JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Formulir Permohonan Informasi dan Data
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Nama
*
Your answer
Jenis Kelamin
*
Pria
Wanita
Alamat
*
Your answer
Nomor Identitas
*
Your answer
Nomor Surat
*
Your answer
Instansi/Universitas/Lembaga/Pekerjaan
*
Your answer
Nomor telepon
Your answer
Rincian Informasi yang dibutuhkan
Your answer
Keperluan
Your answer
Cara memperoleh Informasi
*
Melihat, membaca.
Mendapatkan salinan
Required
Cara mendapatkan salinan Informasi
*
mengambil langsung
Kurir
Email
POS
Faximile
Other:
Required
Waktu
*
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report