Pr. cyberinde Aditama @ a B N FORMULIR PENUTUPAN REKENING aac areotamoaes: ACCOUNT CLOSING FORM No. Pelanggan Customer 10 Nama pemiieetering-Acountholer = “Tange lair - Date of birth SI 7O3/ 1985 tenis kelamin-sex GZ Pria- Mute [] Wanite-Femole No. Kents - entity, (ETH/essport/KMs) 810 39 S00: Name peruse - Company ame & s Oberoi) PT Devs Exmechina \ndonesia Nomor NPWP- Tax registration number 31, lex. S60 .2— 906 .cOO ‘Nomer untuk ciubungi~ Contact number Rumah-Residence ;__ Handphone :__- 081090021 869) Kantor opfce Bet 08 ZIECIS rx ieee Email {eSopport @cleve co. et Jenis Layanan-Senices type CEN Fiver Bronze Tanezal penutupan fective closing date 2B O27 22D Jenis- Te Penutupan- Closing [C1 Penitupan sementara- Temporer Closing (Malsimum 2bulan- Maximum 2 months) Cetatan- Note: Penutupan heanggotsen{sesuai cata di ata juga akan menyababian tertutupnya seluru fasts tambahan-Alladtiona faites wil be closed if the main acount (as mentioned ebove) wos closed. ‘Apatah Anda puas dengan pelayanan kami ?-Ae you satisfied with ourservce ? : J Ya-Yes Dy Bisa saja -Weutra) =) THdak-wo Alasan penutupan = Closing Reason Gr Petayanan trang Wot sotsed with our: 1 Messiah koneksi- Connection issue G cattcenter tampa sow /insufcent Bandwidth DD sates marketing 1 suuk- Bad / Unstable 1D Techical support [Tidak dapat toneks- Unable to connect 1D rinance a Accounting [1 Mesotah agian Bing issue Gr Kerusntan perangkat eras -Hordware allure ( Macalan hares Pring sve Pinan ke etocaion to Linda Provider ke - changing Provider to [D Asean ain other reason lok Harap sertakan ftokopl KTP / Passport / KIM - Please attach copy of 1D/ Pasport /KIMS. arab tenemos long ke nonor £00 700 seela fa ateu emai formulin=Plese reconfirm t 500 780 upon foxing or emaling this form. Petchneaon penutupon mslsimal term sebelum tango] bun berkstva, apablamelewatltanggaltetsebut alan dikenakenbiayabu'anan penuh Coning request shal be received before te fst date ofthe new month, fale todo so wl be subjected to fullmorth charge. Fence berkewalben unisk mengemblicanperanghat CEN yang digunakan selama berlangganan Customer is unde obligation for returning CBN devices, ‘ahh were used during subeription period saya bertanggung jawab penuh atas segaa informs! yang soya berkan da berkewaliban untuk melunas!taghhan-sholbe responsible fr any information given herein dan lam obligated fo poy my oustanding boance. tangest-dote 29 ZO2/ 2022 Ais WW 1 Wayan Svardils