<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
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<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>Print Permohonan Informasi</title>
</head>

<body onLoad="javascript:window.print()">

<table width="80%" border="1" cellspacing="0" style="font-family:'Times New Roman', Times, serif; font-size:9px" align="center">
    <tr>
        <td align="center" colspan="4"><b style="font-size:16px;">PENGADILAN TINGGI AGAMA JAMBI</b><br/>JL. H. AGUS SALIM, KOTA BARU JAMBI<br/>TELP. 0741 - 41092, 40131, 445559<br/>FAX. 0741 - 445293<br/>Home page
     : www.pta.jambi.go.id e-Mail : ptajambi@yahoo.com</td>
    </tr>
    <tr>
        <td align="center" colspan="4"><b style="font-size:14px;">BUKTI PENGAJUAN PERMOHONAN INFORMASI</b><br/><b>Model A - Untuk Prosedur Biasa</b></td>
    </tr>
    <tr align="center">
        <td>Kode Dokumen<br/>FM/AP/01/01</td>
        <td>Tgl. Pembuatan<br/>-</td>
        <td>Tgl. Revisi<br/>-</td>
        <td>Tgl. Efektif<br/>-</td>
    </tr>
</table>

<p style="font-family:cambria; font-size:14px;" align="center"><b>BUKTI PENGAJUAN PERMOHONAN INFORMASI<br/>
		Model A - Untuk Prosedur Biasa</b>
</p><?php
include 'config.php';
 if (isset($_GET['ID']))
 {
  $query = "SELECT * FROM tb_informasi where id_informasi='".$_GET['ID']."'";
$result = mysqli_query($koneksi, $query);
while($data = mysqli_fetch_array($result)){
  ?>
<table width="80%" border="0" cellspacing="0" style="font-family:'Times New Roman', Times, serif; font-size:14px" align="center">

  <tr>
    <td width="35%">Tanggal Pengajuan Permohonan</td>
    <td width="65%"><b>: <?php echo $data['tgl_permohonan'] ?></b></td>
  </tr>
  <tr>
    <td>Tanggal Pemberitahuan Tertulis</td>
    <td>: </td>
  </tr>
  <tr>
    <td>Nomor Pendaftaran</td>
    <td>: <?php echo $data['id_informasi'] ?></td>
  </tr>
</table>
<p></p>
<table width="80%" border="1" cellspacing="0" style="font-family:'Times New Roman', Times, serif; font-size:14px" align="center">
 
