FORMULIR PENGADUAN SENGKETA

FORMULIR PENGADUAN SENGKETA

PEMILU MAHASISWA UIN SYARIF HIDAYATULLAH JAKARTA2014

A.       IdentitasPemohon

Nama                                : ...........................................................................................................

NIM                                  :...........................................................................................................

Fakultas                            :...........................................................................................................

Jurusan/Prodi                    :...........................................................................................................

NomorHp                         :...........................................................................................................

B.       Data Saksi

SaksiUtama

Nama                                :...........................................................................................................

NIM                                  :...........................................................................................................

Fakultas                            :...........................................................................................................

Jurusan/Prodi                    :...........................................................................................................

NomorHp                         :...........................................................................................................

SaksiTambahan

Nama                                :...........................................................................................................

NIM                                  :...........................................................................................................

Fakultas                            :...........................................................................................................

Jurusan/Prodi                    :...........................................................................................................

NomorHp                         :...........................................................................................................

*Isi minimal saksi utama.

C.       Data Pihak yang Diadukan

Instansi                             :...........................................................................................................

Nama                                :...........................................................................................................

*tambahkan data yang perluditambahkanataukosongkanjikatidakperlu.

D.       Data Sengketa

Waktu                               :...........................................................................................................

Tempat                             :...........................................................................................................

Hal yang dilaporkan         :...........................................................................................................

E.       SinopsisSengketa

Mengetahui,

Pemohon

(materaiRp. 6.000)

                                                           

*tulis nama jelas

FORMULIR PENGADUAN SENGKETA DAPAT DI DOWNLOAD DI SINI :

https://docs.google.com/file/d/0B8F8hMFE8-1eX3hMWl84LUkxQzg/edit