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Information Request
Applicant Identity Details
Name
*
ID Number (KTP/Driver's License)
*
Address
*
Phone / Mobile Number
*
Email
*
Information Requested
*
Purpose of Information Use
*
Preferred Method to Obtain Information
*
Website
In Person
Email
Fax
Postal Mail
Newspaper
Please select one method to obtain the information.
Preferred Format of Information
*
Written
Printed
Recorded
Please select one format of information.
Type of Request
*
Individual
Group
Legal Entity
Please select one type of request.
Supporting Letter
*
Supporting letter: Power of Attorney and ID card of the authorized representative
The data and information we obtain will be used in accordance with the applicable laws and regulations.
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