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    This document is a letter of domicile certification from the Penghulu (head) of Tanjung Medan subdistrict in Rokan Hilir Regency, Riau Province, Indonesia. It certifies that Robi Azhar Priatama, born on June 29, 2001 in Kisaran, unmarried, Muslim, currently unemployed, resides at Kampung Dosan subdistrict of Pusako. This letter of domicile certification is issued to provide proof to relevant authorities that Robi Azhar Priatama is domiciled in RT 002 RW 002 Simpang Buntal village of Tanjung Medan subdistrict until present.

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    salmah surat

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    salmah

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    This document is a letter of domicile certification from the Penghulu (head) of Tanjung Medan subdistrict in Rokan Hilir Regency, Riau Province, Indonesia. It certifies that Robi Azhar Priatama, born on June 29, 2001 in Kisaran, unmarried, Muslim, currently unemployed, resides at Kampung Dosan subdistrict of Pusako. This letter of domicile certification is issued to provide proof to relevant authorities that Robi Azhar Priatama is domiciled in RT 002 RW 002 Simpang Buntal village of Tanjung Medan subdistrict until present.

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    5 views1 page

    Salmah

    Uploaded by

    excandra Buana
    This document is a letter of domicile certification from the Penghulu (head) of Tanjung Medan subdistrict in Rokan Hilir Regency, Riau Province, Indonesia. It certifies that Robi Azhar Priatama, born on June 29, 2001 in Kisaran, unmarried, Muslim, currently unemployed, resides at Kampung Dosan subdistrict of Pusako. This letter of domicile certification is issued to provide proof to relevant authorities that Robi Azhar Priatama is domiciled in RT 002 RW 002 Simpang Buntal village of Tanjung Medan subdistrict until present.

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    PEMERINTAH KABUPATEN ROKAN HILIR

    KECAMATAN TANJUNG MEDAN

    KEPENGHULUAN TANJUNG MEDAN

    Jalan Mahmuda No …..Telp …..Fax …..


    TANJUNG MEDAN KODE POS 28983

    SURAT KETERANGAN DOMISILI


    Nomor : / SKD-tm/2023

    Penghulu Tanjung Medan Kecamatan Tanjung Medan Kabupaten Rokan Hilir


    dengan ini menerangkan bahwa :

    Nama : ROBI AZHARI PRATAMA


    Nik : 1407082906010001
    Tempat/tanggal lahir : Kisaran / 29 juni 2001
    Jenis Kelamin : Laki-laki
    Warga Negara : Indonesia
    Agama : Islam
    Pekerjaan : Tidak Bekerja
    Alamat : Kampung Dosan Kec.Pusako

    Bahwa benar nama tersebut diatas adalah penduduk Kepenghuluan Tanjung


    Medan Kecamatan Tanjung Medan Kabupaten Rokan Hilir Provinsi Riau.

    Surat keterangan berdomisili ini diberikan kepada yang bersangkutan guna


    memberi keterangan kepada instansi terkait, bahwa menurut sepengetahuan kami
    yang bersangkutan diatas benar berdomisili di RT. 002 RW 002 Dusun Simpang
    Buntal Kepenghuluan Tanjung Medan Kecamatan Tanjung Medan Kabupaten Rokan
    Hilir Hingga sekarang.

    Demikian surat keterangan Berdomisili ini diberikan kepada yang


    bersangkutan untuk dapat dipergunakan seperlunya.

    Dikeluarkan di : Tanjung Medan


    Pada Tanggal : 5 Januari 2024

    PENGHULU TANJUNG MEDAN


    An. Sekretaris Kepenghuluan

    SUMARDI

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