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11. LAPORAN HASIL PELAKSANAAN PENYELIDIKAN

S-1.4.1
KOPSTUK

LAPORAN HASIL PENYELIDIKAN

I. DASAR
1. Laporan [Informasi/Polisi*] Nomor: [LI/0000/XX/2022/Reskrim / LP/C/0000/XX/2022/Reskrim*] tanggal dd mm yyyy;
2. Surat Perintah Penyelidikan Nomor: SP.Lidik/0000/VII/RES.0.0./2022/Bareskrim tanggal dd mm yyyy;
3. ...... .
II. YANG MELAKUKAN PENYELIDIKAN
1. nama ............................................................................................................................... .................................. ;
pangkat/NRP ..................................................................................................................................................................... . ;
jabatan ............................................................................................................................... ............................... ;
kesatuan : ....................................................................................................................................................... .
2. nama ............................................................................................................................... .................................. ;
pangkat/NRP ............................................................................................................................... .......................................
; jabatan ............................................................................................................................... ...............................
; kesatuan : .......................................................................................................................................................
.
III. PELAKSANAAN PENYELIDIKAN
1. Tanggal ............................................................................................... .............................................................. ;
2. Tempat............................................................................................................................... ............................... ;
3. Cara bertindak : ....................................................................................................................................................... .
IV. SARAN PENYELIDIKAN
1. .................................................................................................................................................................................... ;
2. .................................................................................................................................................................................... .
(terhadap orang, benda atau barang, tempat, peristiwa/kejadian dan/atau kegiatan)
V. HASIL PENYELIDIKAN
1. Terhadap Orang:
nama: [NAMA], nomor identitas: [nomor identitas], kewarganegaraan: [WN ...... ], jenis kelamin: [laki-laki/perempuan*],
tempat/tanggal lahir: [Tempat]/dd mm yyyy, pekerjaan [Pekerjaan], agama: [Agama], alamat [Alamat];
Hasil Observasi : ....................................................................................................................................................... .
2. Terhadap Tempat:
di............................................................................................................................................................... ......... ;
sasaran berupa ........................................................................................................................................................................................
; Hasil Observasi : ....................................................................................................................................................... .
3. Terhadap Barang:
barang berupa .......................................................................................................................................................................................... ;
Hasil Observasi : ....................................................................................................................................................... .
VI. HAMBATAN
1. .................................................................................................................................................................................... ;
2. .................................................................................................................................................................................... .
VII. PENDAPAT DAN SARAN
1. Pendapat............................................................................................... ............................................................. ;
2. Saran ......................................................................................................................................................................... .
VIII. KESIMPULAN
1. Kesimpulan ........................................................................................................................................................................ . ;
2. Rencana Tindak Lanjut .............................................................................................................................................. .
IX. PENUTUP
Demikian laporan hasil penyelidikan ini dibuat denngan sebernarnya untuk dapat dipergunakan pimpinan mengambil
keputusan lebih lanjut.

Kota, dd mm yyyy
yang melakukan Penyelidikan

NA M A
PANGKAT NRP 00000000