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FORMULIR PENGADUAN APARAT SIPIL NEGARA
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Nama Pelapor
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Nomor KTP/SIM Pelapor
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Alamat Pelapor
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Nomor Telepon Pelapor
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Email Pelapor
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Nama Terlapor
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Identitas Terlapor
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Ciri Fisik Terlapor
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Peristiwa yang dilaporkan (Peristiwa, waktu terjadinya, dan lokasi kejadian)
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Saksi yang menguatkan
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