Form Pengaduan Masyarakat / Gratifikasi
Sign in to Google to save your progress. Learn more
Tanggal Kejadian *
MM
/
DD
/
YYYY
Perihal Kejadian *
No HP (jika berkenan)
Update penanganan atas laporan anda  akan disampaikan melalui WA
Poling Pelayanan BKK Kelas I Samarinda *
Tidak Memuaskan
Sangat Memuaskan
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy