Company Account Opening Documentation Checklist

(Daftar Dokumentasi Pembukaan Rekening Perusahaan)

Application Date :
Tanggal Pendaftaran
Applicant’s Name :
Nama Pemohon

NO FORMS AND DOCUMENTATIONS (FORM DAN DOKUMEN)

1 Account Opening Application Form (Formulir Pembukaan Rekening)

2 ID Card/Passport (KTP/Paspor)

3 Family Card (Kartu Keluarga)

4 Consent for Credit and Background Check (Persetujuan untuk Pemeriksaan

Kredit dan Latar Belakang)

Additional for Company

5 Particulars of Company Account (Rincian Rekening Perusahaan)

6 Memorandum and Articles of Association, Business Licence, Capital Verification

Report, Institutional Credit Code Certificate, Account Opening Permit, Change of
company name notice, Return of allotment of share, Notice of situation of
registered office, Latest annual return, and register of director, manager,
secretarial and change of particulars {please provide certified true copy},
Ownership structure diagram signed by an incumbent director to confirm its
authenticity. (Memorandum dan Anggaran Dasar, Izin Usaha, Laporan Verifikasi
Modal, Sertifikat Kode Kredit Kelembagaan, Izin Pembukaan Rekening,
Pemberitahuan perubahan nama perusahaan, Pengembalian penjatahan saham,
Pemberitahuan situasi kantor terdaftar, Pengembalian tahunan terakhir, dan
daftar direktur, manajer, sekretaris, dan perubahan data {harap berikan salinan
asli yang sah}, Diagram struktur kepemilikan ditandatangani oleh direktur yang
sedang menjabat untuk memastikan keasliannya.)
 Account Opening Application Form

Account Purpose Trade Settlement (Penyelesaian Perdagangan)

Tujuan Rekening Investment (Investasi)
Digital Currencies (Mata Uang Digital)
Custodian (Kustodian)
Operations (Operasional)
Others _____________________________

Account Currency US Dollar (USD)

Mata Uang Rekening
Offshore Renminbi (CNH)
Singapore Dollar (SGD)
Hongkong Dollar (HKD)
Malaysia Ringgit (MYR)
USDT
USDC
Others _____________________________

Company Type Private Limited Company (Perseroan Terbatas Swasta)

Tipe Perusahaan Limited Liability Partnership (Kemitraan Perseroan
Terbatas)
Limited Company (Perseroan Terbatas)
Incorporate (Badan Hukum)
Others _____________________________

Applicant’s Particular Company’s Name (Nama Perseroan)

Untuk Pemohon

Business Registration Address (Alamat Pendaftaran Usaha)

Place of Registration (Lokasi Pendaftaran Usaha)

Company’s Address (Alamat Perseroan)

Business Telephone Number Business Facsimile Number

(Nomor Telepon Bisnis) (Nomor Faksimile Bisnis)

Company Email Company Website

(Email Perseroan) (Situs Web Perseroan)

Transaction Date Ever Coin Amount

(Tanggal Transaksi) (Jumlah Koin Ever)
 Value in US Dollar Value in Indonesian Rupiah
(Nilai dalam Dolar) (Nilai dalam Rupiah)

Applicant’s Identity (Identitas Pemohon)

Name (Nama) Mobile Number (No. HP)

Designation (Jabatan) Email (Email)

ID Card/Passport Number Address (Alamat)

(Nomor KTP/Paspor)

Applicant’s Signature
Tanda Tangan Pemohon

Signature: _______________________
Name (Nama):
ID/Passport Number (Nomor KTP/Paspor):