FORMULIR PEMBUKAAN REKENING
ACCOUNT OPENING FORM
PT
BOWSPRIT
ASSET MANAGEMENT
NAMA NASABAH : _____________________________________
Client Name
KODE NASABAH : _____________________________________
Client Code
NO. CIF
: _____________________________________
CIF Number
PT
BOWSPRIT
ASSET MANAGEMENT
Berita Satu Plaza, Lantai 6
Telp. : +6221 52900360
Jl. Jend. Gatot Subroto Kav. 35-36
Fax. : +6221 52900361
Jakarta Selatan 12950
Email :
[email protected]
PT BOWSPRIT
ASSET MANAGEMENT
S Sebelum mengisi, harap membaca Prospektus dan catatan di halaman berikutnya. Gunakan huruf cetak/ketik dan beri tanda (X) sesuai pilihan anda.
Please read the Prospectus and information provided in the next page. Use block letters and put on (X) on your selection.
KHUSUS PERUSAHAAN
FOR CORPORATIONS
D
DATA PERUSAHAAN /COMPANY DATA
Nama Perusahaan : ________________________________________________________________________________________________________________________________________________________
Company name
Alamat Perusahaan : ________________________________________________________________________________________________________________________________________________________
Company Address
_______________________________________________________________________________________________________________________ Kode Pos/Postal Code : _____________ Alamat Korespondensi : _________________________________________________________________________________________________________________________________________________________
Correspondence Address
_______________________________________________________________________________________________________________________ Kode Pos/Postal Code : _____________ Jenis Perusahaan : □ Dana Pensiun/Pension Funds □ Yayasan/Foundation □ Asuransi/Insurance □ Lembaga Keuangan/Financial Institutions □ Bank/Bank □ Lainnya/Others__________________
Company Type
Status Perusahaan : □ Swasta/Private □ BUMN/State-owned companies □ Sosial/Social □ Joint Venture □ PMA/Foreign Investments □ Lainnya/Others _________________
Company Status
Tempat/Tanggal Didirikan : ___________________________________________________________________________________________________________ No. Telp. : __________________________________
Location/Incorporation Date Phone No.
No. NPWP Perusahaan : ___________________________________________________________________________________________________________ No. Faks. : _________________________________
Tax ID Number Fax No.
No. Akte Pendirian : ___________________________________________________________________________________________________________ No. Telex : __________________________________
Incorporation deed No. Telex No.
Dikeluarkan Tanggal : ___________________________________________________________________________________________________________ Email : __________________________________
Date E-mail
PIHAK YANG BERWENANG / AUTHORITIES
Nama/Name : _________________________________________________________________ Jabatan/Position : _________________________________________________________________
Nama/Name : _______________________________________________________________________ Jabatan/Position : ______________________________________________________________________ Alamat/Address : _________________________________________________________________ Alamat/Address : _______________________________________________________________________ No. Telp./Phone No. : ____________________________________________________________ No. Telp./Phone No. : ________________________________________________________________ Jenis Indentitas : □ KTP/ID Card □ Paspor/Passport □ Lainnya/Others ________________
Identity Type
Jenis Indentitas : □ KTP/ID Card □ Paspor/Passport □ Lainnya/Others ______________________
Identity Type
No. Identitas/Identity No. : __________________________________________________________ No. Identitas/Identity No. : _______________________________________________________________
Nama/Name : _________________________________________________________________ Jabatan/Position : _________________________________________________________________
Nama/Name : _______________________________________________________________________ Jabatan/Position : _______________________________________________________________________ Alamat/Address : _________________________________________________________________ Alamat/Address : ________________________________________________________________________ No. Telp./Phone No. : ____________________________________________________________ No. Telp./Phone No. : ___________________________________________________________________ Jenis Indentitas : □ KTP/ID Card □ Paspor/Passport □ Lainnya/Others ________________
Identity Type
Jenis Indentitas : □ KTP/ID Card □ Paspor/Passport □ Lainnya/Others ______________________
Identity Type
No. Identitas/Identity No. : _________________________________________________________ No. Identitas/Identity No. : ________________________________________________________________
DATA KEUANGAN / FINANCIAL INFORMATION
Tujuan Investasi : □ Apresiasi Harga/Price Appreciation □ Investasi/Investment □ Spekulasi/Speculation □ Pendapatan/Income □ Lainnya/Others ___________________________________
Investment Objective
Sumber Dana : □ Laba Usaha/Business Profit □ Pendapatan/Income □ Hasil Investasi/Investment Income □ Hibah/Grant □ Lainnya/Others ___________________________________
Source of Fund
Total Pendapatan/Tahun : _________________________________________________________________________________________________________________________________________________________
Total Revenue/Year
Total Aset/Total Asset : ________________________________________________________________________________________________________________________________________________________ Total Ekuitas/Total Equity : ________________________________________________________________________________________________________________________________________________________
PIHAK YANG BISA DIHUBUNGI / CONTACT PERSON
Nama/Name : _________________________________________________________________ Nama/Name : _______________________________________________________________________ Alamat/Address : _________________________________________________________________ Alamat/Address : _______________________________________________________________________ No. Telp./Phone No. : ____________________________________________________________ No. Telp./Phone No. : ___________________________________________________________________ Jenis Indentitas : □ KTP/ID Card □ Paspor/Passport □ Lainnya/Others _______________
Identity Type
Jenis Indentitas : □ KTP/ID Card □ Paspor/Passport □ Lainnya/Others _______________________
Identity Type
No. Identitas/Identity No. : _________________________________________________________ No. Identitas/Identity No. : ________________________________________________________________ Dengan ini saya/kami menyatakan bahwa semua informasi/data yang diberikan adalah benar.
