FORMULIR PERMOHONAN KREDIT MULTIGUNA Status Permohonan :

BANK JATIM CABANG : KRAKSAAN Baru

Kompensasi/Top Up
Kepada
PT BANK PEMBANGUNAN DAERAH JAWA TIMUR Tbk
CABANG KRAKSAAN

DATA IDENTITAS PEMOHON

Nama Pemohon (sesuai KTP) :
No KTP :
No NPWP (apabila ada) :

Jenis Kelamin : Laki-laki Perempuan

Tempat Lahir :
Tanggal Lahir :
No Hp diri dan pasangan : /
Status Perkawinan : Menikah Tidak Menikah Cerai
Alamat (sesuai KTP) :
RT : RW : Kelurahan :
Kab/Kodya : Kode Pos :
Alamat Rumah (bila berbeda) :
RT : RW : Kelurahan :
Kab/Kodya : Kode Pos :
Status rumah yang ditempati : Milik Sendiri Kantor Sewa Lainnya
Pendidikan Terakhir : SD SLTP SMU Diploma Sarjana
Nama Ibu Kandung :
DATA SUAMI/ISTRI & TANGGUNGAN
Nama Suami/Istri
Pekerjaan Suami/Istri
Alamat Perusahaan/Instansi/Usaha :
Jumlah Anak
Jumlah Tanggungan lainnya

DATA PEKERJAAN
Nama Instansi/Perusahaan :
Alamat Instansi/Perusahaan :
NIP :
Golongan/Pangkat :
Jabatan :
Mulai Bekerja Tahun : Usia Pensiun
Tanggal Pengangkatan Pegawai : No SK :
Tanggal SK Terakhir : No SK :
Nama Bendahara/PAAK :
DATA PENGAJUAN PINJAMAN
Tujuan Pemakaian : Konsumtif Usaha Lainnya
Nilai Gaji/Penghasilan yang diterim :
Nilai pinjaman yang diajukan :
Jangka Waktu :
HUBUNGAN DENGAN BANK JATIM
Menjadi Nasabah sejak tahun :
Kepemilikan Rekening : Giro Tabungan Deposito Kredit
No. Rekening :
Rekening Gaji : Bank Jatim Lainnya
DATA PINJAMAN YANG DIMILIKI

No Jenis & Pemberi Plafond Jangka Sisa Kredit Jatuh Tempo Angsuran/bulan
Pinjaman Waktu
(Bulan)
1
2
3
4
5
6

PENDAPATAN DAN PENGELUARAN

Gaji Pemohon Sumber Pendapatan
Gaji Pokok : - Gaji Bersih Pemohon ( C ) : -
Tunjangan Penghasila : - Gaji bersih suami/istri : -
Tunjangan Kesejahter : - Penghasilan bersih lainny : - +
Tunjangan Struktural : - Total Penghasilan (D) : -
Tunjangan Fungsional : -
Tunjangan istri/suami : - Pengeluaran
Tunjangan Anak : - Biaya sewa/pemeliharaan : -
Tunjangan Beras : - Biaya hidup : -
Penerimaan lain-lain : - + Biaya lainnya : - +
Gaji Kotor (A) : - Total Pengeluaran ( E ) : -

Potongan
Simpanan Wajib : - Sisa Penghasilan : -
Iuran Taspen : - ( F ) (D) - ( E )
Iuran Koperasi : -
Iuran BPJS : - Mengatahui,
Pajak : - Bendahara Gaji
Angsuran Hutang : -
Potongan lainnya : - +
Jumlah Potongan (B) : -
( )
Gaji Bersih C (A-B) : - NIP.
Dengan menandatangi formulir ini, maka saya menyatakan :

Bahwa semua informasi dalam aplikasi pembiayaan ini adalah Pasfoto pemohon 4x6
lengkap dan benar, dan merupakan bagian yang tidak dapat
dipisahkan dengan perjanjian kredit

Saya memberikan persetujuan dan kuasa kepada BANK JATIM

untuk memperoleh referensi dari sumber manapun dan dengan
cara yang dianggap layak oleh BANK JATIM

