JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Form Pengajuan Keberatan
Sign in to Google
to save your progress.
Learn more
* Indicates required question
IDENTITAS PEMOHON
Nama Lengkap
*
Your answer
No. Identitas (KTP/SIM/Paspor)
*
Your answer
Nomor Telepon
*
Your answer
Pekerjaan
Your answer
Email
*
Your answer
Jenis Kelamin
*
Choose
Pria
Wanita
Alamat
*
Your answer
Data Permohonan Informasi
Informasi Yang Dibutuhkan
*
Your answer
Jenis Permohonan
*
Choose
Permohonan Perorangan
Permohonan Kelompok
Permohonan Lembaga
Cara Memperoleh Informasi
*
Choose
Melihat
Mendengarkan
Mencatat
Membaca
Alasan Penggunaan Informasi
*
Your answer
Mendapatkan Salinan Informasi
*
Choose
Hardcopy
Softcopy
Cara Mendapatkan Salinan Informasi
*
Choose
Website
Email
Fax
Via Pos
Submit
Clear form
Never submit passwords through Google Forms.
Forms
This content is neither created nor endorsed by Google.
Report Abuse
Terms of Service
Privacy Policy
Help and feedback
Contact form owner
Help Forms improve
Report