Sample Statement Letter and Details on How to Make It

Statement letter is a form of formal letter used in Indonesia. Of course there are other versions of this letter in various countries as binding contracts. In its use, this binding contract is formal and more as evidence that can even be used legally.

In everyday life, statements can be either verbal or non-verbal. For example, you could promise verbally to return the money you borrowed to buy meatballs. This statement is of course still binding as a promise, but when you want to prove it, the process is more difficult. Of course, evidence for an oral statement can be in the form of other people's witnesses who heard or witnessed your statement. Even so, if there are no witnesses, you can easily break the promises you have made.

Well, if you make a written statement, this evidence will certainly be easier to use. If you are evasive, for example, the party that gave you the debt can show the letter as proof. Things like this make the use of a written statement important to learn.

For those of you who want to make this letter, of course it will be easier for you if you look at an example of a statement and then copy the concept and format. But this certainly won't make you understand why the format of the letter is made that way. Things like letter formats and concepts are better learned than just copied. Therefore, let's look together and learn various other things about this letter before looking at examples of statement letters.

Use of Declaration Letter

In everyday life, the use of this type of letter is certainly quite widely used. Depending on your life situation, the letters you will encounter will be different. For example, you are still in junior high school and you want to register for your favorite high school. For the purpose of registering, you will usually need to submit a self-declaration letter for a specific purpose. The most common use is a drug-free self-declaration letter.

Now, for other needs such as business and work matters, you will certainly find a statement from your superior. This letter has the function of explaining situations or things that subordinates need to know. When compared, the form of this letter is almost the same as a certificate. An example that is often used for this is a statement of employment.

The general use of the latter is usually for organizational and institutional matters. Institutions usually use a statement letter to be signed by their members. Usually in this letter the members of the institution or organization are expected to follow the rules and meet certain requirements. To make a formal binder, this statement letter is used. For examples of letters used for this purpose, for example, a statement of ability.

Functions and Benefits of a Written Statement

Basically a statement letter has 4 main functions. These functions include:

  1. As Declaration

The first function of the statement is to show that the maker of the letter agrees to something. This can be equated with a promise to follow the rules or something according to what is stated in the letter.

  1. As a binder

The next function of the statement letter is as a legal binder. A statement that has the force of law is usually accompanied by a stamp. Because it is a binder, this letter is also often used for matters of contact and agreements.

  1. As Supporting Documents

For some matters, you usually need a statement letter to strengthen the official documents used. For example, when taking foster children at an orphanage, you are definitely required to submit official identity documents and also a statement of ability to care for children. In this case the promissory note is a supporting letter.

  1. As Official Document

A statement letter is actually not only a support for an official letter. It turns out that some of these types of letters have the ability to legally stand alone. Usually this binding letter relates to contracts and agreement matters.

Of the 4 functions above, you can certainly guess the usefulness of this statement for many parties. The following is its use is based on the parties concerned in the statement letter:

Benefits for Letter Makers

For the maker, this statement letter is a responsibility and a promise that must be kept. This is certainly important to be shown in real terms so that it can be discussed legally when dealing with the law. Promises and responsibilities can of course be stated verbally, but this is still not as official as in a statement.

Benefits for Letter Recipients

For recipients, this statement letter is evidence. If the creator breaks the promises and responsibilities stated in this letter, the party receiving the letter can use it to get hill. Using this evidence, the recipient can collect promises or apply sanctions according to what is stated in the statement.

Benefits for Parties Named in the Letter

In a statement letter, sometimes the identity of a third party is used. The parties listed in this letter are usually witnesses or parties involved but indirectly. The benefit of this statement letter for third parties is as a safeguard. If the creator and recipient of the letter have problems, this third party can have a handle as evidence.

Main Characteristics of Statement Letter

As a letter, this document has different formats depending on the needs. If you search for examples of affidavits on the internet, you will find many different types and formats for every affidavit need. Even so, there are main characteristics that can be used as a benchmark for this letter. Following are these features:

  • Use formal language
  • Use denotative words
  • Have complete data
  • Speak firmly and clearly to avoid ambiguity

Some Types and Examples of Declaration Letters

After you study the functions, characteristics and uses of the statement letter above, you certainly know that the use of this letter is many and varied. In this section, let's look at several types of affidavits along with examples. Using the examples provided here, you will better understand the format and arrangement of the forms of this letter. Always remember that depending on the type of affidavit, the format will usually be different. Following are some of the types of statements:

General Declaration Letter

This statement letter is the most basic form of statement letter. In its use, you are free to say any statements in it. Another statement letter is usually a derivation of this statement format. Although it forms the basis of other forms of affidavits, this type has no formal use. You will mostly only see it for needs outside the organization, transactions, agreements and work. So, to know better, below is an example of a general statement letter.

