BORANG ADUAN PELANGGAN PK08/1 (SPSK)

                                                                                                                                          PK 08/1

BORANG ADUAN PELANGGAN

(BERTULIS/LISAN)

 ( N. Rujukan : .............)

1.    Nama Pengadu:.............................................................................................

2.    Alamat Pengadu:.................................................................................

3.    No Telefon:..........................................................................................

4.    Tandatangan (Jika Aduan Bertulis)

.........................................             Tarikh:.........................................

5.    Nama Penerima Aduan:......................................................................

6.    Tandatangan

......................................                Tarikh:.........................................

7.   Perihal Aduan:

............................................................................................................

............................................................................................................

............................................................................................................

URUSAN URUSETIA ADUAN

7.    Tarikh Terima Aduan : ...................................

8.    Kategori Aduan (Rujuk PK08/3.1) :......................................................(LENGKAP /TIDAK LENGKAP*)

9.    Pegawai Bertanggungjawab :.............................................................................................

10.  Tandatangan

..............................................              Tarikh:..........................................

 (* Potong mana yang tidak berkenaan)