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FORMULIR KOMPLAIN KONSUMEN

1. Nama : ________________________________________________________________

2. Alamat : ________________________________________________________________

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3. No. Unit : ________________________________________________________________

4. No. Tlp / HP : ________________________________________________________________

5. Keluhan / Saran : ________________________________________________________________

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Ragajaya, _________ ,____________________ ,_________

Konsumen Penerima

( ______________________ ) ( ________________________ )

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