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  • Formulir Kartu ATM Layanan Elektronik

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    Yesika Parapat
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    This document is an ATM card and electronic services application form. It collects basic information such as name, ID number, date of birth, phone numbers, and address from an individual or corporate applicant. The form requests the type of ATM card services needed, such as a new card, replacement card, card activation, or card closure. It also allows the applicant to request electronic banking services like internet banking, mobile banking, and corporate banking. For corporate banking, it collects approval authorization limits and linked bank account numbers. The applicant and bank officers must sign and date the completed form to finalize the requests.

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    This document is an ATM card and electronic services application form. It collects basic information such as name, ID number, date of birth, phone numbers, and address from an individual or corporate applicant. The form requests the type of ATM card services needed, such as a new card, replacement card, card activation, or card closure. It also allows the applicant to request electronic banking services like internet banking, mobile banking, and corporate banking. For corporate banking, it collects approval authorization limits and linked bank account numbers. The applicant and bank officers must sign and date the completed form to finalize the requests.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    Download as pdf or txt
    13 views1 page

    Formulir Kartu ATM Layanan Elektronik

    Uploaded by

    Yesika Parapat
    This document is an ATM card and electronic services application form. It collects basic information such as name, ID number, date of birth, phone numbers, and address from an individual or corporate applicant. The form requests the type of ATM card services needed, such as a new card, replacement card, card activation, or card closure. It also allows the applicant to request electronic banking services like internet banking, mobile banking, and corporate banking. For corporate banking, it collects approval authorization limits and linked bank account numbers. The applicant and bank officers must sign and date the completed form to finalize the requests.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 1

    FORMULIR KARTU ATM DAN LAYANAN ELEKTRONIK

    ATM CARD AND ELECTRONIC SERVICES FORM


    Tanggal : Unit/Cabang penerima :
    Date Branch

    INFORMASI DASAR/ BASIC INFORMATION


    PERORANGAN/ Individual
    Nama Nasabah : No. CIF :
    Name CIF No
    Nomor Identitas : No Rekening :
    Identity Number Account Number
    :
    Tanggal Lahir Nama Gadis Ibu Kandung :
    Birth of Date Mother's Maiden Name
    :
    Nomor Telepon Selular Email :
    Mobile Phone Number : Email
    Nomor Telepon Rumah/Kantor
    Home/Office Phone Number : Copy KTP/SIM/KITAS/PASSPORT Surat Kepolisian/ Police letter

    Dokumen Pendukung Kartu ATM/Debit/ ATM/Debit Card Lainnya/ Others :


    Supporting Document

    BADAN USAHA/ Corporate


    Nama Perusahaan : No. CIF :
    Company Name CIF No.
    Nomor Tanda daftar Perusahaan : Nomor Telepon Kantor :
    Company Sign Number Office Phone Number
    Nama PIC : Nomor Telepon Selular PIC :
    PIC Name PIC Mobile Phone Number

    LAYANAN KARTU ATM / ATM CARD SERVICES


    PERMOHONAN KARTU ATM/DEBIT/ Request of ATM/Debit Card
    Kartu Baru/ New Card
    Kartu Pengganti dengan Alasan : Hilang/ Lost Tertelan/ Swallowed
    Substitute Cards with Reason
    Rusak/ Broken Lainnya/ Others :

    Lupa Pin/ Forget the PIN


    No. Kartu ATM/Debit yang lama :
    Old ATM/Debit Card No

    PEMELIHARAAN KARTU ATM/DEBIT/ Maintenance of ATM/Debit Card


    Pengaktifan Kartu ATM/Debit (Lepas Blokir)/Salah PIN 3 kali/ ATM/Debit Card Activation (Unblock) PIN 3 times
    No. Kartu ATM/ Debit (ATM/ Debit Card No.) :
    Blokir Kartu ATM/Debit (Blocked ATM/Debit Card)
    :
    Alasan/ Reason
    No. Kartu ATM/Debit (ATM/Debit Card No.) :

    PENUTUPAN KARTU ATM/DEBIT (Closed ATM/Debit Card)


    No. Kartu ATM/Debit (ATM/Debit Card No.) :
    Alasan/ Reason : Tertelan/ Swallowed
    Lainnya/ Others :

    LAYANAN ELEKTRONIK / ELECTRONIC SERVICES


    Jenis Aplikasi : Pendaftaran Baru/ Registration Perubahan/ Modify Penutupan / Close
    Application Type
    Faisilitas yang diinginkan : OK! Personal Banking OK! Mobile Banking OK! Corporate Banking
    Facilitied
    Metode Kode Penerimaan Tanggapan : Soft Token (Android, Iphone Only) OTP (for OK! Corporate Banking)
    Method of Receiving Response Code

    INFORMASI ADMINISTRASI / Administration Information (Only for OK! Corporate Banking)


    1 Informasi Persetujuan : 1 (satu) Persetujuan / 1 (one) Approval 2 (dua) Persetujuan/ 2 (two) Approval
    Approval Information
    Nama User ID Jabatan Batas Transfer Satu Kali Batas Transfer Harian Otoritas Dari/ Authority Of
    Name User ID Position One Time Transfer Limit Daily Transfer Limit
    IDR (Juta Rupiah) IDR (Juta Rupiah) Operating Approval Admin

    2 Informasi Rekening : Rekening Dibawah saja / Only Account Below Semua Rekening / All Account No.

    1.
    2.
    3.
    4.
    5.

    PENUTUPAN LAYANAN ELEKTRONIK / Closed Electronic Services


    Alasan Penutupan Fasilitas :
    Reason of Closing Facility

    Nasabah/ Customer CAP PERUSAHAAN/ Company Stamp PETUGAS BANK/ Officer MANAGER OPERATION/ BM

    (Tanda Tangan dan Nama Jelas) *Hanya untuk OK! Corporate Banking (Paraf & Nama Jelas) (Paraf & Nama Jelas)
    (Signature and Name) OK! Corporate Banking Only (Initial & Name) (Initial & Name)

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