Sample Letter of Declaration of Sale and Purchase of Land

Sample Letter of Declaration of Sale and Purchase of Land

Statement letter


The undersigned below:

Full name: Tujijan

Place, Date of Birth: Poso, 12 March 1989

Male gender


Complete Address: Toro Village, RT.03 RW.09, Panggul, Trenggalek


Hereby declare in all seriousness that:

  1. Until now I have not been bound by a work contract or other ties that involve companies and other agencies anywhere.
  2. I am willing to be employed at any place or branch of the company.
  3. I am able and willing to work for a set period of time.
  4. I promise not to submit my resignation before the end of the valid contract period for any reason.
  5. I am willing not to take time off as long as the work period is still valid.


Thus I write this statement truthfully without any element of coercion from other parties. If in the future it turns out that I violate the statement or it is found that my statement here is not appropriate, in this case I am willing to accept the consequences according to the applicable laws and regulations.


Trenggalek, 21 February 2012



(5000 stamp duty)


(Signature of Tukijan)

Statement of Capability

This letter is used to formally express willingness. The use of this statement of ability is more often used in institutions and work when appointing a certain position or position. For those of you who are curious, here is an example of an affidavit.

Statement of Capability

Statement letter


The undersigned below:

Name: Budi Gunawan

Place, date of birth: Semarang, 11 December 1995

Address: New Village RT.02 RW.01, Semarang


With this statement letter, I declare that I am willing to carry out the responsibility of obtaining a minimum GPA of 3.5 for scholarships for two years while studying at S1 Semarang State University.


Semarang, 23 August 2019

That state,


(Name of Author)

Agreement Statement

This statement of agreement is a formal letter that binds two or more parties. Usually this letter is used when making transactions or legal needs. What makes the format of this letter different from other statements is the use of special articles and even formal legal rules. If you are interested in making a statement of this agreement, here is an example.

Agreement Statement

Agreement Statement


The undersigned below,


Address: RT.02/RW.07 Kebonan Gumukmas

As the first party.


Address: RT.01/RW.08 Kebonan Gumukmas

as the second party.

Explain that:

  1. The first party has a liability to the second party of IDR 44,500,000 (Forty Four Million Five Hundred Thousand Rupiah) as payment of dues.
  2. The first party hereby promises to pay off the payment of Rp. 44,500,000 (Forty Four Million Five Hundred Thousand Rupiah) to the second party no later than January 2012 and no later than June 1, 2012.
  3. If during the grace period the money cannot be paid, the first party states that it is willing to pay a liability of Rp. 58,000,000 (Fifty Eight Million Rupiah) to the second party no later than 1 September 2012.

Thus we made this statement of agreement with our own awareness and without any coercion from any party.

Gumukmas, 21 December 2011

Second Party, First Party,



Debt Statement

For this type of letter, its use is to bind two or more parties regarding matters of loan assets. In this debt statement letter, articles are usually given that determine the witness if the debt is not paid. In addition to sanctions, information on the amount of debt, payment process and time period is also included in this letter. So, to make it clearer, consider the following sample debt statement.

Debt Statement

Debt Statement


The undersigned agrees to enter into a loan agreement. Namely the undersigned as the first party:

Name: Agus Putranto

Place, date of birth: Sleman, 5 August 1983

Livelihoods: Entrepreneur


Address: Jl Kalikaliya No. 168B RT. 05 RW. 07

And the identity below as a second party:

Name: Sulayman Hamzah

Place, date of birth: Bantul, 17 June 1980

Livelihoods: Traders


Address: Jl Kalikalino No. 169A RT. 05 RW. 07

So through this agreement letter it was agreed by both parties that the terms and conditions of accounts payable will be carried out with the following details:

So with this agreement letter agreed by all the parties above with the provisions of accounts payable that are carried out based on the following details:

