Kaos ORMIK & SEMOT Bina Sarana Informatika (BSI)

<div dir="ltr" style="text-align: left;" trbidi="on"> <table border="0" style="width: 100%px;"><tbody> <tr><td class="thmTopBgBox"><b>Orientasi Akademik dan Seminar Motivasi</b></td> </tr> <tr> <td align="right" class="thmContentTxt"><br /></td> </tr> <tr> <td class="thmContentTxt"><b><span style="font-size: medium;">KETENTUAN </span></b><br /> <br /> Pelaksanaan Orientasi Akademik (Kuliah Umum) dan Seminar Motivasi (Semot) akan diselenggarakan secara serentak di lokasi dan jadwal yang telah ditentukan. Agar pelaksanaan Orientasi Akademik dan Seminar Motivasi dapat berjalan dengan baik dan lancar, maka ada beberapa hal yang harus diperhatikan calon mahasiswa baru:<br /> <ul> <li> Wajib diikuti seluruh mahasiswa baru. Jadwal dapat dilihat mulai tanggal 20 Agustus 2013. </li> <li> Membawa Kartu Tanda Mahasiswa Sementara dan KTP sebagai bukti diri</li> <li>Pada saat Orientasi Akademik dan Seminar Motivasi, mahasiswa baru diwajibkan mengenakan pakaian dengan sopan dengan ketentuan sebagai berikut: <ul> <li> Pria, mengenakan kaos yang telah di desain sesuai ketentuan, sepatu tertutup dan celana hitam polos</li> <li> Wanita, mengenakan kaos yang telah di desain sesuai ketentuan, sepatu tertutup dan rok hitam polos</li> </ul> </li> <li> Membawa Jaket Almamater <ul> <li>Jaket almamater dibagikan sesuai waktu yang ditentukan.</li> <li>Dikenakan setelah acara pelantikan. </li> </ul> </li> <li> Pada acara Orientasi Akademik, antara lain akan dijelaskan tentang Panduan Akademik</li> <li> Pada saat Orientasi Akademik dan Seminar Motivasi mahasiswa BSI diwajibkan menyanyikan lagu Mars BSI (wajib dihafalkan)</li> <li>Diwajibkan untuk menyerahkan sumbangan buku bagi Perpustakaan SD (Sekolah Dasar) Terpencil terbitan 2012 ke atas. Judul bebas. </li> </ul> <br /> <b>JADWAL PENGAMBILAN JAKET ALMAMATER</b> DI KAMPUS MASING-MASING <br /> <br /> <span style="color: blue;"><b>Gel. I      15 - 20 Jul 2013 </b></span><br /> <span style="color: blue;"><b>Gel. II     22 - 27 Jul 2013 </b></span><br /> <span style="color: blue;"><b>Gel. III    29 Jul - 3 Agt 2013 </b></span><br /> <span style="color: blue;"><b>Gel. IV    19 - 24 Agt 2013 </b></span><br /> <span style="color: blue;"><b>Gel. V     26 Agt - 6 Sep 2013 </b></span><br /> <br /> <b><span style="font-size: medium;">Ketentuan Kaos</span></b><br /> <br /> Untuk mengikuti Orientasi Akademik dan Seminar Motivasi, calon mahasiswa diwajibkan untuk menyiapkan kaos sendiri-sendiri dengan desain sesuai ketentuan sebagai berikut:<br /> <br /> <div class="separator" style="clear: both; text-align: center;"> <a href="http://t-shirtlicious.blogspot.com/2013/11/kaos-ormik-bsi.html"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvJu0OHR5e0Go8GrmAya-feeResqI6gsy6NntkmE3mPYGKzukaIf2a4dzmTqIekDs0OClzFVa3z4ujM5qnw_fLg6LJ7itF6NpklG3B03-dbsUCIvs1-Yygl9Qdy3GKV6smKP00RI4ieg81/s640/kaos_BSI.jpg" width="640" /></a></div> <br /> <br /> <br /> <a href="http://adf.ly/TIS5j">Download Logo BSI</a><br /> <br /> <br /> <br /> <br /></td></tr> </tbody></table> </div>

Kaos ORMIK & SEMOT Bina Sarana Informatika (BSI)

Orientasi Akademik dan Seminar Motivasi KETENTUAN Pelaksanaan Orientasi Akademik (Kuliah Umum) dan Seminar Motivasi ...

