Asst.

Mgr Manager CFO CEO

       
       
       
Cash Payment Account / Registration Stamp (replace) Report
(Rekening PembayaranTunai / Laporan Registrasi)

According to the payment agreement signed by your company and PT. Global Investment Institusi. Please transmit all of the
related payments to the account below.
(Berdasarkan pada perjanjian pembayaran yang ditandatangani oleh perusahaan anda dan PT. Global Investment Institusi. Mohon
kirimkan semua yang berhubungan dengan pembayaran ke rekening dibawah ini )

1. General Information (Informasi Umum)

Name of company Representative
(Nama Perusahaan) (Perwakilan Perusahaan)
Registration number Telephone
(NomorRegistrasi) (NomorTelepon)
Address
(Alamat)
E-mail address
(Alamat E-mail)

2. Cash Deposit Account Information (InformasiRekeningPembayaranTunai)

Name of Bank Account
(Nama Bank) Stamp
Account No. (Cap
(NomorRekening) Perusahaan
Account holder )
(NamaPemilikRekening)

3. Required Documents (Dokumen yang Diperlukan) :

1) Original Bank Reference (max 6 months ago) / Surat Referensi Bank ASLI (max 6 bulan lalu)
2) Copy of bank book (1 copy) (1 lembar copy buku bank)
3) Letter of attorney (If bank account holder is different from the company name)
(Surat pernyataan (Jika nama pemilik rekening bank berbeda dengan nama perusahaan)

Date (Tanggal): 24 November 2022

Report Janet Supit

Below is for PT. GII use only

For Business team For Finance team
Transaction code Registration
No.
S tam p

Name of Person in
business team charge
Person in charge Confirmation
Explanation