7/23/2019 Pernyataan Hutang

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SURAT PERNYATAAN HUTANG

Saya yang bertanda tangan dibawah ini :

Nama : ......................................................................................................................................................

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

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

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

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

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

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

Dihadapan Allah SWT/Tuhan YME dan Para Saksi, dengan ini menyatakan dengan

sebenarnya dan tidak lain dari pada yang sebenarnya, bahwa Saya pada hari .................................................

tanggal .......................................... bulan .......................................... tahun ...............................................................................

telah meminjamkan uang sejumlah : Rp. ....................................................... (..................................................................

.................................................................. ) kepada :Nama : ......................................................................................................................................................

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

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

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

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

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

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

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

Dengan jaminan berupa : ...........................................................................................................................................................

dengan perjanjian .........................................................................................................................................................................

Demikian surat pernyataan ini saya buat dengan sebenarnya, dalam kondisi sehat jasmani

dan rohani serta tidak dalam tekanan pihak manapun. Jika dikemudian hari ditemukan kesalahan,

Saya siap bertanggung jawab secara hukum, baik hukum Adat, Agama dan/atau Negara.

Ditandatangani dihadapan Para Saksi diatas materai cukup di

..................................................................................................... pada hari ................................................. tanggal

.......................................... bulan .......................................... tahun ...............................................................................

Yang Menyatakan,

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

Para Saksi

Saksi I,

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

Saksi II,

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