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
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 PERORANGAN
FOR INDIVIDUAL
DATA NASABAH / CLIENT DATA
Nama (sesuai KTP/Paspor) : ________________________________________________________________________________________________________________________________________________________
Name (as stated in ID/Passport)
Alamat (sesuai KTP/Paspor) : ________________________________________________________________________________________________________________________________________________________
Address (as stated in ID/Passport)
____________________________________________________________________________________________________ Kode Pos/Postal Code : ________________________________ Alamat (korespondensi) : ________________________________________________________________________________________________________________________________________________________
Correspondence Address
____________________________________________________________________________________________________ Kode Pos/Postal Code : ________________________________ No. NPWP : _________________________________________________________________________________________________________________________________________________________
Tax ID number
DATA PRIBADI / PERSONAL DATA
Jenis Identitas : □ KTP/ID Card □ Paspor/Passport □ Lainnya/Others ________________________________________________________
Identity Type
No. Identitas : ___________________________________________________________________________________ Tanggal Kadaluarsa/Expiry Date : _______________________________________
Identity Card Number
Tanggal Kadaluarsa/Expiry Date : _______________________________________________________________________________________________________________________________________________ Kewarganegaraan/Nationality : □ WNI/Indonesian □ WNA/Foreign Sebutkan (Please Mention) ______________________________________________________________________________________ Tempat/Tanggal Lahir : ___________________________________________________________________________________________________________________________________________________________
Place/Date of Birth
Jenis Kelamin/Sex : □ Laki-laki/Male □ Perempuan/Female
No. Telepon Rumah/Home Phone No. : _______________________________________________________________________________________ No. Faks/Fax No. : _______________________________________ Alamat Email/E-mail : ______________________________________________________________________________________________ Seluler/Mobile Phone No. : __________________________________ Agama/Religion : □ Islam/Moslem □ Katolik/Catholic □ Kristen/Christian □ Hindu/Hindu □ Buddha/Buddhist □ Lainnya/Others __________________________________ Pendidikan/Education : □ SD/Elementary School □ SMP/Junior High School □ SMU/Senior High School □ Akademi/Academic □ S1/Bachelor □ S2/Master Degree □ S3/Doctor Status Perkawinan : □ Belum Menikah/Single □ Menikah/Married □ Janda/Widow □ Duda/Widower
Marital Status
Jumlah Tanggungan : ________________________ Orang/People (anak + istri/children + wife) _________________________ Orang Lainnya/other people
Number of Dependents
Status Rumah/Status of Residence : □ Milik Sendiri/Self owned □ Sewa/Rent □ Milik Keluarga/Family owned □ Lainnya/Other, Please Mention ____________________________ Menempati sejak/Occupied since : _____________________________ Tahun/Year ____________________________ Bulan/Month
Nama Ibu Kandung : ___________________________________________________________________________________________________________________________________________________________
Mother’s Maiden Name
DATA PEKERJAAN / EMPLOYMENT STATUS
Pekerjaan/Occupation : □ Wiraswasta/Entrepreneur □ Profesional/Professional □ Karyawan Swasta/Employee □ PNS/Civil Servant □ BUMN/Employee in State owned companies □ TNI/POLRI/Military/Police □ Pengajar/Teacher □ Pelajar/Mahasiswa/Student □ Ibu Rumah Tangga/Housewife □ Lainnya/Others________________________ Nama Perusahaan : ___________________________________________________________________________________________________________________________________________________________
Name of Company
Alamat Perusahaan : ___________________________________________________________________________________________________________________________________________________________
Company Address
_________________________________________________________________________________________________________________ Kode Pos/Postal Code : ____________________
No. Telepon/Telephone Number : _______________________________________________________________________________ No. Faks/Fax Number : ________________________________________________ Jabatan/Position : __________________________________________________________________________________________ Lama Bekerja/Years in Working : _______________________ Tahun/Year Bidang Usaha/Nature of Business : _________________________________________________________________________________________________________________________________________________
DATA KEUANGAN / FINANCIAL INFORMATION
Tujuan Investasi : □ Apresiasi Harga/Price Appreciation □ Investasi/Investment □ Spekulasi/Speculation □ Pendapatan/Income □ Lainnya/Others __________________________________
Investment Objectives
Sumber Dana : □ Gaji □ Hasil Usaha □ Hasil Investasi □ Dari Orang Tua/Anak/Suami/Istri □ Warisan □ Hibah □ Undian □ Lainnya _____________________
Source of Fund Salary Business Profit Investment Income From Parents/children/Spouse Beneficiary Grant Lottery Others
Penghasilan /Tahun : □ < Rp 10 juta □ Rp 10 juta – Rp 50 juta □ Rp 50 juta – Rp 100 juta □ Rp 100 juta – Rp 500 juta □ Rp 500 juta – Rp 1 miliar □ > Rp 1 miliar
Annual Income < IDR 10 Million IDR 10 Million – IDR 50 Million IDR 50 Million – IDR 100 Million IDR 100 Million – IDR 500 Million IDR 500 Million – IDR 1 Billion > IDR 1 Billion
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 Nasabah/Signature
DIISI OLEH PETUGAS/FILLED IN BY OFFICERS
Marketing Fund Admin Direktur Tanda Tangan/Signature
Nama/Name Tanggal/Date
DATA AHLI WARIS / HEIRS DETAIL
Nama/Name : __________________________________________________________________ Nama/Name : __________________________________________________________________________ Alamat/Address : __________________________________________________________________
__________________________________________________________________
Alamat/Address : _________________________________________________________________________ _________________________________________________________________________ Jenis Identitas : □ KTP/ID Card □ Paspor/Passport
Iidentity type □ Lainnya/Others __________________________
Jenis Identitas : □ KTP/ID Card □ Paspor/Passport
Identity type □ Lainnya/Others ____________________________
No. Identitas : __________________________________________________________________
ID Card Number
No. Identitas : ________________________________________________________________________
ID Card Number
Hubungan dengan Pewaris : __________________________________________________________
Relationship
Hubungan dengan Pewaris : ________________________________________________________________
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 declare that all the information/data provided are true according to my investment profile/us . In the later case I/we choose different investment instruments with investment risk profile as mentioned above, I/we take full responsibility with my investment options/us.
__________________________ , ______________________________ Tempat, Tanggal/Place, Date
Tanda Tangan / Signature
DIISI OLEH PETUGAS/FILLED IN BY OFFICERS
Pemasaran (Marketing) Fund Admin (Fund Admin) Direktur (Director) Tanda Tangan/Signature Nama/Name Tanggal/Tanggal
.
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 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 PT Bowsprit Asset Management 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 Prospectus Mutual Funds managed by PT Bowsprit Asset Management where I / we invest . I / we have the authority and legal capacity to purchase Units of the Fund, has sufficient age life and believes that every inves tment that I / we do in accordance with my/our investment needs. It is my/our duty to read each prospectus of the Mutual Funds managed by PT Bowsprit Asset Management 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 PT Bowsprit Asset Management (“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 PT Bowsprit Asset Management ("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 withdrawals instruction 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 PT Bowsprit Asset Management 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 PT Bowsprit Asset Management 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
