BERITA ACARA PEMBAYARAN HUTANG

Pada hari ini hari .......................................... tanggal ........................................ bulan .......................................... tahun ..............................................................................., yang bertanda tangan di bawah ini : 1. Nama : ......................................................................................................................................................

Tempat/Tgl. Lahir : ......................................................................................................................................................

Jenis Kelamin : ......................................................................................................................................................

Agama : ......................................................................................................................................................

Pekerjaan : ......................................................................................................................................................

Alamat : ......................................................................................................................................................

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Dalam hal ini bertindak untuk dan atas nama ......................................................................................................., yang untuk selanjutnya disebut PIHAK PERTAMA

2. Nama : ......................................................................................................................................................

Tempat/Tgl. Lahir : ......................................................................................................................................................

Jenis Kelamin : ......................................................................................................................................................

Agama : ......................................................................................................................................................

Pekerjaan : ......................................................................................................................................................

Alamat : ......................................................................................................................................................

......................................................................................................................................................

Dalam hal ini bertindak untuk dan atas nama ......................................................................................................., yang untuk selanjutnya disebut PIHAK KEDUA

Dihadapan Allah SWT/Tuhan YME dan Para Saksi, telah dilakukan pembayaran Hutang atas nama : Nama : ...................................................................................................................................................... Tempat/Tgl. Lahir : ...................................................................................................................................................... Jenis Kelamin : ...................................................................................................................................................... Agama : ...................................................................................................................................................... Pekerjaan : ...................................................................................................................................................... Alamat : ...................................................................................................................................................... ...................................................................................................................................................... Yang menggunakan jaminan berupa : .................................................................................................................................. dan perjanjian .................................................................................................................................................................................

Pembayaran dilakukan oleh PIHAK PERTAMA yang terkait sebagai Ahli Waris atas jaminan tersebut kepada PIHAK KEDUA secara tunai sejumlah : Rp. .................................................................................... (............................................................................................................................................................................................................) yang merupakan jumlah total hutang atas perincian : 1. .......................................................................................................................................................................................................................... 2. .......................................................................................................................................................................................................................... 3. .......................................................................................................................................................................................................................... 4. ..........................................................................................................................................................................................................................

Demikian berita acara ini dibuat dengan sebenarnya, dalam kondisi Para Pihak sehat jasmani dan rohani serta tidak dalam tekanan pihak manapun, ditandatangani dihadapan Para Saksi diatas materai cukup di ....................................................................................... pada hari ................................................. tanggal .......................................... bulan .......................................... tahun ...............................................................................

PARA PIHAK

PIHAK PERTAMA,

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PIHAK KEDUA,

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Para Saksi Saksi I,

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Saksi II,

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