Download - Formulir Data Pelanggan
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7/26/2019 Formulir Data Pelanggan
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Profl Kelembagaan:
Nama Institusi : ......................................................................
.........Alamat : ......................................................................
.........
NPWP : ......................................................................
.........Jumlah Perwakilan : ......................................................................
.........PIC Perjalanan Dinas : ......................................................................
.........Jabatan : ......................................................................
.........Tempat/Tanggal Lahir : ......................................................................
.........N. Telepn : ......................................................................
.........!a" : ......................................................................
.........N. Telp #eluler : ......................................................................
.........Alamat $mail : ......................................................................
.........
Profl Pimpinan Lembaga:
Nama : ......................................................................
.........Alamat %antr : ......................................................................
.........
Tempat/Tanggal Lahir : ...............................................................................
Alamat $mail : ......................................................................
!rmulir Data Pelanggan &aru'a In'nesia
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7/26/2019 Formulir Data Pelanggan
2/2
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Data Perjalanan Dinas:
Anggaran (ia)a Jasa Penerbangan per Tahun : ..............................*ata+rata pembelanjaan jasa penerbangan
&aru'a In'nesia per tahun : .............................*ute Penerbangan )ang sering 'iterbangi + Dmestik :
........................................... + Internasinal:
...........................................
Apakah ter'apat kegiatan tahunan )ang menggunakan jasa
penerbangan,
- Ti'ak- a sebutkan:
............................................
#a)a men)atakan bahwa pern)ataan )ang 'iberikan 'i atas a'alahbenar.
................................ ..........................0tempat1 DD/22/
tt'
................................
nama 3 jabatan pemhn'isertai stempel ke'inasan