Formulir Pengkinian Data Nasabah

(Customer Data Update Form)

I. Data Profil Nasabah

(Customer Profile Data)
Nama lengkap Alamat (sesuai identitas) :
: (Full name) (ID Card Address)
Tempat & Tgl. Lahir : Alamat (korespondensi) :
(Place & Date of Birth) (Current Address)
No. KTP/Paspor No. Telepon :
(Mobile Phone Number)
: (ID/Passport number) Email :
NPWP (E-mail)
: Nama Gadis Ibu Kandung :
(Tax Identity Payer Number) (Mother’s Maiden Name)
Status Perkawinan :
(Marriage Status)
Nama Pasangan :
(Spouse’s Name)

II. Data Pekerjaan

(Employment Data)

Pekerjaan : Jabatan :
(Occupation) (Position)
Nama Perusahaan : Sumber Dana :
(Company’s Name) (Source of Funds)
Alamat Perusahaan : Total Pendapatan
(Company’s Address)
No. Telepon Perusahaan: : (Total Income)
(Company’s Phone Number) Kekayaan Bersih
Wajib diisi bila sumber dana dari pasangan atau dari orang tua. : (Net Worth)
(Required if the source of funds is from spouse or parents)
Nama Lengkap :
(Full Name)
Tempat & Tgl. Lahir :
(Place & Date of Birth) No. KTP/Paspor :
Pekerjaan : (ID/Passport number)
(Occupation)
: NPWP :
Nama Perusahaan
(Tax Identity Payer Number)
(Company’s Name)
Jabatan :
Alamat Perusahaan : (Position)
(Company’s Address)
: Total Pendapatan :
No. Telepon Kantor
(Total Income)
(Company’s Phone Number)
Kekayaan Bersih :
(Net Worth)

III. Referensi Bank

(Bank Reference)

No. Rekening :
(Account Number)
Pemilik Rekening

: (Account Owner’s Name)

Nama Bank

:
(Bank Name)

Tanggal :
(Date)

Tandatangan :
(Signature)

Nama :
(Name)

Nasabah wajib melampirkan:

(Customer required to attach):
 Foto copy e-KTP.
(Copy of ID Card)
 Foto copy NPWP.
(Copy of Tax Identity Payer Number)
 Foto selfie Nasabah sambil memegang e-KTP.
(Cutomer’s portrait selfie while holding ID Card)
 Halaman depan buku tabungan (jika ada perubahan pada referensi bank).
(The front page of the passbook (if there is a change in the bank reference))
FM/IAD/CR/09/20/002-02