City Service Registration

City / Regency Name *

Province *

Government Office Address * Please provide the complete address for agreement delivery.

Official Website *

Mayor / Regent / Governor Name *

PIC Name *

PIC Position *

PIC Email *

PIC Phone / WhatsApp *

Installment Payment *

Paid in Full 2 Installments

Contract Signing by *

Mayor / Regent / Governor Deputy Mayor / Deputy Regent / Deputy Governor Other

If "Other", provide the signatory's name and position.

Number of Legal Standing * Appointment decree or other authorization reference.

Plans * Select one or more plans.

Tata Kelola & Pelaporan Kajian & Strategi Keberlanjutan Pelatihan & Layanan On-Demand

Estimated Date of Assessment Meeting 1 *

Estimated Date of Assessment Meeting 2

Estimated Date of Assessment Meeting 3

Offline Meeting *

All Virtual Meeting 1 Meeting 2 Meeting 3

UI GreenMetric City Service Form