Apabila permohonan saya disetujui, saya akan tunduk dan terikat

pada ketentuan dan syarat-syarat yang ditetapkan oleh BANK
JATIM
Bank mempunyai hak untuk menyetujui / menolak permohonan
saya tanpa kewajiban untuk menunjukkan alasannya
Permohonan ini beserta seluruh lampirannya menjadi milik Bank
Jatim
Permohonan yang saya ajukan ini adalah untuk kepentingan saya Pasfoto pasangani 4x6
dan bukan untuk orang lain.
Bahwa sampai dengan pengajuan kredit ini, saya tidak sedang
dalam masalah administratif atau hukum pada
Instansi/Dinas/Perusahaan tempat saya bekerja
Saya membebaskan PT Bank Jatim Tbk dari segala keluhan, klaim,
kerugian, gugatan dan/atau tuntutan hukum dari pihak manapun
di kemudian hari, sehubungan dengan demikian sepenuhnya
menjadi risiko dan beban serta tanggung jawab saya.

__________, tgl ____________

Mengetahui suami/istri, Tanda tangan pemohon

__________________________ Nip.___________________________
RANI : 081.222.807.077 BUNGA PROMO AKHIR TAHUN ! PENGAJUAN TANPA REKOM
DAFTAR ANGSURAN KREDIT MULTI GUNA
BANK JATIM CABANG KRAKSAAN
ANGSURAN
PLAFOND
11.00% Anuitas
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
12 24 36 48 60 72 84 96 108 120 132 144 156 168 180 192 204 216 228
10,000,000.00 883,816.59 466,078.38 327,387.17 258,455.23 217,424.23 190,340.79 171,224.36 157,084.26 146,258.61 137,750.01 130,923.49 125,355.53 120,752.74 116,905.42 113,659.69 110,900.04 108,538.06 106,504.96 104,746.39
15,000,000.00 1,325,724.88 699,117.57 491,080.76 387,682.84 326,136.35 285,511.19 256,836.55 235,626.38 219,387.92 206,625.02 196,385.24 188,033.29 181,129.10 175,358.13 170,489.54 166,350.06 162,807.10 159,757.45 157,119.58
20,000,000.00 1,767,633.17 932,156.76 654,774.34 516,910.45 434,848.46 380,681.58 342,448.73 314,168.51 292,517.22 275,500.02 261,846.98 250,711.05 241,505.47 233,810.85 227,319.39 221,800.08 217,076.13 213,009.93 209,492.78
25,000,000.00 2,209,541.46 1,165,195.95 818,467.93 646,138.07 543,560.58 475,851.98 428,060.91 392,710.64 365,646.53 344,375.03 327,308.73 313,388.81 301,881.84 292,263.56 284,149.23 277,250.10 271,345.16 266,262.41 261,865.97
30,000,000.00 2,651,449.76 1,398,235.15 982,161.51 775,365.68 652,272.69 571,022.37 513,673.09 471,252.77 438,775.83 413,250.03 392,770.47 376,066.58 362,258.21 350,716.27 340,979.08 332,700.12 325,614.19 319,514.89 314,239.17
35,000,000.00 3,093,358.05 1,631,274.34 1,145,855.10 904,593.29 760,984.81 666,192.77 599,285.28 549,794.90 511,905.14 482,125.04 458,232.22 438,744.34 422,634.58 409,168.98 397,808.93 388,150.14 379,883.23 372,767.38 366,612.36
40,000,000.00 3,535,266.34 1,864,313.53 1,309,548.68 1,033,820.90 869,696.92 761,363.16 684,897.46 628,337.03 585,034.44 551,000.05 523,693.96 501,422.10 483,010.94 467,621.69 454,638.77 443,600.16 434,152.26 426,019.86 418,985.56
