KOP PERUSAHAANNomer : ………………………Lampiran : ………………………Perihal : Daftar Isian Permintaan Izin Usaha Industri ( Baru / Ulang )Kepada Yth Bupati Tanah Bumbu Cq. Kepala Badan Pelayanan Perizinan Dan Penanaman Modal Daerah Kab.Tanah Bumbu Di- Batulicin I. KETERANGAN PEMOHON 1.Nama : ………………………………………………........ 2.Alamat : ……………………………………………………II. KETERANGAN PERUSAHAAN INDUSTRI 1. Nama Perusahaan : …………………………………………………… Alamat : …………………………………………………… Nomor Telp : …………………………………………………… 2. NPWP : …………………………………………………... 3. a. Nama Pemilik : …………………………………………………… b. Alamat : …………………………………………………… 4. Lokasi Pabrik : …………………………………………………… a. Desa / Kelurahan : …………………………………………………… b. Kecamatan : …………………………………………………… c. Kabupaten : …………………………………………………… d. Propinsi : …………………………………………………… 5. Banguanan Pabrik :...
Rabu, 19 Maret 2014
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