Manual Prosedur Umum dan Pengelolaan Aset

FORM.

PERMOHONAN IZIN
PERBAIKAN ALAT KANTOR
DI LINGKUNGAN F MIPA UNDIP

Yang bertanda tangan di bawah ini :
Nama Lembaga/ Unit
Penanggung Jawab
NIP
No. Telp
Alamat

:
:
:
:
:

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Mengajukan permohonan perbaikan alat kantor berupa :
Nama Barang/Alat
No. Inventaris
Jenis Kerusakan
Keterangan lain

: .........................................................................................
: .........................................................................................
: .........................................................................................
.........................................................................................
: .........................................................................................
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Demikian ajuan permohonan ini kami ajukan. Terima kasih.

Semarang,
Mengetahui,
Ketua/Kepala Unit/PS/Jurusan,
.................................................

Pemohon,

...................................................
NIP.

..............................................
NIP.

Mengetahui,
Pembantu Dekan II,

Drs. Agung Suprihadi, M.Si
NIP. 196109201987031001