KOMISI INFORMASI PROVINSI KALIMANTANBARAT DATA RESPONDEN PEMERINGKATAN KETERBUKAAN INFORMASI BADAN PUBLIK TAHUN 2017 Self Assesment Questionnaire (SAQ) Data Badan Publik Nama Badan Publik : .................................................................................................. ........................ Alamat Badan Publik : .................................................................................................. ........................ No. Telp / Faks : .................................................................................................. ........................ Website : .............................................................................................. ............................

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KOMISI INFORMASIPROVINSI KALIMANTANBARAT

DATA RESPONDENPEMERINGKATAN KETERBUKAAN INFORMASI BADAN PUBLIK TAHUN 2017

Self Assesment Questionnaire (SAQ)

Data Badan Publik

Nama Badan Publik : ..........................................................................................................................

Alamat Badan Publik : ..........................................................................................................................

No. Telp / Faks : ..........................................................................................................................

Website : ..........................................................................................................................

Data RespondenNama Responden : ..........................................................................................................................

Jabatan : ..........................................................................................................................

No. Telp / HP : ..........................................................................................................................

E-mail : ..........................................................................................................................

KOMISI INFORMASIPROVINSI KALIMANTANBARAT

DATA RESPONDENPEMERINGKATAN KETERBUKAAN INFORMASI BADAN PUBLIK TAHUN 2017

Self Assesment Questionnaire (SAQ)Data PPID / Pejabat di Bidang Informasi, Komunikasi atau Kehumasan

Nama PPID / Pejabat di bidang Informasi, Komunikasi atau Kehumasan : ..........................................................................................................................

No. Telp / HP : ..........................................................................................................................

E-mail : ..........................................................................................................................

Pontianak, 2017

Mengetahui dan Menyetujui,

Responden PPID / Pejabat di bidang Informasi,Komunikasi atau Kehumasan

_________________________ _________________________Pangkat/Golongan Pangkat/Golongan

Nip.................. Nip..................