  1. The first party has lent Rp. 10,000,000 to the second party on November 17, 2017.
  2. The second party has submitted collateral in the form of a Motor BPKB which has a value similar to the amount of debt lent.
  3. For matters of debt repayment, it will be carried out in three stages of payment for 6 months. This payment uses the following details:
    • Payment for the second month: IDR 4,000,000
    • Payment for the fourth month: IDR 3,000,000
    • Payment for the sixth month: IDR 3,000,000
  1. If within 6 months the money has not been paid, the guarantee and the motorbike will transfer ownership to the first party.
  2. The second party will be given 30 days of relief before being declared late in paying.
  3. If in the future there is a violation of this statement, both parties promise to resolve it amicably. But when the problem cannot be resolved amicably, both parties are willing to take the problem to legal channels.


Thus this letter is made with the full awareness of each party involved. The making of this statement is also not due to coercion or the influence of any party. This letter is made witnessed and signed by witnesses, the first party and the second party.


Yogyakarta, 14 February 2017

First Party Second Party


Agus Putranto Sulaiman Hamzah




Tri Agni Kusuma


Statement of Employment

This statement of work is usually used when employees receive assignments from superiors. The purpose of this letter is to bind employees who declare their ability to work. In this letter usually contains about the ability to work, ready to accept punishment if the task is not completed and of course fired if you make a fatal mistake. So that you can make this letter yourself, here is an example of a job application letter.

Statement of Employment



Scout Street No. 90 Jakarta

tel. 021-98463647 Tel. 021-XXXXX647


No. 025/SK.PSS/XI/2018


The undersigned below,

Name: Beni Hartoyo

Position: Main Director

Address: Jl. Pinang Mas No. 46 Jakarta

Phone: 081XXXXX365


State that:

Name: Lusi Widiawati

Place/Date of Birth: Bandung, 5 February 1992

Phone: 081XXXXX365

It is true that we are employees of our company who have held positions in the production staff since August 2015 until today.

Thus I made this statement letter with the hope that it will be used properly.


Jakarta, 5 November 2018

Who make a statement

(Duty stamp)

Director of PT Andalan Semesta


School Statement Letter

For this type of school statement, this is similar to the one used for work purposes. Basically this letter is used to bind students to school rules. For its use, prospective students who will enter the school are the parties who make this statement. For those of you who want to learn how to make a letter, below is an example of a school statement letter that can be used as a reference.

School Statement Letter



NO: B.11-00056/TU/KET/IV/2015


The undersigned below:

Name: Wahyuningsih, Mpd

Position: Principal


This explains that:

Name: Amin Hermasyah

Father's name: Ismail Habibi

Address: Jalan Jambu Mente No. 14, Bali


It is true that there are 8A grade students at SMAN 4 Bali.

Thus this statement letter is made so that it can be used properly.


Bali, 16 April 2015,

Best regards,



Wahyuningsih, Mpd



CPNS Statement Letter

This statement letter is usually made by prospective CPNS applicants. This CPNS statement letter is the same as a work letter, but is intended more for government institutions and organizations. This letter is official and is used to insert registration documents. So, for those of you who need to write this letter, please look at the format of the sample CPNS statement letter below.

CPNS Statement Letter


Statement letter


The undersigned below:

Name: Alifah Septia

Place, Date of Birth: Denpasar, 29 August 1992


Address: Jalan Ngurah Rai 231 Denpasar


Hereby declare:

  1. Do not have a history of criminal acts and other crimes that could result in a prison sentence or imprisonment based on a court that has the force of law.
  2. Never received dishonorable dismissal as a civil servant, TNI and POLRI soldier or dishonorably discharged as an employee of a company or private institution.
  3. Does not have a position as CPNS or PNS for now.
  4. Willing to be placed in all regions of Indonesia and countries determined by the government.
  5. Willing to carry out assignments for placement in any area.
  6. Does not participate as a member of any political party
  7. Willing to not change domicile as long as the work placement is still incomplete, that is, for a minimum of 5 years.


Thus this statement is made with true sincerity. I am willing to accept the demands of the court if it is proven that the statement above is untrue and a lie.


Denpasar, 25 July 2016

Who make a statement


(Duty stamp)

Alifah Septia


Unmarried Statement Letter

This unmarried statement can be used informally without a stamp. In its contents, the author must explain with text to make sure that he is still single and not yet married. This letter is usually used for the purpose of registering for college or work with single requirements. Let's immediately look at the example of this unmarried statement letter as follows.

