Formulir Pengaduan / Grievance Form
EQSI Project - Yayasan Kalla
Data Pelapor
Complainant Data
Nama *
name
Alamat *
Address
Nomor Telepon
Phone No.
Fax
E-Mail
Informasi Pengaduan
Grievance Information
Lokasi *
Location
Pihak yang dilaporkan *
Parties was reported
Tanggal Kejadian *
Date of Occurence
MM
/
DD
/
YYYY
Isi Pengaduan
detail grievance
Dokumen pendukung / support document
(lengkapi dengan bukti atau dokumen terkait/Completed with related evidence or documents)(jika bagian ini tidak cukup dapat menggunakan kerta tambahan/ if this part is insufficient, then allowed to use additional paper)
Tanda tangan pelaporan *
Required
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