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Reg.

No : 0208
PT. WIRA SANDI
Safety & Security Services
Jl. Kesehatan No. 16 Pasar Rebo Jakarta Timur
Tlp. 021-87796143 / 021-87782402 fax. 021-87792568

FORM KOMPLAIN

Nama :......................................................................................................................
Alamat KTP :......................................................................................................................
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NIK : ....................................................................................................................
Alamat Tinggal:.....................................................................................................................
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No Hp :......................................................................................................................

Riwayat Penugasan :
1. ...................................................................................................................................
2. ....................................................................................................................................
3. ....................................................................................................................................
4. ....................................................................................................................................

Keterangan komplain ( BPJS/ THR/ GAJI/ KOPERASI/Lain-lain)


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Jakarta :.........................................

Pemohon Mengetahui Supervisor

Operasional Wira Sandi

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