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Pernyataan menegaskan bahwa calon belum pernah dinyatakan diterima melalui jalur SNBP di Perguruan Tinggi Negeri manapun, serta belum pernah melakukan proses daftar ulang melalui jalur SNBT tahun 2026 di Perguruan Tinggi Negeri manapun. Dokumen juga memuat konsekuensi bila ketentuan butir 1 dan 2 tidak terpenuhi, yaitu kesediaan untuk didiskualifikasi dan dinyatakan gugur.",{"@graph":63,"@context":120},[64,81,103],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,72,75,78],{"item":68,"name":69,"@type":70,"position":71},"https://docshare.wps.com","Home","ListItem",1,{"item":73,"name":9,"@type":70,"position":74},"https://docshare.wps.com/id/document/",2,{"item":76,"name":43,"@type":70,"position":77},"https://docshare.wps.com/id/document/ujian/",3,{"item":79,"name":59,"@type":70,"position":80},"https://docshare.wps.com/id/document/declaration-letter-of-not-accepted-by-snbp-and-not-re-enrolled-for-snbt-in-2026-at-politeknik-negeri-madiun/231660/",4,{"url":79,"name":59,"@type":82,"image":83,"author":88,"headline":59,"publisher":91,"fileFormat":94,"inLanguage":57,"description":61,"dateModified":95,"datePublished":96,"encodingFormat":94,"isAccessibleForFree":97,"interactionStatistic":98},"DigitalDocument",{"url":84,"@type":85,"width":86,"height":87},"https://docshare.wps.com/thumbnails/declaration-letter-of-not-accepted-by-snbp-and-not-re-enrolled-for-snbt-in-2026-at-politeknik-negeri-madiun/231660.png","ImageObject",300,407,{"name":89,"@type":90},"Lucas Martin","Person",{"url":68,"name":92,"@type":93},"DocShare","Organization","application/pdf","2026-10-07","2026-09-10",true,{"@type":99,"interactionType":100,"userInteractionCount":102},"InteractionCounter",{"@type":101},"ViewAction",7,{"@type":104,"mainEntity":105},"FAQPage",[106,112,116],{"name":107,"@type":108,"acceptedAnswer":109},"Apa isi utama surat pernyataan ini?","Question",{"text":110,"@type":111},"Surat ini menyatakan calon mahasiswa PNM belum diterima SNBP 2026 di PTN manapun dan belum melakukan daftar ulang SNBT 2026 di PTN manapun.","Answer",{"name":113,"@type":108,"acceptedAnswer":114},"Bagaimana jika ketentuan pada butir 1 dan 2 tidak terpenuhi?",{"text":115,"@type":111},"Calon bersedia kelulusannya sebagai calon mahasiswa/mahasiswi PNM didiskualifikasi dan dinyatakan gugur.",{"name":117,"@type":108,"acceptedAnswer":118},"Bagian apa saja yang harus diisi dalam surat?",{"text":119,"@type":111},"Surat meminta pengisian nama, tempat tanggal lahir, nomor pendaftaran, program studi, serta nomor telepon/HP, kemudian ditandatangani oleh calon.","https://schema.org",{"og:url":79,"og:type":122,"og:title":59,"og:site_name":92,"og:description":61},"article",{"robots":124,"canonical":79},"index,follow",{"doc_id":126,"site_id":56},231660,1789066380,{"code":4,"msg":5,"data":129},{"doc_id":126,"user_id":130,"nickname":89,"user_avatar":131,"doc_module":4,"category_id":42,"category_name":43,"doc_title":59,"doc_description":61,"doc_content":132,"file_id":133,"file_url":134,"file_type":135,"file_size":136,"view_count":102,"is_deleted":4,"is_public":71,"is_downloadable":71,"audit_status":71,"page_count":71,"language":137,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":138,"faqs":139,"seo_title":140,"seo_description":61,"update_tm":127,"read_time":74},8796095360427,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","SURAT PENYATAAN  \nTIDAK DITERIMA SNBP DAN TIDAK DAFTAR ULANG SNBT  \nSaya yang bertandatangan di bawah ini :  \nNama :  \nTempat Tanggal Lahir :  \nNomor Pendaftaran :  \nProgram Studi :  \nNo. Telpon /HP :  \nAdalah calon mahasiswa/mahasiswi *) baru Politeknik Negeri Madiun(PNM) menyatakan hal – hal berikut :  \n1. Bahwa hingga saat ini saya tidak/belum pernah dinyatakan diterima jalur SNBP tahun 2026 di Perguruan Tinggi Negeri manapun  \n2. Bahwa hingga saat ini saya tidak/belum pernah melakukan proses daftar ulang jalur SNBT tahun 2026 di Perguruan Tinggi Negeri manapun  \n3. Apabila dalam butir 1 dan 2 tidak terpenuhi, saya bersedia, kelulusan saya sebagai calon mahasiswa/mahasiswi*) Politeknik Negeri Madiun (PNM) didiskualifikasi dan dinyatakangugur.  \nMadiun,  \nCalon Mahasiswa  \n(Meterai 10.000)  \n( nama terang dan tanda tangan )  \n*) coretyang tidak perlu","cbCaipLrgicTy30Y","https://ap.wps.com/l/cbCaipLrgicTy30Y","pdf",112863,"Indonesian","# Surat Pernyataan\n## Identitas Calon Mahasiswa\n## Pernyataan dan Ketentuan","[{\"question\":\"Apa isi utama surat pernyataan ini?\",\"answer\":\"Surat ini menyatakan calon mahasiswa PNM belum diterima SNBP 2026 di PTN manapun dan belum melakukan daftar ulang SNBT 2026 di PTN manapun.\"},{\"question\":\"Bagaimana jika ketentuan pada butir 1 dan 2 tidak terpenuhi?\",\"answer\":\"Calon bersedia kelulusannya sebagai calon mahasiswa/mahasiswi PNM didiskualifikasi dan dinyatakan gugur.\"},{\"question\":\"Bagian apa saja yang harus diisi dalam surat?\",\"answer\":\"Surat meminta pengisian nama, tempat tanggal lahir, nomor pendaftaran, program studi, serta nomor telepon/HP, kemudian ditandatangani oleh calon.\"}]","Surat Pernyataan Tidak Diterima SNBP dan Tidak Daftar Ulang SNBT Tahun 2026 di Politeknik Negeri Madiun | PDF"]