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Beasiswa (BSI) Bina Sarana Informatika

<div dir="ltr" style="text-align: left;" trbidi="on"> <i><b>Contoh bentuk surat pernyataan atau surat keterangan pengajuan Beasiswa di Bina Sarana Informatika :</b></i><br /> <br /> <br /> <br /> <br /> <div align="center" class="MsoNormal" style="text-align: center;"> <span style="font-size: large;"><b><span style="font-family: "Times New Roman","serif"; line-height: 115%;">Surat Permohonan Pengajuan Beasiswa</span></b></span></div> <div align="center" class="MsoNormal" style="text-align: center;"> </div> <div align="right" class="MsoNormal" style="text-align: right;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Jakarta, 30 Juli 2013</span></div> <div class="MsoNormal"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Kepada Yth,</span></div> <div class="MsoNormal"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Direktur AKOM (<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">Sesuai akademi yang diambil</i></b>) Bina Sarana Informatika</span></div> <div class="MsoNormal"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Di Tempat</span></div> <div class="MsoNormal"> </div> <div class="MsoNormal"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Dengan hormat, </span></div> <div class="MsoNormal" style="text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Sehubungan dengan adanya informasi beasiswa prestasi dari bina sarana informatika, maka dengan ini saya :</span></div> <div class="MsoNormal" style="text-indent: 36pt;"> </div> <div class="MsoNormal"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">            NIM                :</span></div> <div class="MsoNormal"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">            Nama              :</span></div> <div class="MsoNormal"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">            Jurusan            :</span></div> <div class="MsoNormal"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">            Semester         : (<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">semester sekarang</i></b>)</span></div> <div class="MsoNormal"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">            IPK                 : (<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">IPK yang sudah keluar nilai nya</i></b>)</span></div> <div class="MsoNormal"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">            Alamat            :</span></div> <div class="MsoNormal"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">            No telepon      :</span></div> <div class="MsoNormal"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">            No Rekening   : (<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">Nama Bank</i></b>) cabang .... , (<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">No rekening</i></b>) , A/n .......</span></div> <div class="MsoNormal"> </div> <div class="MsoNormal" style="text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Bermaksud untuk mengajukan permohonan beasiswa. Demikian surat permohonan ini saya sampaikan. Atas perhatian nya saya ucapkan terima kasih.</span></div> <div class="MsoNormal"> </div> <div class="MsoNormal" style="margin-left: 288.0pt; text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Hormat saya,</span></div> <div class="MsoNormal"> </div> <div class="MsoNormal"> </div> <div class="MsoNormal" style="margin-left: 288pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">         (<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">nama pemohon</i></b>)</span></div> <div class="MsoNormal" style="margin-left: 288pt;"> </div> <div class="MsoNormal" style="margin-left: 288pt;"> </div> <div class="MsoNormal" style="margin-left: 288pt;"> </div> <div class="MsoNormal" style="margin-left: 288pt;"> </div> <div class="MsoNormal" style="margin-left: 288pt;"> </div> <div align="center" class="MsoNormal" style="text-align: center;"> <span style="font-size: large;"><b><span style="font-family: "Times New Roman","serif"; line-height: 115%;">Surat Pernyataan </span></b></span></div> <div align="center" class="MsoNormal" style="text-align: center;"> <span style="font-size: large;"><b><span style="font-family: "Times New Roman","serif"; line-height: 115%;">Tidak Sedang Menerima Beasiswa dari Instansi lain</span></b></span></div> <div align="center" class="MsoNormal" style="text-align: center;"> </div> <div class="MsoNormal"> </div> <div class="MsoNormal"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Yang bertanda tangan dibawah ini, saya :</span></div> <div class="MsoNormal"> </div> <div class="MsoNormal" style="text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Nama Mahasiswa                    :</span></div> <div class="MsoNormal" style="text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">NIM                                        :</span></div> <div class="MsoNormal" style="text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Jenjang Program                      : Diploma III (D3) atau S1</span></div> <div class="MsoNormal" style="text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Semester / IPK                        : (<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">semester sekarang/IPK yang sudah keluar nilainya</i></b>)</span></div> <div class="MsoNormal" style="text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Alamat                                    : </span></div> <div class="MsoNormal" style="text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">No Telepon                             :</span></div> <div class="MsoNormal"> </div> <div class="MsoNormal"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Dengan ini menyatakan bahwa saya ;</span></div> <ol> <li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span style="font: 7pt "Times New Roman";"></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Pada saat ini tidak sedang menerima beasiswa dari instansi / lembaga tertentu.