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Section 1 of 3
Formulir Pernyataan Keberatan Atas Permohonan Informasi
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Nomor Register Permohonan Informasi Publik (tanyakan ke petugas)
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Nama
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Alamat
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Nomor HP
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Section 2 of 3
Identitas Kuasa Pemohon (Jika ada Kuasa Pemohon)
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Kontak (Alamat Email atau Nomor HP)
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Section 3 of 3
Pengajuan Keberatan
Alasan Pengajuan Keberatan
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Permohonan informasi ditolak
Informasi berkala tidak disediakan
Permohonan informasi tidak ditanggapi
Permohonan informasi ditanggapi tidak sebagaimana mestinya
Permohonan informasi tidak dipenuhi
Biaya yang dikenakan tidak wajar
Informasi disampaikan melebihi jangka waktu yang ditentukan
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Kasus Posisi (Catatan)
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Pengajuan Keberatan
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Email
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Nomor Register Permohonan Informasi Publik (tanyakan ke petugas)
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Nama
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Alamat
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Nomor HP
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Identitas Kuasa Pemohon (Jika ada Kuasa Pemohon)
Nama
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Kontak (Alamat Email atau Nomor HP)
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Pengajuan Keberatan
Alasan Pengajuan Keberatan
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Kasus Posisi (Catatan)
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Pengajuan Keberatan
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