Ikrarsurat Pernyataan Jantung Epilepsi.docx

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SURAT PERNYATAAN

Saya yang bertanda tangan dibawah ini Nama

: IKRAR MAHARDHIKA PRATIWI

Umur

: 24 TAHUN

Agama

: ISLAM

Alamat

: JL. P. DIPONEGORO NO.19 RT.08 RW.02 DS. GADING, KEC. BULULAWANG, KAB. MALANG

Menyatakan bahwa saya tidak memiliki riwayat penyakit jantung dan epilepsi. Demikian surat pernyataan ini saya buat dengan sesungguhnya tanpa ada paksaan dari pihak manapun.

Bandung, ………………….2019 Yang menyatakan,

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