</span></li> <li><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span style="font: 7pt "Times New Roman";"></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Sampai dengan bulan desember 2012 masih aktif / belum lulus.</span></li> </ol> <div class="MsoNormal"> </div> <div class="MsoNormal"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Apabila dikemudian hari ternyata terbukti saya menerima beasiswa lain. Saya sanggup dikenakan sanksi dan bersedia mengembalikan bantuan tersebut kepada pihak yang berwenang.</span></div> <div class="MsoNormal"> </div> <div class="MsoNormal" style="margin-left: 252.0pt; text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">                   </span><br /> <br /> <br /> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">                        Jakarta, 30 Juli 2013 </span></div> <div class="MsoNormal" style="margin-left: 288.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">                   Yang membuat pernyataan</span></div> <div class="MsoNormal" style="margin-left: 252.0pt; text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">                        Pemohon beasiswa</span><br /> <br /> <br /> <br /></div> <div class="MsoNormal"> </div> <div class="MsoNormal" style="margin-left: 324.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">                     (<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">TTD</i></b>)</span></div> <div class="MsoNormal" style="margin-left: 288.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">                          (<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">materai 6000</i></b>)</span></div> <div class="MsoNormal" style="margin-left: 252.0pt; text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">               (<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">Nama mahasiswa pemohon</i></b>)</span><br /> <br /> <br /></div> <div class="MsoNormal" style="margin-left: 252pt; text-indent: 36pt;"> </div> <div class="MsoNormal" style="margin-left: 252pt; text-indent: 36pt;"> </div> <div class="MsoNormal" style="margin-left: 252pt; text-align: justify; text-indent: 36pt;"> </div> <div class="MsoNormal" style="margin-left: 252pt; text-indent: 36pt;"> </div> <div class="MsoNormal" style="margin-left: 252pt; text-indent: 36pt;"> </div> <div class="MsoNormal" style="margin-left: 252pt; text-indent: 36pt;"> </div> <div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-align: center; text-autospace: none;"> <span style="font-size: large;"><b><span style="font-family: "Times New Roman","serif"; line-height: 150%;">SURAT PERNYATAAN</span></b></span></div> <span style="font-size: large;"> </span> <br /> <div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0cm; text-align: center;"> <span style="font-size: large;"><b><span style="font-family: "Times New Roman","serif"; line-height: 150%;">PENGHASILAN ORANG TUA</span></b></span></div> <div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-align: center; text-autospace: none;"> </div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Yang bertanda tangan dibawah ini :</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> </div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none; text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nama               :</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none; text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pekerjaan         :</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none; text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Alamat              :</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none; text-indent: 36.0pt;"> </div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adalah orang tua / wali dari</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> </div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none; text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nama               :</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none; text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">NIM                :</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none; text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Semester          : (<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">semester sekarang</i></b>)</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none; text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jurusan            :</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none; text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Program Studi :</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none; text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Alamat             :</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none; text-indent: 36.0pt;"> </div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menyatakan dengan sebenar-benarnya bahwa penghasilan saya perbulan sebesar Rp.................................. dengan tanggungan keluarga sebanyak orang. </span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> </div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Demikianlah surat pernyataan ini dibuat dengan sebenarnya.</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> </div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 252.0pt; margin-right: 0cm; margin-top: 0cm; mso-layout-grid-align: none; text-autospace: none; text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">               Jakarta, .......................... 