{"id":8311,"date":"2020-09-11T05:16:04","date_gmt":"2020-09-10T22:16:04","guid":{"rendered":"https:\/\/blud.co.id\/wp\/?p=8311"},"modified":"2023-02-24T22:27:36","modified_gmt":"2023-02-24T15:27:36","slug":"surat-pernyataan-bersedia-diaudit-badan-layanan-umum-daerah","status":"publish","type":"post","link":"https:\/\/blud.co.id\/wp\/surat-pernyataan-bersedia-diaudit-badan-layanan-umum-daerah\/","title":{"rendered":"SURAT PERNYATAAN BERSEDIA DIAUDIT BADAN LAYANAN UMUM DAERAH"},"content":{"rendered":"

Surat pernyataan bersedia diaudit merupakan salah satu dari keenam syarat administratif penerapan Badan Layanan Umum Daerah (BLUD). Jika salah satu dari enam syarat administratif BLUD tidak terpenuhi, maka sebuah UPT tidak dapat ditetapkan menjadi BLUD. Format surat pernyatan bersedia diaudit BLUD adalah sebagai berikut.<\/p>\n

PEMERINTAH PROVINSI\/ KABUPATEN\/ KOTA …………….. (1)<\/p>\n

……………………………………. (2)<\/p>\n

PERNYATAAN BERSEDIA UNTUK DIAUDIT<\/p>\n

\u00a0<\/strong><\/p>\n

Yang bertanda tangan di bawah ini\u00a0\u00a0\u00a0 :<\/p>\n

Nama\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 : ………………………………………………………………… (3)<\/p>\n

Jabatan\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 : ………………………………………………………………… (4)<\/p>\n

Bertindak untuk dan atas nama: ………………………………………………………………… (5)<\/p>\n

Alamat\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 : ………………………………………………………………… (6)<\/p>\n

Telepon\/ Fax\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 : ………………………………………………………………… (7)<\/p>\n

Email\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 : ………………………………………………………………… (8)<\/p>\n

Dengan ini menyatakan dengan sesungguhnya bahwa untuk memenuhi salah satu persyaratan administratif untuk menerapkan Badan Layanan Umum Daerah (BLUD) sebagaimana diatur dalam Peraturan Menteri Dalam Negeri Nomor 79 Tahun 2018<\/em><\/a> tentang Badan Layanan Umum Daerah, bersedia untuk diaudit oleh pemeriksa eksternal pemerintah sesuai dengan ketentuan peraturan perundang-undangan.<\/p>\n

Demikian Surat Pernyataan ini saya buat dengan sesungguhnya, penuh kesadaran dan tanggung jawab serta tidak ada unsur paksaan dari pihak manapun.<\/p>\n\n\n\n\n\n
Mengetahui,<\/td>\n……………, ………………..20…… (9)<\/td>\n<\/tr>\n
……………………………………………………. (10)<\/td>\n……………………………………………. (11)<\/td>\n<\/tr>\n
 <\/p>\n

 <\/p>\n

 <\/p>\n

(ttd)<\/p>\n

 <\/p>\n

 <\/td>\n

\n\n\n\n
\n\n\n\n\n\n
Materai<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

 <\/p>\n

(ttd)<\/td>\n<\/tr>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nama Lengkap<\/td>\nNama Lengkap<\/td>\n<\/tr>\n
NIP ………………………………<\/td>\nNIP ………………………………<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Petunjuk pengisian surat :<\/p>\n

    \n
  • Diisi nama Provinsi\/ Kabupaten\/ Kota<\/li>\n
  • Diisi nama unit pelaksana teknis dinas\/ badan daerah yang akan menerapkan BLUD<\/li>\n
  • Diisi nama Kepala Unit pelaksana teknis dinas\/ badan daerah yang akan menerapkan BLUD<\/li>\n
  • Diisi jabatan unit pelaksana teknis dinas\/ badan daerah yang akan menerapkan BLUD<\/li>\n
  • Diisi nama unit pelaksana teknis dinas\/ badan daerah yang akan menerapkan BLUD<\/li>\n
  • Diisi alamat unit pelaksana teknis dinas\/ badan daerah yang akan menerapkan BLUD<\/li>\n
  • Diisi nomor telpon\/ fax\/ nomor telepon seluler unit pelaksana teknis dinas\/ badan daerah yang akan menerapkan BLUD<\/li>\n
  • Diisi alamat email unit pelaksana teknis dinas\/ badan daerah yang akan menerapkan BLUD<\/li>\n
  • Diisi tempat, tanggal, bulan, tahun<\/li>\n
  • Diisi jabatan Kepala SKPD<\/li>\n
  • Diisi jabatan unit pelaksana teknis dinas\/ badan daerah yang akan menerapkan BLUD<\/li>\n<\/ul>\n

    \n","protected":false},"excerpt":{"rendered":"

    Surat pernyataan bersedia diaudit merupakan salah satu dari keenam syarat administratif penerapan Badan Layanan Umum Daerah (BLUD). Jika salah satu dari enam syarat administratif BLUD tidak terpenuhi, maka sebuah UPT tidak dapat ditetapkan menjadi BLUD. Format surat pernyatan bersedia diaudit BLUD adalah sebagai berikut. PEMERINTAH PROVINSI\/ KABUPATEN\/ KOTA …………….. (1) ……………………………………. (2) PERNYATAAN BERSEDIA UNTUK […]<\/p>\n","protected":false},"author":1,"featured_media":5118,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"default","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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