45,000,000.00 3,977,174.63 2,097,352.72 1,473,242.27 1,163,048.52 978,409.04 856,533.56 770,509.64 706,879.15 658,163.75 619,875.05 589,155.71 564,099.86 543,387.31 526,074.40 511,468.62 499,050.18 488,421.29 479,272.34 471,358.75
50,500,000.00 4,463,273.76 2,353,695.83 1,653,305.21 1,305,198.89 1,097,992.37 961,220.99 864,683.04 793,275.50 738,605.98 695,637.56 661,163.63 633,045.40 609,801.32 590,372.38 573,981.45 560,045.20 548,117.23 537,850.07 528,969.26
55,000,000.00 4,860,991.22 2,563,431.10 1,800,629.44 1,421,503.74 1,195,833.27 1,046,874.35 941,734.00 863,963.41 804,422.36 757,625.06 720,079.20 689,455.39 664,140.05 642,979.82 625,128.31 609,950.22 596,959.35 585,777.30 576,105.14
60,000,000.00 5,302,899.51 2,796,470.29 1,964,323.03 1,550,731.36 1,304,545.38 1,142,044.74 1,027,346.19 942,505.54 877,551.66 826,500.07 785,540.94 752,133.15 724,516.41 701,432.54 681,958.16 665,400.24 651,228.39 639,029.79 628,478.33
65,000,000.00 5,744,807.80 3,029,509.48 2,128,016.61 1,679,958.97 1,413,257.50 1,237,215.14 1,112,958.37 1,021,047.67 950,680.97 895,375.07 851,002.69 814,810.92 784,892.78 759,885.25 738,788.01 720,850.26 705,497.42 692,282.27 680,851.53
70,000,000.00 6,186,716.10 3,262,548.67 2,291,710.20 1,809,186.58 1,521,969.62 1,332,385.53 1,198,570.55 1,099,589.80 1,023,810.27 964,250.08 916,464.43 877,488.68 845,269.15 818,337.96 795,617.85 776,300.28 759,766.45 745,534.75 733,224.72
75,000,000.00 6,628,624.39 3,495,587.86 2,455,403.78 1,938,414.20 1,630,681.73 1,427,555.93 1,284,182.73 1,178,131.92 1,096,939.58 1,033,125.08 981,926.18 940,166.44 905,645.52 876,790.67 852,447.70 831,750.30 814,035.48 798,787.23 785,597.92
80,000,000.00 7,070,532.68 3,728,627.06 2,619,097.37 2,067,641.81 1,739,393.85 1,522,726.32 1,369,794.91 1,256,674.05 1,170,068.88 1,102,000.09 1,047,387.92 1,002,844.20 966,021.89 935,243.38 909,277.55 887,200.32 868,304.52 852,039.71 837,971.11
85,000,000.00 7,512,440.97 3,961,666.25 2,782,790.95 2,196,869.42 1,848,105.96 1,617,896.72 1,455,407.10 1,335,216.18 1,243,198.19 1,170,875.10 1,112,849.67 1,065,521.97 1,026,398.25 993,696.09 966,107.39 942,650.34 922,573.55 905,292.20 890,344.31
90,000,000.00 7,954,349.27 4,194,705.44 2,946,484.54 2,326,097.04 1,956,818.08 1,713,067.11 1,541,019.28 1,413,758.31 1,316,327.49 1,239,750.10 1,178,311.41 1,128,199.73 1,086,774.62 1,052,148.80 1,022,937.24 998,100.36 976,842.58 958,544.68 942,717.50
95,000,000.00 8,396,257.56 4,427,744.63 3,110,178.13 2,455,324.65 2,065,530.19 1,808,237.51 1,626,631.46 1,492,300.44 1,389,456.80 1,308,625.11 1,243,773.16 1,190,877.49 1,147,150.99 1,110,601.51 1,079,767.09 1,053,550.38 1,031,111.61 1,011,797.16 995,090.69
100,000,000.00 8,838,165.85 4,660,783.82 3,273,871.71 2,584,552.26 2,174,242.31 1,903,407.90 1,712,243.64 1,570,842.57 1,462,586.10 1,377,500.11 1,309,234.90 1,253,555.26 1,207,527.36 1,169,054.23 1,136,596.93 1,109,000.40 1,085,380.64 1,065,049.64 1,047,463.89
