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Format Buku Pengaduan
* Indicates required question
Tanggal Pengaduan
*
MM
/
DD
/
YYYY
Nama Pelapor
*
Your answer
Nomor Telepon /HP
*
Your answer
Alamat
*
Your answer
E-mail
*
Your answer
Pekerjaan
*
Your answer
Tanggal Kejadian
*
MM
/
DD
/
YYYY
Mekanisme Pengaduan
*
Your answer
Isi Pengaduan
*
Your answer
Nama Terlapor
*
Your answer
NIP
*
Your answer
Instansi
*
Your answer
Jabatan
*
Your answer
Hasil Penelahaan
*
Berkadar Pengawasan
Tidak Berkadar Pengawasan
Lain-Lain
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