  <tr style="height:50px;">
    <td width="35%" style="padding-left:10px">Nama</td>
    <td widht="65%" style="padding-left:10px"><?php echo $data['nama'] ?></td>
  </tr>
  <tr style="height:50px;">
    <td width="30%" style="padding-left:10px">Alamat</td>
    <td widht="70%" style="padding-left:10px"><?php echo $data['alamat'] ?></td>
  </tr>
  <tr style="height:50px;">
    <td width="30%" style="padding-left:10px">Pekerjaan</td>
    <td widht="70%" style="padding-left:10px"><?php echo $data['pekerjaan'] ?></td>
  </tr>
  <tr style="height:50px;">
    <td width="25%" style="padding-left:10px">Nomor Telpon / e-mail</td>
    <td widht="75%" style="padding-left:10px"><?php echo $data['telp']. "/" .$data['email'] ?></td>
  </tr>
  <tr style="height:50px;">
    <td width="25%" style="padding-left:10px">Rincian Informasi Yang DIbutuhkan</td>
    <td widht="75%" style="padding-left:10px"><?php echo $data['rincian'] ?></td>
  </tr>
  <tr style="height:50px;">
    <td width="25%" style="padding-left:10px">Tujuan Penggunaan informasi</td>
    <td widht="75%" style="padding-left:10px"><?php echo $data['tujuan'] ?></td>
  </tr>
  <?php
        if ($data['cara_memperoleh'] == 'Membaca' OR $data['cara_memperoleh'] == 'Melihat' OR $data['cara_memperoleh'] == 'Mendengar'){ ?>
  <tr>
    <td width="25%" rowspan="2" style="height:50px padding-left:10px">Cara Memperoleh Informasi</td>
    <td widht="75%" style="height:50px;">
        <div class="form-check" style="padding-left:10px">
            <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault" checked>
            <label class="form-check-label" for="flexCheckDefault">
                Melihat/Membaca/Mendengar***
            </label>
        </div>
    </td>
  </tr>
  <tr>
    <td widht="75%" style="height:50px;">
    <div class="form-check" style="padding-left:10px">
            <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault">
            <label class="form-check-label" for="flexCheckDefault">
                Mendapat Salinan Informasi (Softcopy/Hardcopy)***
            </label>
        </div>
    </td>
  </tr>
  <?php
        }else{
            ?>
             <tr>
    <td width="25%" rowspan="2" style="height:50px; padding-left:10px">Cara Memperoleh Informasi</td>
    <td widht="75%" style="height:50px;">
        <div class="form-check" style="padding-left:10px">
            <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault">
            <label class="form-check-label" for="flexCheckDefault">
                Melihat/Membaca/Mendengar***
            </label>
        </div>
    </td>
  </tr>
  <tr>
    <td widht="75%" style="height:50px">
    <div class="form-check" style="padding-left:10px">
            <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault" checked>
            <label class="form-check-label" for="flexCheckDefault">
                Mendapat Salinan Informasi (Softcopy/Hardcopy)***
            </label>
        </div>
    </td>
  </tr>
            <?php
        }
        ?>
  <?php
        if ($data['cara_mendapatkan'] == 'Mengambil Lansung'){ ?>
  <tr>
    <td width="25%" rowspan="2" style="height:50px; padding-left:10px">Cara Mendapatkan Informasi</td>
    <td widht="75%" style="height:50px;">
        <div class="form-check" style="padding-left:10px">
            <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault" checked>
            <label class="form-check-label" for="flexCheckDefault">
                Mengambil Lansung
            </label>
        </div>
    </td>
  </tr>
  <tr>
    <td widht="75%" style="height:50px;">
    <div class="form-check" style="padding-left:10px">
            <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault">
            <label class="form-check-label" for="flexCheckDefault">
                e-Mail
            </label>
        </div>
    </td>
  </tr>
  <?php
        }else{
            ?>
             <tr>
    <td width="25%" rowspan="2" style="height:50px; padding-left:10px">Cara Mendapatkan Informasi</td>
    <td widht="75%" style="height:50px;">
        <div class="form-check" style="padding-left:10px">
            <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault">
            <label class="form-check-label" for="flexCheckDefault">
                Mengambil Lansung
            </label>
        </div>
    </td>
  </tr>
  <tr>
    <td widht="75%" style="height:50px;" >
    <div class="form-check" style="padding-left:10px">
            <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault" checked>
            <label class="form-check-label" for="flexCheckDefault">
                e-Mail
            </label>
        </div>
    </td>
  </tr>
            <?php
        }
        ?>
</table>
<br/>
<table width="80%" border="0" cellspacing="0" style="font-family:'Times New Roman', Times, serif; font-size:14px" align="center">

  <tr align="center">
    <td width="50%">Petugas Informasi</td>
    <td width="50%">Pemohon Informasi</td>
  </tr>
  <tr align="center">
    <td style="padding-top:50px">...................</td>
    <td style="padding-top:50px"><?php echo $data['nama'] ?></td>
  </tr>
</table>
<br/>
<p style="font-family:'Times New Roman', Times, serif; font-size:10px; padding-left:90px;" widht="80%"><b>Keterangan :</b>
<br/>*     Diisi Oleh Petugas
<br/>**    Diisi Oleh Petugas berdasarkan nomor register permohonan Informasi
<br/>***   Pilih salah satu dengan memberi tanda (V)
<br/>****  Coret yang tidak perlu
    </p>
<?php
  }
  }
  ?>
</body>
</html>
