Anda di halaman 1dari 1

PT.

BANK NEGARA INDONESIA (PERSERO) TBK


KANTOR KLN PULAU SAMBU

FORMULIR PENGADUAN NASABAH

Nama Petugas Layanan Nasabah :


Tanggal Terima :
Nomor Register :

DATA NASABAH
1. Nama Nasabah : MHD SAIFUL BACHRI
2. Nama Bank : BNI CAB. TEMBILAHAN
3. Nomor Rekening : 0696917252
4. Nomor Kartu : 5264 2204 5126 3283
5. Alamat : JL. SUDIRMAN COMP.PU, TEBING TINGGI
6. No. Telepon : 081373351093

PERMASALAHAN
1. Tgl. Transaksi : 12 JULI 2020
2. Lokasi Penarikan : ATM CENDANA – PT. THIP
3. Nominal Transaksi : Rp. 2.500.000,- (Dua Juta Lima Ratus Ribu Rupiah)
4. Keterangan
a. Uang tidak keluar Rekg. Terdebet : PENARIKAN TUNAI DI ATM, UANG TIDAK KELUAR TETAPI
SALDO TERDEBET
b. Possible Dump : ….................................................................................................
c. Rekening terdebet 2 X : ….................................................................................................
d. Tidak merasa mengambil : ….................................................................................................
….................................................................................................
….................................................................................................

Penyelesaian :
…............................................................................................................................................
…............................................................................................................................................
…............................................................................................................................................
…............................................................................................................................................

Sei Guntung, 8 Agustus 2020


Nasabah Penerima Selesai Mengetahui
Tgl. ….............. Tgl................. Tgl …..............

(MHD SAIFUL BACHRI) ( …............................) (…..............................) (….............................)


Nasabah Pelayanan Nasabah Settlement Pengelola

Anda mungkin juga menyukai