105,000,000.00 9,280,074.14 4,893,823.01 3,437,565.30 2,713,779.87 2,282,954.42 1,998,578.30 1,797,855.83 1,649,384.69 1,535,715.41 1,446,375.12 1,374,696.65 1,316,233.02 1,267,903.73 1,227,506.94 1,193,426.78 1,164,450.42 1,139,649.68 1,118,302.13 1,099,837.08
110,000,000.00 9,721,982.44 5,126,862.20 3,601,258.88 2,843,007.49 2,391,666.54 2,093,748.69 1,883,468.01 1,727,926.82 1,608,844.71 1,515,250.12 1,440,158.40 1,378,910.78 1,328,280.09 1,285,959.65 1,250,256.63 1,219,900.44 1,193,918.71 1,171,554.61 1,152,210.28
115,000,000.00 10,163,890.73 5,359,901.39 3,764,952.47 2,972,235.10 2,500,378.65 2,188,919.09 1,969,080.19 1,806,468.95 1,681,974.02 1,584,125.13 1,505,620.14 1,441,588.54 1,388,656.46 1,344,412.36 1,307,086.47 1,275,350.46 1,248,187.74 1,224,807.09 1,204,583.47
120,000,000.00 10,605,799.02 5,592,940.58 3,928,646.05 3,101,462.71 2,609,090.77 2,284,089.48 2,054,692.37 1,885,011.08 1,755,103.32 1,653,000.14 1,571,081.89 1,504,266.31 1,449,032.83 1,402,865.07 1,363,916.32 1,330,800.48 1,302,456.77 1,278,059.57 1,256,956.67
125,000,000.00 11,047,707.32 5,825,979.77 4,092,339.64 3,230,690.33 2,717,802.88 2,379,259.88 2,140,304.55 1,963,553.21 1,828,232.63 1,721,875.14 1,636,543.63 1,566,944.07 1,509,409.20 1,461,317.78 1,420,746.17 1,386,250.50 1,356,725.81 1,331,312.05 1,309,329.86
130,000,000.00 11,489,615.61 6,059,018.97 4,256,033.23 3,359,917.94 2,826,515.00 2,474,430.27 2,225,916.74 2,042,095.34 1,901,361.93 1,790,750.15 1,702,005.38 1,629,621.83 1,569,785.57 1,519,770.49 1,477,576.01 1,441,700.52 1,410,994.84 1,384,564.54 1,361,703.06
135,000,000.00 11,931,523.90 6,292,058.16 4,419,726.81 3,489,145.55 2,935,227.11 2,569,600.67 2,311,528.92 2,120,637.46 1,974,491.24 1,859,625.15 1,767,467.12 1,692,299.59 1,630,161.93 1,578,223.21 1,534,405.86 1,497,150.54 1,465,263.87 1,437,817.02 1,414,076.25
140,000,000.00 12,373,432.19 6,525,097.35 4,583,420.40 3,618,373.17 3,043,939.23 2,664,771.06 2,397,141.10 2,199,179.59 2,047,620.54 1,928,500.16 1,832,928.87 1,754,977.36 1,690,538.30 1,636,675.92 1,591,235.71 1,552,600.56 1,519,532.90 1,491,069.50 1,466,449.44
145,000,000.00 12,815,340.49 6,758,136.54 4,747,113.98 3,747,600.78 3,152,651.35 2,759,941.46 2,482,753.28 2,277,721.72 2,120,749.85 1,997,375.16 1,898,390.61 1,817,655.12 1,750,914.67 1,695,128.63 1,648,065.56 1,608,050.58 1,573,801.93 1,544,321.98 1,518,822.64
150,000,000.00 13,257,248.78 6,991,175.73 4,910,807.57 3,876,828.39 3,261,363.46 2,855,111.85 2,568,365.47 2,356,263.85 2,193,879.15 2,066,250.17 1,963,852.36 1,880,332.88 1,811,291.04 1,753,581.34 1,704,895.40 1,663,500.60 1,628,070.97 1,597,574.46 1,571,195.83
155,000,000.00 13,699,157.07 7,224,214.92 5,074,501.15 4,006,056.00 3,370,075.58 2,950,282.25 2,653,977.65 2,434,805.98 2,267,008.46 2,135,125.18 2,029,314.10 1,943,010.65 1,871,667.41 1,812,034.05 1,761,725.25 1,718,950.62 1,682,340.00 1,650,826.95 1,623,569.03
