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Form Penilaian Personal Disabilitas Perdata
LEMBAR PENILAIAN PERSONAL
PENYANDANG DISABILITAS YANG BERHADAPAN HUKUM
DALAM PERKARA PERDATA
PADA PENGADILAN NEGERI ANDOOLO
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* Indicates required question
JENIS
PERKARA
*
Your answer
NOMOR
PERKARA
*
Your answer
NAMA
*
Your answer
JENIS
KELAMIN
*
LAKI-LAKI
PEREMPUAN
STATUS
*
PEMOHON
TERMOHON
PENGGUGAT
TERGUGAT
SAKSI
SAKSI AHLI
ADVOKAT
PENDAMPING
UMUR (SESUAI KALENDER KARTU IDENTITAS)
*
Your answer
UMUR MENTAL
(*hanya diisi jika umur kalender berbeda dengan umur
biologis, Ini menggunakan dasar dari psikolog)
Your answer
STATUS
PERKAWINAN
*
KAWIN
TIDAK / BELUM KAWIN
CERAI
ALAMAT KTP
*
Your answer
ALAMAT
DOMISILI
*
Your answer
NOMOR KONTAK YANG BISA DIHUBUNGI
*
Your answer
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