Unmarried Statement Letter

Unmarried Statement Letter


With this letter, I, the undersigned,

Name: Akasia Nur Latifa

No. KTP: 887XXXXXX001

Place, Date of Birth: Bantul, 16 October 1998

Female gender


Address: Segar Asri Housing Block A7 No. 16

State that until the time this letter was written, I have never been married, be it according to customary law, religion, or according to state law regulations. As the writer of the statement, I agree that I will not marry while studying S1 Health. If I violate the statements in this letter, I am willing to accept the consequences in accordance with applicable regulations.

Thus this statement is made with full awareness and is true without coercion from other parties.


Knowing, Yogyakarta, January 17 2018

Parent/Guardian Making Declaration


(6000 stamp)

(Name of Parent/ Guardian)


Custody Declaration Letter

A statement that is usually used for adoptive parents or relatives who take custody. This custody statement usually contains the ability to care for the child and certain conditions. For example, promising to care for them until a certain level of education or age or until the real parents come to take their child back. For those of you who want to learn how to make one, use the sample custody statement below as a reference.

Custody Declaration Letter

Custody Declaration Letter


I, the undersigned below:

Name: Irna Purnomo

Place, Date of Birth: Sleman, 15 October 1870

Female gender

Address: Jalan Salah Situ, No. 56 RT. 05 RW. 12


Occupation: Housewife

Marital Status: Widow

Who has the identity as the biological mother of the child named Anissa Aziza with this letter declares the transfer of custody and guardianship rights to the husband and wife:


  1. Name: Muhammad Sumitra

Place, Date of Birth: Jakarta, October 6, 1980

Male gender

Address: Damai Permai Housing Block AB, No. 17


Occupation: Self-employed

Marital Status: Married


  1. Name: Irna Purnomo

Place, Date of Birth: Jember, 8 September 1983

Female gender

Address: Damai Permai Housing Block AB, No. 17


Occupation: Housewife

Marital Status: Married


I make this statement with full awareness and sincerity. I gave up custody and guardianship of my child to the husband and wife above due to economic problems. I admit that I am not able to take good care of the child with my own income. If in the future a case arises that discusses the custody and guardianship of my child, I promise to fight for the foster parents listed in this statement.

Thus the letter I wrote for the purpose of holding the foster parents. I hope this letter can be used as it should.


Yogyakarta, 2 January 2018,

Biological Parents Foster Guardian Biological Mother, Witness,


(6000 stamp)


Muhammad Sumitra Irna Purnomo Indra Retno Puspa


Guilt Statement

This one letter is an official made as an accountability for mistakes in the agency. Depending on the burden of guilt and its impact, this letter also contains elements of apology, acknowledgment and also a list of penalties to be taken. If you are curious about the form of this type of letter, here is an example of an affidavit of guilt.

Guilt Statement

Guilt Statement


I, the undersigned below:

Name: Amalia Sri Gupati

NPM: 765XXXX926

Address: Jalan Merah Delima No. 7 RT.07 RW.05 Sleman, DIY

Position: Marketing Officer


With this letter, I honestly declare that I have unintentionally used the allocated funds for a marketing program of IDR 2,200,000 (Two Million Two Hundred Thousand Rupiah) for purposes other than planned activities and projects.

Because of this mistake, I am willing to take responsibility to the company by replacing all losses that have been caused. I hope that all colleagues and managerial ranks will accept my regret with a big heart. I am here begging to be accepted back into the company and promise not to repeat this mistake again. If in the future, I am proven negligent and repeat the same mistakes, I will accept all the consequences and punishments according to the applicable regulations.

Thus, I convey this statement of guilt without coercion and with full awareness. I hope this letter can be used as a consideration in determining managerial policies when discussing the mistakes I made. For your attention, I thank you profusely.


Yogyakarta, 5 December 2017

Yours faithfully


(6000 Materials)


Amalia Sri Gupati



So many types of discussion and examples - examples of statement letters. The examples above are a small part of the various types of other statements used. If you want to find examples of other statements, please search the internet. If you search the internet, you will find many websites that provide examples and directions on how to make various other types of statements that are not discussed here.