I/We herewith state that all information that I/We have given in this Account Opening Form is correct.
_________________________________ , _____________________________________________ Tempat, Tanggal/Place, Date
_______________________________________________________________________________ Tanda Tangan dan Stempel Perusahaan/Signature & Company Stamp
DIISI OLEH PETUGAS/FILLED IN BY OFFICERS
Pemasaran (Marketing) Fund Admin (Fund Admin) Direktur (Director) Tanda Tangan/Signature Nama/Name Tanggal/Date
PT BOWSPRIT
ASSET MANAGEMENT
PROFIL INVESTASI / INVESTMENT PROFILE
Tujuan investasi/Investment Objectives
① Likuiditas & keamanan investasi ② Pendapatan & perlindungan terhadap inflasi
Liquidity & investment security Income & protection against inflation
③ Pendapatan & pertumbuhan dalam jangka pendek ④ Pendapatan & pertumbuhan dalam jangka panjang Income & short time growth Income & long time growth
Tingkat risiko yang sanggup ditanggung/Acceptable level of risk
① Risiko rendah ② Risiko rendah-menengah
Low risk Low-medium risk
③ Risiko menengah ④ Risiko tinggi Medium risk High risk
Jangka waktu investasi/Investment period
① < 1 tahun ② 1 - 3 tahun
< 1 year 1 – 3 year
③ 3 - 5 tahun ④ > 5 tahun
3 – 5 year > 5 year
Apa yang anda lakukan jika investasi anda mengalami kerugian > 25% dari modal
What would you do if your investment value goes down > 25% from your initial investment
① Jual secepatnya untuk mencegah kerugian lebih jauh ② Tahan dulu & menjualnya ketika kembali modal Sell as soon as possible to prevent further loss Hold it & Sell it when break even
③ Bertahan dengan investasi ini untuk jangka panjang ④ Beli lebih banyak lagi agar menurunkan harga rata-rata pembelian
Hold it for long-term Buy more in order to lower the average purchase price
Jumlah investasi yang ditanamkan dalam instrumen pasar modal dari total asset
Amount of total asset invested in capital market instrument
① < 5% ② 5% - 10% ③ 10% - 20% ④ > 20%
Pengetahuan mengenai instrumen pasar modal
Knowledge of capital market instruments
① Terbatas/Limited ② Cukup/Middle ③ Mampu/Capable ④ Ahli/Expert Total poin
Total point
6 - 12 13 - 18 19 - 24 Profil risiko investasi
Investment risk profile
Konservatif Conservative Moderat Moderate Agresif Aggressive
Dengan ini saya/kami menyatakan bahwa semua informasi/data yang diberikan adalah benar adanya sesuai dengan profil investasi saya/kami. Dalam hal di kemudian hari saya/kami memilih instrumen investasi berbeda dengan profil risiko investasi sebagaimana disebut diatas, saya/kami bertanggung jawab penuh dengan pilihan investasi saya/kami.
I/we herewith declare that all the information/data provided are true according to my/our investment profile. In the case I/we choose different investment instruments with the aforementioned investment risk profile, I/we take full responsibility with my/our investment option.
_______________________ , _________________________________ Tempat, Tanggal/Place, Date
_________________________________________________________ Tanda Tangan dan Stempel Perusahaan/Signature & Company Stamp
DIISI OLEH PETUGAS/FILLED IN BY OFFICERS
Marketing (Marketing) Fund Admin (Fund Admin) Direktur (Director) Tanda Tangan/Signature Nama/Name Tanggal/Date
.
