BORANG ADUAN PELANGGAN PK08/1 (SPSK)

PK 08/1

BORANG ADUAN PELANGGAN

(BERTULIS/LISAN) ( Nombor 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)