SAMPILANB..............................................................................................................
INSTRUMENPONORIUKAN
ItemPonorubungan SeparaStruktur
MAKLUMATAM:
PONGUHATANPONORUBUNGAN:
PonguhatanApangkal Nuut
1 .NunupogoduhantondutinaruDusundamot
monontian?2 .NunupogoduhantondutinaruDusunhapas
osusu?NgaranInforman :...........................................
Tadauwulan :...........................................
Kinoyonon :...........................................