E-Complaint

Nama | Name *

Emel | Email *

No. Tel | Tel. No *

Alamat Pengadu | Complainant Address *

Tajuk Aduan | Complaint Subject *

Jenis Pencemaran | Type Of Pollution *

Punca Daripada | Source From *

Nama Kilang/Premis | Name of Plant/Premis *

Alamat Lokasi Pencemaran | Pollution Location Address *

Sila nyatakan alamat terperinci supaya JAS dapat menyiasat lokasi | Please provide detail address so DOE can investigate the location

State / Negeri *

Keterangan | Description *

DOE Address