h .
M en get a h u i , Pet u ga s In for m a s i (Pen er i m a k eb er a t a n )
(… … … . . …… … . . )
Na m a d a n t a n d a t a n ga n
K E T E R A NG A N:
* Nom or regis ter pen ga ju a n k ebera t a n d i is i b erd a s a r k a n b u k u regi s ter pen ga j u a n k ebera t a n
** Id en ti t a s k u a s a pem oh on , d i i s i j i k a p er moh on a n d ik u a s a k a n p a d a p i h a k l a i n (s u r a t k u a s a d il a m p i rk a n ) *** D i i s i oleh pen ga j u k eber a ta n s es u a i a l a s a n
**** D i i s i s es u a i j a n gk a w a k tu d a la m Perbu p i n i (1 0 h a r i k erja , den ga n perp a n ja n ga n 7 h a r i k erja )
K E ME NT E R IA N P E R INDUS T R IA N R .I
B A D A N P E NE L IT IA N DA N P E NG E MB A NG A N
B A L A I B E S A R I N D U S T R I A G R O
C enter F or Agr0-Based Industry (C ABI)
J l. Ir. H. J uanda No. 11 B og or 16122 T elp ( 0251) 8324068 ( Hunting ) , F ax. ( 0251) 8
E -mail : c abi@ bbia.g o.id ; http://www.bbia.g o.id
K E B E R A T A N A T A S P E R M O H O NA N I NF O R M A S I
K E B E R A T A N Nom or R egi s t r a s i K eber a t a n * :
: P en ggu n a a n In for m a s i :
: . . . .. . . . : . . . .. . . . . . . .. . . . : . . . . : . . . .
: . . . . : . . . . . . . .. . . . : . . . .. . . . : . . . .. . . .
P er m oh on a n i n for m a s i d i t ol a k In for m a s i b er k a l a t i d a k d i s edi a k a n P er m i n t a a n i n for m a s i t i d a k di t a n gga p i
P er m i n t a a n i n for m a s i d i t a n gga pi t i d a k s eb a ga i m a n a y a n g di m i n t a B i a y a y a n g d i k en a k a n t i d a k w a j a r
In for m a s i d i s a m p a i k a n m el ebi h i j a n gk a w a k t u y a n g d i b er i k a n
H A R I / T A NG G A L T A NG G A P A N A T A S K E B E R A T A N A K A N D I B E R I K A N ****
D em i k i a n k eb er a t a n i n i S a y a s a m p a i k a n , a t a s per h a t i a n d a n t a n gga p a n n y a di u c a p k a n t er i m a
B og or ,
P en ga j u K eber a t a n
(… … … ) Na m a d a n t a n d a t a n ga n
Nom or regis ter pen ga ju a n k ebera t a n d i is i b erd a s a r k a n b u k u regi s ter pen ga j u a n k ebera t a n
Id en ti t a s k u a s a pem oh on , d i i s i j i k a p er moh on a n d ik u a s a k a n p a d a p i h a k l a i n (s u r a t k u a s a d il a m p i rk a n ) D i i s i oleh pen ga j u k eber a ta n s es u a i a l a s a n p en ga j u a n k ebera t a n
D i i s i s es u a i j a n gk a w a k tu d a la m Perbu p i n i (1 0 h a r i k erja , den ga n perp a n ja n ga n 7 h a r i k erja )
K E ME NT E R IA N P E R INDUS T R IA N R .I
E L IT IA N DA N P E NG E MB A NG A N INDUS T R I
I N D U S T R I A G R O
Based Industry (C ABI)
Ir. H. J uanda No. 11 B og or 16122
1) 8323339
http://www.bbia.g o.id
K E B E R A T A N A T A S P E R M O H O NA N I NF O R M A S I
. . . . . . . . . .. . . . . . . . .
. . . . . . . . . . . . . . .
d i t a n gga pi t i d a k s eb a ga i m a n a y a n g di m i n t a
**** :
d a n t a n gga p a n n y a di u c a p k a n t er i m a
(… … … )
Na m a d a n t a n d a t a n ga n
Nom or regis ter pen ga ju a n k ebera t a n d i is i b erd a s a r k a n b u k u regi s ter pen ga j u a n k ebera t a n
Id en ti t a s k u a s a pem oh on , d i i s i j i k a p er moh on a n d ik u a s a k a n p a d a p i h a k l a i n (s u r a t k u a s a d il a m p i rk a n )
