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E-Form Registrasi Penggunaan Alat Bantu Disabilitas
Catatan :
- Penggunaan fasilitas disabilitas hanya berlaku di Pengadilan Tinggi Sulawesi Tenggara
- E-form registrasi ini dapat diisi sebelum pengunjung datang ke
Pengadilan Tinggi Sulawesi Tenggara
- Permohonan akan diproses 1 hari setelah tanggal pengisian
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* Indicates required question
Nama Lengkap
*
Your answer
Pekerjaan
*
Pegawai Negeri Sipil (PNS)
Pegawai Swasta
Pengusaha
TNI/POLRI
Pengacara
Pedagang
Nelayan
Mahasiswa
Other:
Alamat Lengkap
*
Your answer
Nomor Telepon
*
Your answer
Tanggal Kunjungan
*
MM
/
DD
/
YYYY
Fasilitas Disabilitas
*
Kursi Roda/Kursi Dorong
Alat Bantu Jalan/Tongkat
Buku Braile (Panduan Pelayanan)
Brosur Digital (E-Brosur)
Required
Saran
Your answer
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