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SURAT PERNYATAAN

Yang bertanda tangan dibawah,

Nama

: I WAYAN WIDIANA

Tempat tanggal lahir

: Tabanan, 11 November 1963

Alamat

: Taman Sekar V Blok G.46, Kel/ Desa Padang Sambian, Kecamatan Denpasar Barat, Kota Denpasar

Pekerjaan

: Pensiunan Swasta

NPWP

: 48.188.474.0-901.000

Dengan ini menerangkan bahwa biaya hidup saya ditanggung anak.

Demikian surat pernyataan ini saya buat dengan sebenarnya.

Denpasar, 10 April 2018 Tertanda,

I Wayan Widiana

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