Formulir Pengaduan

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FORMULIR PENGADUAN

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PEMERINTAH PROVINSI JAWA TENGAH

DINAS KEPEMUDAAN, OLAHRAGA DAN

PARIWISATA
Jl. Kimangunsarkoro Nomor 12 Telp. (024) 8419956, 8419957, 8419958 Fax. (024) 8419959
SEMARANG – Kode pos 50241

FORMULIR PENGADUAN LAYANAN INFORMASI PPID PEMBANTU

DINAS KEPEMUDAAN, OLAHRAGA DAN PARIWISATA PROVINSI JAWA TENGAH

Nama* :………………………………………………………………………………………………………

Alamat* :………………………………………………………………………………………………………

No. Telepon /Fax/ Email* : …………………………………………………………………………………..

No. KTP/NPWP* :…………………………………………………………………………………………………

Pengaduan, kronologi kejadian, dan/atau saran:

………………………………………………………………………………………………………………………………

…………………………………………………………………………

Semarang,

(…………………………………)

Nama jelas dan Tanda tangan

* ) Harus Diisi

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