FORM LAYANAN ARSIP
 Kawasan Thamrin (Unit Kearsipan I BRIN)
Sign in to Google to save your progress. Learn more
Email *
Nama Pemohon *
Unit Kerja *
No. HP *
Jenis Arsip yang dipinjam/diperlukan, periode tercipta *
Maksud dan Keperluan Peminjaman Arsip *
Klasifikasi Arsip *
Tgl. Peminjaman / Tgl Penyerahan Arsip Digital
MM
/
DD
/
YYYY
Nomor Berkas & Nomor Isi Berkas
Tgl. Pengembalian Arsip
MM
/
DD
/
YYYY
Keterangan Lain (bila ada) *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms