Google Authenticator Reset Statement Letter

The undersigned below :

Full name : ……………………………........

Passport Number : …………………………………
Hereinafter referred to as "I",

That I have previously been registered as an Indodax Member / Verified Member with the
following information:

Username : ……………………………........
Registered account email : ……………………………........
Main mobile number : ……………………………........

That I can fulfill the data requested by Indodax regarding Indodax's actions to reset Google
Authenticator on my Indodax registered account, with details as follows:

Scan / Photo of Passport : attached

Selfie photo with Form and Passport : attached
(Will be sent together with this statement letter to indodax email address at
support@indodax.com as an inseparable unit)
Reason for Reset Google Authenticator : ...................................................................................
…………………………….…………...............................…………………………….…………...........
....................…………………………….…………...............................…………………………….…...

Hereby declaring my approval upon Indodax’s action to reset Google Authenticator on my

registered account in the Indodax mobile application and I’m willing to take full responsibility
for the instruction to reset Google Authenticator on my instructions, and release Indodax from
all forms of lawsuits, claims, or lawsuits if in the future There was a problem regarding the
Google Authenticator reset action by Indodax on my account.

Thus, this Statement Letter is made using my original identity and using my real signature,
based on good faith, without coercion / force from anyone and any party.

……………..,………………….
*Place, date of filling in the form

With respect,

Indonesia Stamp
IDR 10.000,00

(………………………………......)
*Account’s owner full name

(Note: Please complete with either handwriting or typing on the dots that we have provided)