160,000,000.00 14,141,065.36 7,457,254.11 5,238,194.74 4,135,283.62 3,478,787.69 3,045,452.64 2,739,589.83 2,513,348.10 2,340,137.76 2,204,000.18 2,094,775.85 2,005,688.41 1,932,043.77 1,870,486.76 1,818,555.10 1,774,400.64 1,736,609.03 1,704,079.43 1,675,942.22
165,000,000.00 14,582,973.66 7,690,293.30 5,401,888.32 4,264,511.23 3,587,499.81 3,140,623.04 2,825,202.01 2,591,890.23 2,413,267.07 2,272,875.19 2,160,237.59 2,068,366.17 1,992,420.14 1,928,939.47 1,875,384.94 1,829,850.66 1,790,878.06 1,757,331.91 1,728,315.42
170,000,000.00 15,024,881.95 7,923,332.49 5,565,581.91 4,393,738.84 3,696,211.92 3,235,793.43 2,910,814.19 2,670,432.36 2,486,396.37 2,341,750.19 2,225,699.34 2,131,043.93 2,052,796.51 1,987,392.18 1,932,214.79 1,885,300.68 1,845,147.10 1,810,584.39 1,780,688.61
175,000,000.00 15,466,790.24 8,156,371.68 5,729,275.50 4,522,966.46 3,804,924.04 3,330,963.83 2,996,426.38 2,748,974.49 2,559,525.68 2,410,625.20 2,291,161.08 2,193,721.70 2,113,172.88 2,045,844.90 1,989,044.64 1,940,750.70 1,899,416.13 1,863,836.88 1,833,061.81
180,000,000.00 15,908,698.53 8,389,410.88 5,892,969.08 4,652,194.07 3,913,636.15 3,426,134.22 3,082,038.56 2,827,516.62 2,632,654.98 2,479,500.20 2,356,622.83 2,256,399.46 2,173,549.24 2,104,297.61 2,045,874.48 1,996,200.72 1,953,685.16 1,917,089.36 1,885,435.00
185,000,000.00 16,350,606.83 8,622,450.07 6,056,662.67 4,781,421.68 4,022,348.27 3,521,304.62 3,167,650.74 2,906,058.75 2,705,784.29 2,548,375.21 2,422,084.57 2,319,077.22 2,233,925.61 2,162,750.32 2,102,704.33 2,051,650.74 2,007,954.19 1,970,341.84 1,937,808.20
190,000,000.00 16,792,515.12 8,855,489.26 6,220,356.25 4,910,649.30 4,131,060.38 3,616,475.01 3,253,262.92 2,984,600.87 2,778,913.59 2,617,250.21 2,487,546.32 2,381,754.98 2,294,301.98 2,221,203.03 2,159,534.18 2,107,100.76 2,062,223.22 2,023,594.32 1,990,181.39
195,000,000.00 17,234,423.41 9,088,528.45 6,384,049.84 5,039,876.91 4,239,772.50 3,711,645.41 3,338,875.10 3,063,143.00 2,852,042.90 2,686,125.22 2,553,008.06 2,444,432.75 2,354,678.35 2,279,655.74 2,216,364.02 2,162,550.78 2,116,492.26 2,076,846.80 2,042,554.58
200,000,000.00 17,676,331.70 9,321,567.64 6,547,743.42 5,169,104.52 4,348,484.61 3,806,815.80 3,424,487.29 3,141,685.13 2,925,172.20 2,755,000.23 2,618,469.81 2,507,110.51 2,415,054.72 2,338,108.45 2,273,193.87 2,218,000.80 2,170,761.29 2,130,099.29 2,094,927.78
205,000,000.00 18,118,240.00 9,554,606.83 6,711,437.01 5,298,332.14 4,457,196.73 3,901,986.20 3,510,099.47 3,220,227.26 2,998,301.51 2,823,875.23 2,683,931.55 2,569,788.27 2,475,431.08 2,396,561.16 2,330,023.72 2,273,450.82 2,225,030.32 2,183,351.77 2,147,300.97
210,000,000.00 18,560,148.29 9,787,646.02 6,875,130.59 5,427,559.75 4,565,908.85 3,997,156.59 3,595,711.65 3,298,769.39 3,071,430.81 2,892,750.24 2,749,393.30 2,632,466.04 2,535,807.45 2,455,013.87 2,386,853.56 2,328,900.84 2,279,299.35 2,236,604.25 2,199,674.17
