Identitas Utama<\/h4><\/div><\/div><\/div>

Nama (Sesuai KTP) *<\/span><\/label><\/div><\/div><\/div>

Alamat *<\/span><\/label><\/div><\/div><\/div>

Pekerjaan<\/label><\/div><\/div><\/div>

No. Telepon *<\/span><\/label><\/div><\/div><\/div>

Identitas Kuasa Pemohon<\/h4><\/div><\/div><\/div>

Nama Kuasa<\/label><\/div><\/div><\/div>

Alamat Kuasa<\/label><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-2\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-2_671205a5997a7\" class=\"forminator-label\">No. Telepon Kuasa<\/label><input type=\"text\" name=\"phone-2\" value=\"\" placeholder=\"6281524xxxxxxxx\" id=\"forminator-field-phone-2_671205a5997a7\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-2\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-2_671205a5997a7\" class=\"forminator-label\">Upload KTP\/ Identitas Kuasa Pemohon<\/label><div class=\"forminator-file-upload \" data-element=\"upload-2_671205a5997a7\" aria-describedby=\"forminator-field-upload-2_671205a5997a7-description\"><input type=\"file\" name=\"upload-2\" 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class=\"forminator-radio-label\">Permohonan informasi ditolak<\/span><\/label><label for=\"forminator-field-radio-1-2-671205a5997a7\" class=\"forminator-radio\" title=\"Informasi berkala tidak disediakan\"><input type=\"radio\" name=\"radio-1\" value=\"Informasi berkala tidak disediakan\" id=\"forminator-field-radio-1-2-671205a5997a7\" data-calculation=\"0\" aria-describedby=\"forminator-field-radio-1-671205a5997a7-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Informasi berkala tidak disediakan<\/span><\/label><label for=\"forminator-field-radio-1-3-671205a5997a7\" class=\"forminator-radio\" title=\"Permintaan informasi tidak ditanggapi\"><input type=\"radio\" name=\"radio-1\" value=\"Permintaan informasi tidak ditanggapi\" id=\"forminator-field-radio-1-3-671205a5997a7\" data-calculation=\"0\" aria-describedby=\"forminator-field-radio-1-671205a5997a7-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Permintaan informasi tidak ditanggapi<\/span><\/label><label for=\"forminator-field-radio-1-4-671205a5997a7\" class=\"forminator-radio\" title=\"Permintaan informasi ditanggapi tidak sebagaimana diminta\"><input type=\"radio\" name=\"radio-1\" value=\"Permintaan informasi ditanggapi tidak sebagaimana diminta\" id=\"forminator-field-radio-1-4-671205a5997a7\" data-calculation=\"0\" aria-describedby=\"forminator-field-radio-1-671205a5997a7-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Permintaan informasi ditanggapi tidak sebagaimana diminta<\/span><\/label><label for=\"forminator-field-radio-1-5-671205a5997a7\" class=\"forminator-radio\" title=\"Permintaan informasi tidak dipenuhi\"><input type=\"radio\" name=\"radio-1\" value=\"Permintaan informasi tidak dipenuhi\" id=\"forminator-field-radio-1-5-671205a5997a7\" data-calculation=\"0\" aria-describedby=\"forminator-field-radio-1-671205a5997a7-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Permintaan informasi tidak dipenuhi<\/span><\/label><label for=\"forminator-field-radio-1-6-671205a5997a7\" class=\"forminator-radio\" title=\"Biaya yang dikenakan tidak wajar\"><input type=\"radio\" name=\"radio-1\" value=\"Biaya yang dikenakan tidak wajar\" id=\"forminator-field-radio-1-6-671205a5997a7\" data-calculation=\"0\" aria-describedby=\"forminator-field-radio-1-671205a5997a7-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Biaya yang dikenakan tidak wajar<\/span><\/label><label for=\"forminator-field-radio-1-7-671205a5997a7\" class=\"forminator-radio\" title=\"Informasi disampaikan melebihi jangka waktu yang ditentukan\"><input type=\"radio\" name=\"radio-1\" value=\"Informasi disampaikan melebihi jangka waktu yang 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