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BERITA ACARA PEMBAYARAN HUTANG Pada hari ini hari .......................................... tanggal ........................................ bulan .......................................... tahun ..............................................................................., yang bertanda tangan di bawah ini : 1.
Nama
: ......................................................................................................................................................
2.
Nama
: ......................................................................................................................................................
1. 2. 3. 4.
.......................................................................................................................................................................................................................... .......................................................................................................................................................................................................................... .......................................................................................................................................................................................................................... ..........................................................................................................................................................................................................................
Tempat/Tgl. Lahir Jenis Kelamin : Agama : Pekerjaan : Alamat :
: ...................................................................................................................................................... ...................................................................................................................................................... ...................................................................................................................................................... ...................................................................................................................................................... ...................................................................................................................................................... ...................................................................................................................................................... Dalam hal ini bertindak untuk dan atas nama ......................................................................................................., yang untuk selanjutnya disebut PIHAK PERTAMA Tempat/Tgl. Lahir Jenis Kelamin : Agama : Pekerjaan : Alamat :
: ...................................................................................................................................................... ...................................................................................................................................................... ...................................................................................................................................................... ...................................................................................................................................................... ...................................................................................................................................................... ...................................................................................................................................................... Dalam hal ini bertindak untuk dan atas nama ......................................................................................................., yang untuk selanjutnya disebut PIHAK KEDUA Dihadapan Allah SWT/Tuhan YME dan Para Saksi, telah dilakukan pembayaran Hutang atas nama : Nama : ...................................................................................................................................................... Tempat/Tgl. Lahir : ...................................................................................................................................................... Jenis Kelamin : ...................................................................................................................................................... Agama : ...................................................................................................................................................... Pekerjaan : ...................................................................................................................................................... Alamat : ...................................................................................................................................................... ...................................................................................................................................................... Yang menggunakan jaminan berupa : .................................................................................................................................. dan perjanjian ................................................................................................................................................................................. Pembayaran dilakukan oleh PIHAK PERTAMA yang terkait sebagai Ahli Waris atas jaminan tersebut kepada PIHAK KEDUA secara tunai sejumlah : Rp. .................................................................................... (............................................................................................................................................................................................................) yang merupakan jumlah total hutang atas perincian :
Demikian berita acara ini dibuat dengan sebenarnya, dalam kondisi Para Pihak sehat jasmani dan rohani serta tidak dalam tekanan pihak manapun, ditandatangani dihadapan Para Saksi diatas materai cukup di ....................................................................................... pada hari ................................................. tanggal .......................................... bulan .......................................... tahun ............................................................................... PIHAK PERTAMA,
PARA PIHAK
.................................................................. Saksi I,
..................................................................
PIHAK KEDUA,
.................................................................. Para Saksi
Saksi II,
..................................................................