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  • Jiwasraya: Surat Permintaan Asuransi Jiwa Kumpulan

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    Bang Day
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    This document is a request form for group life insurance from Jiwasraya by an individual acting on behalf of an organization. It requests basic identifying information about the organization such as name, address, license details, and relationship of those to be insured to the organization. The individual filling out the form is also requesting group life insurance coverage for employees, customers, or members of the organization.

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    form jiwasraya

    Original Title

    Form Jiwasraya2

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    This document is a request form for group life insurance from Jiwasraya by an individual acting on behalf of an organization. It requests basic identifying information about the organization such as name, address, license details, and relationship of those to be insured to the organization. The individual filling out the form is also requesting group life insurance coverage for employees, customers, or members of the organization.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    15 views6 pages

    Jiwasraya: Surat Permintaan Asuransi Jiwa Kumpulan

    Uploaded by

    Bang Day
    This document is a request form for group life insurance from Jiwasraya by an individual acting on behalf of an organization. It requests basic identifying information about the organization such as name, address, license details, and relationship of those to be insured to the organization. The individual filling out the form is also requesting group life insurance coverage for employees, customers, or members of the organization.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 6

    Jiwasraya

    r
    SURAT PERMINTAAN ASURANSI JIWA KUMPULAN

    Yang bertandatangan di bawah ini:


    yang bersangkutan
    a. Nama .

    gak tahu siapa


    b. Jabatan

    Selaku Calon Pemegang Polis

    123456
    Bertindak untuk dan atas nama

    asdasdsad

    asdasd
    Alamat/kedudukan

    Kotamadya/Kabupaten .

    Propinsi .

    Kode Pos .

    Tempat dan tanggal pendirian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · ·

    Nomor Telp/Fax :Telp Fax .

    Alamat e-mail

    Jenis Usaha/Kegiatan

    No. lzin Usaha/Kegiatan

    Tanggal Penerbitan lzin

    NomorNPWP

    Hubungan tertanggung dengan Galon Pemegang Polis (pilih salah satu) :

    1. Karyawan/ti

    2. Nasabah

    3. Anggota

    4 .

    SPAJK-00-03.17

    1
    Malang 15 Desember 17

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