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Formulir Permohonan Informasi
Formulir berikut digunakan secara Publik untuk melakukan permohonan Informasi secara Online pada Dinas Perkebunan Provinsi Jawa Timur
* Indicates required question
Email
*
Record my email address with my response
Nama Lengkap
*
Your answer
No. KTP / SIM / PASSPORT
*
Your answer
Pekerjaan
*
Your answer
Alamat
*
Your answer
No. Handphone
*
Your answer
Email
*
Your answer
Rincian Informasi yang Dibutuhkan
*
Your answer
Tujuan Penggunan Informasi
*
Your answer
Cara Memperoleh Informasi
*
Membaca / Melihat / Mendengarkan / Mencatat
Mendapatkan Salinan Informasi (hadrcopy/softcopy)
Required
Cara Mendapatkan Salinan Informasi
*
Mengambil Langsung
Kurir
POS
Email
Faksimili
Required
Send me a copy of my responses.
Submit
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