PENTING / IMPORTANT
Harap dibaca sebelum mengisi Formulir Pembukaan Rekening
Please read before filling the Account Opening Form
Saya/kami telah menerima, membaca dan menyetujui syarat-syarat dalam Prospektus Reksa Dana kelolaan PT Bowsprit Asset Management (“Manager Investasi”) yang akan saya/kami investasikan. Saya/kami memiliki wewenang dan kemampuan hukum untuk membeli Unit Penyertaan Reksa Dana, memiliki cukup umur dan yakin bahwa setiap investasi yang saya/kami lakukan sesuai dengan kebutuhan investasi saya/kami. Adalah kewajiban saya/kami untuk membaca setiap Prospektus dari Reksa Dana kelolaan Manajer Investasi yang akan saya/kami akan investasikan atau pertukarkan unitnya.
I/we have received , read and agree to the terms and conditions as stated in the Mutual Funds Prospectus managed by PT Bowsprit Asset Management (“The Investment Manager”) where I/we invest . I/we have the authority and legal capacity to purchase Units of the Fund, has sufficient age and believe that every investment that I/we have are in accordance with my/our investment needs. It is my/our duty to read each prospectus of the Mutual Funds managed by the Investment Manager where I/We will invest or redeem the units.
Unit Penyertaan Reksa Dana ditawarkan dan dijual berdasarkan Prospektus, Informasi tertulis lainnya yang dikeluarkan oleh Manajer Investasi serta Kontrak Investasi Kolektif Reksa Dana antara Manajer Investasi dan Bank Kustodian.
Mutual Funds Unit are offered and sold based on the prospectus , other written information issued by the Investment Manager a nd the Collective Investment Contract between Investment Manager and the Custodian Bank.
Unit Penyertaan dijual berdasarkan informasi yang tertera di Prospektus dan Informasi lainnya yang dikeluarkan oleh Manajer Investasi. Manajer Investasi tidak bertanggung jawab atas informasi dan representasi selain dari yang tercantum dalam Prospektus dan Informasi tertulis lainnya yang dikeluarkan oleh Manajer Investasi.
Units are sold based on the information contained in the Prospectus and other information issued by the Investment Manager. The Investment Manager is not responsible for the information and representations other than those contained in the Prospectus and other written information issued by the Investment Manager.
Manajer Investasi dapat menolak/menunda investasi nasabah apabila nasabah belum atau tidak dapat melengkapi formulir dan dokumentasi dan/atau sesuai dengan ketentuan prinsip mengenal nasabah.
Investment Manager may refuse / postpone customer’s investment if the customer can not or do not complete the forms and documentation and / or in accordance with the provisions of Know Your Customer principle.
Reksa Dana atau Manajer Investasi tidak bertanggung jawab atas setiap kerugian, gugatan, ongkos, atau biaya dalam menjalankan instruksi yang diberikan kepadanya oleh investor.
Mutual Funds or Investment Manager shall not be liable for any losses , claims , costs , or expenses in carrying out the instructions given by investors.
Setiap instruksi penarikan hanya dapat ditujukan ke rekening bank dengan nama pemilik yang sama dengan nama yang tercantum di formulir registrasi ini.
Every withdrawal instructions can only be made to the bank account under the same name with the name listed in this registration form.
Saya/kami memahami bahwa semua penjabaran wewenang dan pernyataan dalam formulir ini berlaku untuk setiap investasi yang saya /kami lakukan ke dalam Reksa Dana kelolaan Manajer Investasi sampai saya/kami memberitahukan Manajer Investasi atas setiap adanya perubahan secara tertulis.
I/we understand that all of the authority and statements in this form applies to any investment that I / we make to Mutual Funds managed by the Investment Manager until I/we notify the Investment Manager on any changes in writing.
Saya/kami setuju bahwa demi keamanan/proteksi, Manajer Investasi dapat meminta pernyataan tertulis dari saya/kami sebelum bertindak atas instruksi yang diberikan.
PT BOWSPRIT
ASSET MANAGEMENT
KARTU SPESIMEN / SPECIMEN CARD
NamaNasabah _________________________________________________________________ Client’s Name No. Telp. _________________________________________________ Phone No. No. Rekening Account No. __________________________________________________________________ __ No. HP/Faks. _________________________________________________ Mobile/Fax No. Nama Bank Bank Name
________________________________________________________________ Kepemilikan □ Sendiri □ Perusahaan
Ownership Personal Company
No. Rekening Bank
Account Bank No.
________________________________________________________________ Atas Nama
On behalf
________________________________________________________________ Syarat Tanda Tangan □ Satu □ Dua □ ____________________
Signature requirement One Two
Jenis Rekening
Account types
□ Tabungan □ Giro □ Lainnya__________________________________
Savings Giro Others
Tanda Tangan Signature _____________________________________________________ Tanda Tangan Signature _______________________________________________________ Nama Name Nama Name Tanda Tangan Signature _____________________________________________________ Tanda Tangan Signature _______________________________________________________ Nama Name Nama Name Stempel Perusahaan Company Stamp
PT BOWSPRIT
ASSET MANAGEMENT
KARTU SPESIMEN / SPECIMEN CARD
NamaNasabah _________________________________________________________________ Client’s Name No. Telp. _________________________________________________ Phone No. No. Rekening Account No. __________________________________________________________________ __ No. HP/Faks. _________________________________________________ Mobile/Fax No. Nama Bank Bank Name
________________________________________________________________ Kepemilikan □ Sendiri □ Perusahaan
Ownership Personal Company
No. Rekening Bank
Account Bank No.
________________________________________________________________ Atas Nama
On behalf
________________________________________________________________ Syarat Tanda Tangan □ Satu □ Dua □ ____________________
Signature requirement One Two
Jenis Rekening
Account types
□ Tabungan □ Giro □ Lainnya__________________________________
Savings Giro Others
Tanda Tangan Signature _____________________________________________________ Tanda Tangan Signature _______________________________________________________ Nama Name Nama Name Tanda Tangan Signature _____________________________________________________ Tanda Tangan Signature _______________________________________________________ Nama Name Nama Name Stempel Perusahaan Company Stamp
PT BOWSPRIT
ASSET MANAGEMENT
KELENGKAPAN DAN PENGEMBALIAN FORMULIR
COMPLETE AND RETURN FORM
Lengkapi Formulir Pembukaan Rekening Reksa Dana ini dengan :
Complete this Account Opening form along with
Jenis rekening /
Types of Accounts
Kelengkapan dokumen /
Document Needed
Perorangan / Individual Fotokopi KTP/identitas /Copy of ID Card/Identity Fotokopi NPWP / Copy of Tax ID Number Fotokopi bukti transfer / Copy of proof of transfer PT/ Company BUMN/ State-owned Companies Yayasan/ Foundation Dana Pensiun/ Pension Fund Koperasi/
Co-operative Kelengkapan dokumen / Document Needed
√ √ √
Fotokopi akta pendirian dan perubahan terakhir berikut persetujuannya
Copy of article of articulation and latest amendment and approval Ministry of Justice’s and Human Rights Republic Indonesia
√ √ √ Fotokopi akta Notaris perihal susunan BOD dan BOC terbaru Copy of notarial deed concerning the composition of the latest BOD and BOC
√
Fotokopi Akta Pendirian yg telah diumumkan dlm Berita Negara atau Tanda Daftar pada Kementrian Kehakiman (AD/ART+ perubahan terakhir)
Copy of Deed of Establishment which was published within the Official Gazette or Certificate of Registration of the Ministry of Justice ( AD / ART + last amendment )
√ √ Fotokopi SIUP & TDP Copy of trading business licences & IndonesianCompany Registration Certificate √ Fotokopi SK Meneg BUMN (Pengganti SIUP) Copy of State-owned Companies Minister SK (Substitute licences)
√ Fotokopi izin bidang kegiatan yayasan Copy license of foundation activities √ Gambaran kegiatan yayasan
Description of activity the foundation
√ Fotokopi Pengesahan Pendirian Dana Pensiun dari Menteri Keuangan RI
Copy of Establishment of Pension fund endorsed of The Minister of Finance
√ Buku peraturan Dana Pensiun Pension Fund regulation book √ √ √ √ √ Fotokopi surat keterangan domisili
Copy of legal domicile
√ √ √ √ √ Fotokopi NPWP Copy of Tax registration
√ √ √ √ √ Fotokopi laporan keuangan ( 3 tahun terakhir ) Copy of latest Financial Statement √ √ √ √ √ Fotokopi KTP/identitas Pengurus/Direksi Copy of ID Card/management/Board of Directors
√ √ √ √ √ Surat kuasa dari Pejabat yang ditunjuk (jika Authorized Signature diluar AD/ART)
Original Power of attorney of the authorized officials (if authorized signature beyond AD/ART)
√ √ √ √ √ Struktur kepemilikan dan manajemen terbaru
Ownership structure and latest management
√ √ √ √ √ Fotokopi bukti transfer
Copy of proof of transfer
Kembalikan formulir ini ke :
Return this form to
PT Bowsprit Asset Management
Berita Satu Plaza, Lantai 6 Jl. Jend. Gatot Subroto Kav. 35-36 Jakarta Selatan 12950 Indonesia
Telp. +6221 52900360 Fax. +6221 52900361
