CHAIRUL AAN

Phone: +62811254555 / Email: aan@saka.id / lacruse74@gmail.com

CLIENT INFORMATION SHEET

All Questions must be completed in written English.

Individual owner information

Name CHAIRUL AAN
Address JL. JLAGRAN LOR NO.243 PRINGGOKUSUMAN
City, Country, Post (Zip) Code YOGYAKARTA, INDONESIA, 55272.
Date and Place of Birth 07 OCTOBER 1974
Passport Number and Country of Issue X1210369
Date of Issue of the Passport 15 JULY 2021
Expiry Date of the Passport 15 JULY 2026
Telephone Number +62274-562555
Cell phone +62811254555
E-mail Address aan@saka.id ; lacruse74@gmail.com
Skype N/A

Corporate Information // FOUNDATION

Full Name of Institution PT. INTERNUSA SEMESTA INVESTAMA
Registration Number 4022082234105594
Date of Registration 11 AUGUST 2022
Domicile / Jurisdiction INDONESIA
Postal Address 55581
JL. PALAGAN TENTARA PELAJAR KM.8 SARIHARJO NGAGLIK
Registration Address
SLEMAN DI YOGYAKARTA
Physical Address (if different from JL. PALAGAN TENTARA PELAJAR KM.8 SARIHARJO NGAGLIK
Registration Address) SLEMAN DI YOGYAKARTA
Business Telephone Number +62274-562555
Business Facsimile Number +62274-562555
E-mail Address internusainvestama@gmail.com
Website www.saka.id
Corporate Officers and Titles President & CEO

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 CHAIRUL AAN
Phone: +62811254555 / Email: aan@saka.id / lacruse74@gmail.com

Languages English but have translators for 120 Languages

Do you speak English? Yes

If NO, what language/s do you speak?
Translator’s Name
Translator’s Address
Translator’s Phone Number/s
Translator’s Facsimile Number
Translator’s E-mail Address
Translator’s Skype Address

Legal Advisor
Legal Advisor Name MASRI ALANWARI
Legal Advisor Address JL.TERNATE NO.12 B/C CIDENG GAMBIR JAKARTA PUSAT
Legal Advisor Phone Number/s 081221997549
Legal Advisor Facsimile Number N/A
Leal Advisor Email Address fellaslawyer@gmail.com
Legal Advisor Skype Address N/A

Details of Bank Account to receive Federal Wire/Deposit payment for herein stated (If more than one bank account,
please insert additional lines or add an additional page with bank details) - OR - In case of system related
payments, please assist in opening system accounts.
Bank Name MANDIRI BANK
Bank Address JL. JENDRAL SUDIRMAN NO.26 YOGYAKARTA
Bank Swift Code BMRiiDJA
Account Name PT. INTERNUSA SEMESTA INVESTAMA
Account Number 1370033457777
Account Signatory Name and Title
Bank Officer Name and Title Mrs. Kirana

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 CHAIRUL AAN
Phone: +62811254555 / Email: aan@saka.id / lacruse74@gmail.com

Bank Officer Phone Number +62274-552140

Bank Officer Facsimile Number +62274-552143
Bank Officer E-Mail Address kirana16@gmail.com

Details of Bank Account to receive Federal Wire/Deposit payment for herein stated (If more than one bank account,
please insert additional lines or add an additional page with bank details) - OR - In case of system related
payments, please assist in opening system accounts.
Bank Name BANK CENTRAL ASIA.
Bank Address JL.JENDRAL SUDIRMAN NO.49-51 YOGYAKARTA
Bank Swift Code CENAIDJA
Account Name PT. INTERNUSA SEMESTA INVESTAMA
Account Number 1267114455
Account Signatory Name and Title
Bank Officer Name and Title MRS NURI
Bank Officer Phone Number +62 8122960086
Bank Officer Facsimile Number
Bank Officer E-Mail Address

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