form pm ekonomi - laz alhakim sucofindo
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LAZ AL HAKIM SUCOFINDO FORMULIR VERIVIKASI EKONOMI MAPAN SUCOFINDO PROGRAM EKONOMI NO. SYARAT : 1. KTP 2. KK 3. SKTM 4. ISI FORM FOTO 3X4 1. NAMA : ............................................................................................................ 2. TEMPAT TGL. LAHIR : ............................................................................................................ 3. ALAMAT : ............................................................................................................ KELURAHAN : ...................................................................................... KAB/KOTA :.........................................Telp/hp : ................................... 4. STATUS : ............................................................................................................ 5. PENDIDIKAN : ............................................................................................................ 6. AGAMA : ............................................................................................................ 7. JENIS USAHA : ........................................................LAMA : ........................................ 8. : .......................................................................................................... LOKASI 9. KONDISI KELUARGA : ................................ Orang Anak dan :............................................... 10. STATUS RUMAH : SENDIRI/KONTRAK/NUMPANG. 11. PENGHASILAN KOTOR : ................................................./Hari. Atau ............................./bulan 12. MODAL PERHARI : RP .................................................................. 13. HAMBATAN : ............................................................................................................ 14. RENCANA USAHA : ............................................................................................................ 15. KEBUTUHAN MODAL SAAT INI : ............................................................................................... 16. JIKA MODAL DI DAPAT DIPERGUNAKAN UNTUK : ..................................................................... ....................................................................... 17. PEMASARAN DIMANA : ............................................................................................................ LEMBAR PENGESAHAN Di buat oleh, Menyetujui, Mengetahui, (........................................) (........................................) (........................................)