SOURCE OF WEALTH DECLARATION

THE PURPOSE OF OPENING ACCOUNT

Hedging Speculation Short Time Investment Long Time Investment

Price Appreciation Others, mention _________________________

Crypto Asset Trading Transaction Experience

Yes, mention _______________________ No

Have you been declared bankrupt by the court?

Yes, mention _______________________ No

SOURCE OF FUNDS

Occupation Entrepreneur Karyawan Swasta Pegawai Negeri Sipil

Professional/Consultant BUMN employee Student

House wife Others, mention: ____________
Company name ______________________________________________________________

Business fields ______________________________________________________________

Position ______________________________________________________________

Length of work ____ Years In the previous office _____ Years

Office Address ______________________________________________________________

Incomer per year IDR 100 – 250 Million IDR 250 -500Million

IDR 500 juta – 1 Billion Above IDR 1 Milyar

Wealth list House worth ________________

Savings worth _______________

Crypto Asset worth _____________

PT. Aset Digital Berkat

Prudential Centre, Jl. Casablanka Raya kav 88, Lantai 21 unit A
Menteng Dalam, Tebet, Jakarta Selatan 12870
+6221 30629429
Customer's bank account for depositing and withdrawing crypto assets trading results

Bank name ______________________________________________________

Customer Name in bank account ______________________________________________________

Branch ______________________________________________________

Bank account number ______________________________________________________

Bank account type Saving Current account Others ____________

STATEMENT OF TRUTH AND LIABILITY

By filling in the “YES” column below, I certify that all information and all documents that I
attach in the CUSTOMER PROPERTY DECLARATION FORM are true and correct, I will be
fully responsible if in the future something happens in connection with the untruth of the
data I provide

Acceptance statement Yes No

____________, / /

Sign

Customer Name :

PT. Aset Digital Berkat

Prudential Centre, Jl. Casablanka Raya kav 88, Lantai 21 unit A
Menteng Dalam, Tebet, Jakarta Selatan 12870
+6221 30629429