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    Pt. Sri Ratu Indonesia: Client Information Sheet - Cis

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    2km present
    This document provides customer information for PT. SRI RATU INDONESIA including details about the company representative Sri Sutarti such as her nationality, passport information, date of birth, address, and contact information. It also lists the company's bank coordinate details including the bank name, account numbers, signatory, and bank officer contact. Sri Sutarti affirms that the information provided is true and accurate and that she has full authority and control over the assets and bank account.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    Pt. Sri Ratu Indonesia: Client Information Sheet - Cis

    Uploaded by

    2km present
    190 views3 pages
    This document provides customer information for PT. SRI RATU INDONESIA including details about the company representative Sri Sutarti such as her nationality, passport information, date of birth, address, and contact information. It also lists the company's bank coordinate details including the bank name, account numbers, signatory, and bank officer contact. Sri Sutarti affirms that the information provided is true and accurate and that she has full authority and control over the assets and bank account.

    Original Title

    c i s - Pt. s r i. Bri

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    This document provides customer information for PT. SRI RATU INDONESIA including details about the company representative Sri Sutarti such as her nationality, passport information, date of birth, address, and contact information. It also lists the company's bank coordinate details including the bank name, account numbers, signatory, and bank officer contact. Sri Sutarti affirms that the information provided is true and accurate and that she has full authority and control over the assets and bank account.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    190 views3 pages

    Pt. Sri Ratu Indonesia: Client Information Sheet - Cis

    Uploaded by

    2km present
    This document provides customer information for PT. SRI RATU INDONESIA including details about the company representative Sri Sutarti such as her nationality, passport information, date of birth, address, and contact information. It also lists the company's bank coordinate details including the bank name, account numbers, signatory, and bank officer contact. Sri Sutarti affirms that the information provided is true and accurate and that she has full authority and control over the assets and bank account.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 3

    PT.

    SRI RATU INDONESIA


    Jalan Rawa Jati Timur X No. 1.RT/RW 002/006. Kalibata – Pancoran, 12750
    JAKARTA - INDONESIA

    CLIENT INFORMATION
    \ SHEET – CIS

    In accordance with Articles 2 through 5 of the Due Diligence Convention and the Federal
    Banking Commission Circular of December 1998, and under the US Patriot Act of 2002, as amended
    in February 2003 concerning the prevention of money laundering and 305 of the Swiss Criminal
    Code, the following information may be supplied to banks and/or other financial institutions for
    purposes of verification of identity and activities of the Client described below, and the nature
    and origin of the funds which are to be utilized. The foregoing is subject to agreement by all
    parties to whom this information is provided that they are obligated to respect the privacy
    rights of the Client and all individuals described herein, as well as the generally accepted
    professional standards relating to the maintenance of confidential information, and to take
    all appropriate precautions to protect the confidentiality of the information contained herein,
    This legal obligation shall remain in full force indefinitely without restriction.

    I hereby submit the following information for your consideration. I understand that this
    information will be relied upon, unconditionally, as statements by me of material fact.

    CUSTUMER INFORMATION SHEET ( CIS ) :

    No. INFORMATION QUIRY DETAIL

    1 PROFIL

    a). Represented By SRI SUTARTI

    b). Nationality INDONESIA

    c). Passport Number C0526714

    d). Date Of Issue May, 17th, 2018

    e). Date Of Expiration May, 17th, 2023

    f). Date Of Birth December, 12 th, 1967.

    g). Place Of Birth Bengkulu

    h). Identity Card No. (KTP) 1708045212670007

    i). Contact Address Jalan Rawa Jati Timur X No. 1.RT/RW 002/006. Kalibata –
    Pancoran, 12750

    j). Contact Telp No.


    k). Mobile Telp No. 081271847645

    l). Email sinarratuindonesia04@gmail.com

    m). Occupation Businessman

    n). Company Name PT. SINAR RATU INDONESIA

    o). Company Registration 8120010210743

    p). Office Address Jalan Rawa Jati Timur X No. 1.RT/RW 002/006. Kalibata –
    Pancoran, 12750
    q). Office Telp No

    r). Office Fax No.

    s). Email sinarratuindonesia04@gmail.com

    2. Address for Mail Jalan Rawa Jati Timur X No. 1.RT/RW 002/006. Kalibata –
    Pancoran, 12750

    3. Address for Courier Jalan Rawa Jati Timur X No. 1.RT/RW 002/006. Kalibata –
    Pancoran, 12750

    4. BANK COORDINATE

    a). BANK NAME BANK RAKYAT INDONESIA (PERSERO) TBK

    b). Branch and Address Kantor Cabang Kalibata Jl Raya Pasar Minggu No. 5 Jakarta
    Selatan

    c). Account Numbers 1732-01-000015-302 . IDR

    d). Account Name PT. SINAR RATU INDONESIA

    e). Account signatory SRI SUTARTI

    f). SWIFT Code BRINIDJA

    g). Bank Officer Name Mrs. Heni Nurtini

    h). Bank Telephone No. (021) 29317003

    i). Bank Officer Email heninurtini@corp.bri..co.id


    5. Affirmation

    I hereby swear under the full penalty of perjury, that the information provided herein is
    both true and accurate. I am in control of the assets stated bellow and have signatory
    authority on the aforementioned bank account and have full authority to execute all
    contracts and agreements relating to pleading the assets for a loan. The funds are in full
    compliance with the anti-money laundering policies set forth by Financial Action Task Force
    (FATF) 6/01.

    Signed, December 14th, 2020

    SIGNATORY

    Name : SRI SUTARTI


    Title : Commissioner
    Passport Number : C0526714
    Country of Issuance : Indonesia

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