Company Letterhead

Statement Letter
No.

I, the undersigned below:

Name :
Position :
ID Number :
Company Name :
Address :

On behalf of our company your company name, would like to register our company e-mail
address using the public domain service: name@domain (such as @gmail.com, @yahoo.com,
@yahoo.co.id, @ymail.com, @hotmail.com, etc), that we use to communicate through
electronic mail (e-mail) – based communication tool between our company with APP.

I, hereby state that the e-mail address is our official company e-mail address, as we do not have
the company private domain service e-mail address yet.

If in the future, is cases of fraud may cause from using our company e-mail address or misuse(s)
may occurred from using our company e-mail address, I am willing to be processed according to
the law regulation applied in the Republic of Indonesia.

This statement letter I made without any coercion from any party.

City, DD/MM/YYYY

Company Stamp

Director's Name
Position:

Form-NVD-026 e-Mail General Account Overseas rev0