Executed this ___________day of ___

Executed this ___________day of _________________________ (month), 2015.



__________________________________ ________________________________
Signature of Employee Name of Employee (please print)



___________________________________ _______________________________
Signature of Employer Name of Employer (please print)

Hasil (Bahasa Indonesia) 1:

Dijalankan ini ___day ___ (bulan), 2015. __________________________________ ________________________________Tanda tangan dari karyawan nama karyawan (harap cetak)___________________________________ _______________________________Tanda tangan dari majikan nama majikan (harap cetak)

Hasil (Bahasa Indonesia) 2:

Dieksekusi ___________day ini _________________________ (bulan), 2015. __________________________________ ________________________________ Tanda tangan Nama Karyawan Karyawan (silakan mencetak) ___________________________________ _______________________________ Tanda tangan Majikan Nama Perusahaan (silakan mencetak)