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  • Cso-Formulir Penutupan Rekening-Rev 1.3

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    Leon Larahan
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    This document is an account closing form for PT. Cyberindo Aditama. It requests customer information like name, ID number, account number, and contact details. It asks for the effective closing date and reason for closing like relocation, changing providers, or dissatisfaction with services. The form notes that additional facilities will close when the main account closes and that customers must return any CBN devices. It states that the closing request must be received by the first of the month to avoid fees and that the customer takes full responsibility for the information provided and payment of outstanding balances.

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    cso-formulir_penutupan_rekening-rev_1.3 (1)

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    This document is an account closing form for PT. Cyberindo Aditama. It requests customer information like name, ID number, account number, and contact details. It asks for the effective closing date and reason for closing like relocation, changing providers, or dissatisfaction with services. The form notes that additional facilities will close when the main account closes and that customers must return any CBN devices. It states that the closing request must be received by the first of the month to avoid fees and that the customer takes full responsibility for the information provided and payment of outstanding balances.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    10 views1 page

    Cso-Formulir Penutupan Rekening-Rev 1.3

    Uploaded by

    Leon Larahan
    This document is an account closing form for PT. Cyberindo Aditama. It requests customer information like name, ID number, account number, and contact details. It asks for the effective closing date and reason for closing like relocation, changing providers, or dissatisfaction with services. The form notes that additional facilities will close when the main account closes and that customers must return any CBN devices. It states that the closing request must be received by the first of the month to avoid fees and that the customer takes full responsibility for the information provided and payment of outstanding balances.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    PT.

    Cyberindo Aditama
    Cyber 2 Tower, 33rd Floor
    FORMULIR PENUTUPAN REKENING Jl. HR Rasuna Said Blok X5 No. 13
    Jakarta Selatan 12950
    ACCOUNT CLOSING FORM Phone : (62-21) 299 64 900, (62-21) 5799 4500
    Fax : (62-21) 574 2481
    Website: https://cbn.id

    DATA PELANGGAN - Customer Data

    No. Pelanggan - Customer ID :


    Nama pemilik rekening - Account holder :
    Tanggal lahir - Date of birth : Jenis Kelamin - Sex : Pria - Male Wanita - Female
    No. Iden!tas - Iden!ty No. (KTP/Passport/KMIS) :
    Nama perusahaan - Company name :

    Nomor NPWP - Tax registra!on number :


    Nomor untuk dihubungi - Contact number : Rumah - Residence : _______ - ______________ Handphone : _______ - ______________
    Kantor - Office : _______ - ______________ Fax : _______ - ______________
    E-mail :
    Jenis Layanan - Services type :
    Tanggal penutupan - Effec!ve closing date :
    Jenis - Type : Penutupan - Closing
    Penutupan sementara - Temporary Closing ( Maksimum 2 bulan - Maximum 2 months )

    Catatan - Note : Penutupan keanggotaan (sesuai data di atas) juga akan menyebabkan tertutupnya seluruh fasilitas tambahan. - All addi!onal facili!es will be closed if
    the main account (as men!oned above) was closed.

    Apakah Anda puas dengan pelayanan kami ? - Are you sa!sfied with our service ? : Ya - Yes Biasa saja - Neutral Tidak - No

    Alasan penutupan - Closing Reason :


    Pelayanan kurang - Not sa!sfied with our : Masalah koneksi - Connec!on issue

    Call Center Lambat - Slow / Insufficient Bandwidth


    Sales & Marke!ng Buruk - Bad / Unstable
    Technical Support Tidak dapat koneksi - Unable to connect
    Finance & Accoun!ng Masalah tagihan - Billing issue
    Kerusakan perangkat keras - Hardware Failure Masalah harga - Pricing issue
    Sudah !dak dipergunakan lagi - Internet connec!on no longer used / ac!ve
    Pindah ke - Reloca!on to
    Pindah Provider ke - Changing Provider to
    Alasan lain - Other reason :

    * Harap sertakan fotokopi KTP / Passport / KIMS - Please a%ach copy of ID / Passport / KIMS.
    * Harap konfirmasi ulang ke nomor 500 780 setelah fax atau email formulir ini - Please reconfirm to 500 780 upon faxing or emailing this form.
    * Permintaan penutupan maksimal diterima sebelum tanggal 1 bulan berikutnya, apabila melewa! tanggal tersebut akan dikenakan biaya bulanan penuh -
    Closing request shall be received before the first date of the new month, failure to do so will be subjected to full monthly charge.
    * Pelanggan berkewajiban untuk mengembalikan perangkat CBN yang digunakan selama berlangganan - Customer is under obliga!on for returning CBN devices,
    which were used during subcrip!on period.

    Saya bertanggung jawab penuh atas segala informasi yang saya berikan dan berkewajiban untuk melunasi tagihan - I shall be responsible for any informa!on given
    herein dan I am obligated to pay my outstanding balance.

    Tanggal - Date

    Tanda tangan - Signature CA-JKT-CSO-FRM-1103045-1.3

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