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F. LAPORAN KEUANGAN : dilampirkan pada form khusus.
G. LAIN-LAIN : .......................................................................................................................
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Laporan dan keterangan ini dibuat dengan sebenar-benarnya, di .............................................
Pada tanggal ..............................................................................................................................
Yang melaporkan:
Sekretaris
(..................................................)
Mengetahui:
Minister,
(..................................................)
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