KOP SURAT

CLIENT INFORMATION SHEET (CIS)

CLIENT INFORMATION
1 Client Name
2 Number NIK (KTP)
3 Date / Place of Birth
HOME INFORMATION
1 Street address
2 City/State/ZIP Code
3 Telephone Number
4 Email
BUSINESS INFORMATION
1 Name of Company
2 Business Address
3 Title/ Position
4 Telephone / Fax Number
5 Email Address
6 Type Of Business Conducted
7 Registered Office
8 Place Of Issue
9 Date Of Issue
10 Business Registration Number (NIB)
11 Tax Number
12 Legal Advisor Name
13 Street Address
BANK INFORMATION
1 Bank Name
2 Branch
3 Street Adress
4 City / State / Zip Code
5 Office Phone Number
6 S.W.I.F.T. Code
7 Bank Officer Name
8 Bank Officer Telephone
9 Bank Officer Email
10 Account Name
11 Account Number

Jakarta , ….. Oktober 2021

PT. ………………………………………

Stempel Basah

XXXXXXXXXXXXXXXXXXX
( Direktur )