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Form Pernyataan Keberatan atas Informasi Publik
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Nomor registrasi Keberatan
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Nomor Pendaftaran Permintaan
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Informasi
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Tujuan Penggunaan Informasi
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Identitas Pemohon**
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Judul Tanpa Judul
Alamat
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Nomor Telepon
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ALASAN PENGAJUAN KEBERATAN***
Permohohonan informasi ditolak
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Informasi berkala tidak disediakan
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Permintaan informasi tidak ditanggapi
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Permintaan informasi ditanggapi tidak sebagaimana yang diminta
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Permintaan informasi tidak dipenuhi
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Biaya yang dikenakan tidak wajar
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Informasi disampaikan melebihi jangka waktu yang ditentukan
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