2013</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> </div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengetahui : </span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ka.Instansi/Lurah/Kades setempat</span></i></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">,                                                               Orang tua / Wali,         </span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> </div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> </div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">                        </span><br /> <br /></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">..............................................                                                             .............................................</span></div> <div class="MsoNormal" style="line-height: 150%;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Di bubuhi cap/stempel instansi terkait                                                        Tanda tangan dan nama terang.</span></div> <div class="MsoNormal" style="line-height: 150%;"> </div> <div class="MsoNormal" style="line-height: 150%;"> </div> <div class="MsoNormal" style="line-height: 150%;"> </div> <div class="MsoNormal" style="line-height: 150%;"> _____________________________________________________________________________</div> <div class="MsoNormal" style="line-height: 150%;"> </div> <div class="MsoNormal" style="line-height: 150%;"> </div> <div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-align: center; text-autospace: none;"> <span style="font-size: large;"><b><span style="font-family: "Times New Roman","serif"; line-height: 150%;">SURAT PERNYATAAN</span></b></span></div> <span style="font-size: large;"> </span> <br /> <div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0cm; text-align: center;"> <span style="font-size: large;"><b><span style="font-family: "Times New Roman","serif"; line-height: 150%;">KELUARGA TIDAK MAMPU</span></b></span></div> <div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-align: center; text-autospace: none;"> </div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Yang bertanda tangan dibawah ini :</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> </div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none; text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nama               :</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none; text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pekerjaan         :</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none; text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Alamat              :</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none; text-indent: 36.0pt;"> </div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adalah orang tua / wali dari</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> </div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none; text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nama               :</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none; text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">NIM                :</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none; text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Semester          :</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none; text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jurusan            :</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none; text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Program Studi :</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none; text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Alamat            :</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none; text-indent: 36.0pt;"> </div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menyatakan dengan sebenar-benarnya bahwa penghasilan saya perbulan sebesar</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rp.................................. dengan tanggungan keluarga sebanyak orang, dan masuk dalam kategori KELUARGA TIDAK MAMPU di lingkungan saya.</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> </div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Demikianlah surat pernyataan ini dibuat dengan sebenarnya.</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> </div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 252.0pt; margin-right: 0cm; margin-top: 0cm; mso-layout-grid-align: none; text-autospace: none; text-indent: 36.0pt;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">             Jakarta , .......................... 2013</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengetahui : </span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kepala Desa/ Lurah setempat,                                                                          Orang tua / Wali,</span></div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> </div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> </div> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; text-autospace: none;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.............................................                                                            .............................................</span></div> <div class="MsoNormal" style="line-height: 150%;"> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Di bubuhi cap/stempel instansi terkait                                                      Tanda tangan dan nama terang</span></div> <div class="MsoNormal" style="line-height: 150%;"> </div> <div class="MsoNormal" style="line-height: 150%;"> </div> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBvEUhMx3KUWa0C0mZW17QC0t9iG0iCrPxQy9cOQK4VsaISH-YKjmhpxZWGTFAx6dZLZIZRw7H_6uoIni61JC26mw1ebMu2FlDoC5pbyxaTNSuGVG3mRFLUk7aTv03YzK31ogFSidM2c3N/s1600/last(gr)2562.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBvEUhMx3KUWa0C0mZW17QC0t9iG0iCrPxQy9cOQK4VsaISH-YKjmhpxZWGTFAx6dZLZIZRw7H_6uoIni61JC26mw1ebMu2FlDoC5pbyxaTNSuGVG3mRFLUk7aTv03YzK31ogFSidM2c3N/s1600/last(gr)2562.png" /></a></div> <div class="MsoNormal" style="line-height: 150%;"> </div> </div>

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