CONTOH BORANG ADUAN

CONTOH BORANG ADUAN

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:

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URUSAN KETUA BAHAGIAN/KETUA UNIT

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

8.    Kategori Aduan  :................................................................................................(LENGKAP /TIDAK LENGKAP*)

9.    Pegawai Bertanggungjawab Yang Diarahkan...............................................................

10.  Jenis Arahan .....................................................................(S. 127, S 425, S. 426 KTN)

11.  Jangka masa tindakan........................................................................../SERTAMERTA

12.  Tandatangan......................................Tarikh:..........................................

13.  Lain-lain .................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

 (* Potong mana yang tidak berkenaan)