215,000,000.00 19,002,056.58 10,020,685.21 7,038,824.18 5,556,787.36 4,674,620.96 4,092,326.99 3,681,323.83 3,377,311.52 3,144,560.12 2,961,625.24 2,814,855.04 2,695,143.80 2,596,183.82 2,513,466.59 2,443,683.41 2,384,350.86 2,333,568.39 2,289,856.73 2,252,047.36
220,000,000.00 19,443,964.87 10,253,724.40 7,202,517.77 5,686,014.97 4,783,333.08 4,187,497.38 3,766,936.02 3,455,853.64 3,217,689.42 3,030,500.25 2,880,316.79 2,757,821.56 2,656,560.19 2,571,919.30 2,500,513.26 2,439,800.88 2,387,837.42 2,343,109.21 2,304,420.56
225,000,000.00 19,885,873.17 10,486,763.59 7,366,211.35 5,815,242.59 4,892,045.19 4,282,667.78 3,852,548.20 3,534,395.77 3,290,818.73 3,099,375.25 2,945,778.54 2,820,499.32 2,716,936.56 2,630,372.01 2,557,343.10 2,495,250.90 2,442,106.45 2,396,361.70 2,356,793.75
230,000,000.00 20,327,781.46 10,719,802.79 7,529,904.94 5,944,470.20 5,000,757.31 4,377,838.17 3,938,160.38 3,612,937.90 3,363,948.03 3,168,250.26 3,011,240.28 2,883,177.09 2,777,312.92 2,688,824.72 2,614,172.95 2,550,700.92 2,496,375.48 2,449,614.18 2,409,166.95
235,000,000.00 20,769,689.75 10,952,841.98 7,693,598.52 6,073,697.81 5,109,469.42 4,473,008.57 4,023,772.56 3,691,480.03 3,437,077.34 3,237,125.27 3,076,702.03 2,945,854.85 2,837,689.29 2,747,277.43 2,671,002.80 2,606,150.94 2,550,644.51 2,502,866.66 2,461,540.14
240,000,000.00 21,211,598.05 11,185,881.17 7,857,292.11 6,202,925.43 5,218,181.54 4,568,178.96 4,109,384.74 3,770,022.16 3,510,206.65 3,306,000.27 3,142,163.77 3,008,532.61 2,898,065.66 2,805,730.14 2,727,832.64 2,661,600.96 2,604,913.55 2,556,119.14 2,513,913.33
245,000,000.00 21,653,506.34 11,418,920.36 8,020,985.69 6,332,153.04 5,326,893.65 4,663,349.36 4,194,996.93 3,848,564.29 3,583,335.95 3,374,875.28 3,207,625.52 3,071,210.37 2,958,442.03 2,864,182.85 2,784,662.49 2,717,050.98 2,659,182.58 2,609,371.63 2,566,286.53
250,000,000.00 22,095,414.63 11,651,959.55 8,184,679.28 6,461,380.65 5,435,605.77 4,758,519.75 4,280,609.11 3,927,106.41 3,656,465.26 3,443,750.28 3,273,087.26 3,133,888.14 3,018,818.40 2,922,635.57 2,841,492.34 2,772,501.00 2,713,451.61 2,662,624.11 2,618,659.72
400,000,000.00 35,352,663.41 18,643,135.28 13,095,486.85 10,338,209.04 8,696,969.23 7,613,631.60 6,848,974.57 6,283,370.26 5,850,344.41 5,510,000.45 5,236,939.62 5,014,221.02 4,830,109.43 4,676,216.90 4,546,387.74 4,436,001.60 4,341,522.58 4,260,198.57 4,189,855.56
 20
240
103,218.84
154,828.26
206,437.68
258,047.10
309,656.52
361,265.94
412,875.36
464,484.78
521,255.14
567,703.62
619,313.04
670,922.46
722,531.87
774,141.29
825,750.71
877,360.13
928,969.55
980,578.97
1,032,188.39
1,083,797.81
1,135,407.23
1,187,016.65
1,238,626.07
1,290,235.49
1,341,844.91
1,393,454.33
1,445,063.75
1,496,673.17
1,548,282.59
1,599,892.01
1,651,501.43
1,703,110.85
1,754,720.27
1,806,329.69
1,857,939.11
1,909,548.53
1,961,157.95
2,012,767.37
2,064,376.78
2,115,986.20
2,167,595.62
2,219,205.04
2,270,814.46
2,322,423.88
2,374,033.30
2,425,642.72
2,477,252.14
2,528,861.56
2,580,470.98
4,128,753.57