COMPANY HEAD LETTER

From :
Company name :
Complete address with postal code :

To :
PT. Johnson Controls Hitachi Air Conditioning Indonesia
Intiland Tower, 11th Floor, Jl. Jend. Sudirman Kav. 32 Karet Tengsin, Tanah Abang
Jakarta 10220

ACCOUNT STATEMENT LETTER

Bank Name :
Bank Branch Name :
Bank Address : (complete with postal code)
Beneficiary Name :
Bank Account Number :
Currency :
Swift Code :
Bank Key : (kode bank + kode cabang bank).
Term of Payment : 90 NPR (Next Payment Run),
Reason for Payment Deviation :
Person in Charge :
Phone Number :
Email Address :

I certify that the information above is true and correct and that I, as the authorized representative for
the above named company, hereby authorize PT. Johnson Controls Hitachi Air Conditioning Indonesia
’ Account Payable Department to electronically deposit into the designated bank account as stated
above.

This authorization shall remain in full force until PT. Johnson Controls Hitachi Air Conditioning Indonesia
’ Account Payable Department receive written and authorized notification from my company requesting
a change or cancellation.
Signature : (complete with company stamp)

Full Name :
Title : (minimal Finance Manager)
Place and Date :