Tandatangan
Kontraktor
Tandatangan Saksi
Nama
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Nama Penuh : ......................................
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No.
K.P : .................................
No. K.P
: ..............................................
Alamat
: Alamat
: ...........................................
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Jawatan
: ................................
Jawatan
: .............................................
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(Meteri
atau Cop Kontraktor)
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