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 Jl. Jend. Gatot Subroto Kav. 35-36 Jakarta Selatan 12950 Indonesia
Telp. : +6221 52900360 Fax. : +6221 52900361 Email :
[email protected] Website : www.bowsprit-am.com
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
: _________________________________________________________________
Nama/Name
: _______________________________________________________________________
Jabatan/Position : _________________________________________________________________
Jabatan/Position : ______________________________________________________________________
Alamat/Address : _________________________________________________________________
Alamat/Address : _______________________________________________________________________
No. Telp./Phone No. : ____________________________________________________________
No. Telp./Phone No.
Jenis Indentitas : □ KTP/ID Card Identity Type
Jenis Indentitas : □ KTP/ID Card Identity Type
□ Paspor/Passport
□ Lainnya/Others ________________
: ________________________________________________________________ □ Paspor/Passport
□ Lainnya/Others ______________________
No. Identitas/Identity No. : __________________________________________________________
No. Identitas/Identity No. : _______________________________________________________________
Nama/Name
Nama/Name
: _________________________________________________________________
: _______________________________________________________________________
Jabatan/Position : _________________________________________________________________
Jabatan/Position : _______________________________________________________________________
Alamat/Address : _________________________________________________________________
Alamat/Address : ________________________________________________________________________
No. Telp./Phone No. : ____________________________________________________________
No. Telp./Phone No. : ___________________________________________________________________
Jenis Indentitas : □ KTP/ID Card Identity Type
Jenis Indentitas : □ KTP/ID Card Identity Type
□ Paspor/Passport
□ Lainnya/Others ________________
No. Identitas/Identity No. : _________________________________________________________
□ Paspor/Passport
□ Lainnya/Others ______________________
No. Identitas/Identity No. : ________________________________________________________________
DATA KEUANGAN / FINANCIAL INFORMATION Tujuan Investasi Investment Objective Sumber Dana Source of Fund Total Pendapatan/Tahun Total Revenue/Year Total Aset/Total Asset
: □ Apresiasi Harga/Price Appreciation
□ Investasi/Investment
□ Spekulasi/Speculation
: □ Laba Usaha/Business Profit
□ Pendapatan/Income
□ Hasil Investasi/Investment Income
□ Pendapatan/Income
□ Lainnya/Others ___________________________________
□ Hibah/Grant □ Lainnya/Others ___________________________________
: _________________________________________________________________________________________________________________________________________________________ : ________________________________________________________________________________________________________________________________________________________
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 No. Identitas/Identity No. : _________________________________________________________
Jenis Indentitas : □ KTP/ID Card □ Paspor/Passport □ Lainnya/Others _______________________ Identity Type 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
DIISI OLEH PETUGAS/FILLED IN BY OFFICERS Pemasaran (Marketing) Tanda Tangan/Signature
Nama/Name Tanggal/Date _______________________________________________________________________________ Tanda Tangan dan Stempel Perusahaan/Signature & Company Stamp
Fund Admin (Fund Admin)
Direktur (Director)
PT BOWSPRIT ASSET MANAGEMENT PROFIL INVESTASI / INVESTMENT PROFILE Tujuan investasi/Investment Objectives ① Likuiditas & keamanan investasi Liquidity & investment security
② Pendapatan & perlindungan terhadap inflasi Income & protection against inflation
③ Pendapatan & pertumbuhan dalam jangka pendek Income & short time growth
④ Pendapatan & pertumbuhan dalam jangka panjang Income & long time growth
Tingkat risiko yang sanggup ditanggung/Acceptable level of risk ① Risiko rendah Low risk
② Risiko rendah-menengah Low-medium risk
③ Risiko menengah Medium risk
④ Risiko tinggi High risk
Jangka waktu investasi/Investment period ① < 1 tahun < 1 year
② 1 - 3 tahun 1 – 3 year
③ 3 - 5 tahun 3 – 5 year
④ > 5 tahun > 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 Sell as soon as possible to prevent further loss
② Tahan dulu & menjualnya ketika kembali modal Hold it & Sell it when break even
③ Bertahan dengan investasi ini untuk jangka panjang Hold it for long-term
④ Beli lebih banyak lagi agar menurunkan harga rata-rata pembelian 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 Profil risiko investasi Investment risk profile
6 - 12
13 - 18
19 - 24
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) Tanda Tangan/Signature
Nama/Name Tanggal/Date
Fund Admin (Fund Admin)
Direktur (Director)
. 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. I/we agree that for safety / protection , the Investment Manager may request a written statement from me / us before acting based on the instructions given.
PT BOWSPRIT ASSET MANAGEMENT KARTU SPESIMEN / SPECIMEN CARD NamaNasabah Client’s Name No. Rekening Account No. Nama Bank Bank Name No. Rekening Bank Account Bank No. Atas Nama On behalf Jenis Rekening Account types Tanda Tangan Signature
_________________________________________________________________ __________________________________________________________________ __ ________________________________________________________________
No. Telp. _________________________________________________ Phone No. No. HP/Faks. _________________________________________________ Mobile/Fax No. Kepemilikan Ownership
□ Sendiri Personal
□ Perusahaan Company
________________________________________________________________ ________________________________________________________________ □ Tabungan Savings
□ Giro Giro
Syarat Tanda Tangan □ Satu Signature requirement One
□ Dua Two
□ ____________________
□ Lainnya__________________________________ Others Tanda Tangan Signature
Nama Name Tanda Tangan Signature
_____________________________________________________
Nama Name Tanda Tangan Signature
_______________________________________________________
Nama Name Stempel Perusahaan Company Stamp
_____________________________________________________
Nama Name
_______________________________________________________
PT BOWSPRIT ASSET MANAGEMENT KARTU SPESIMEN / SPECIMEN CARD NamaNasabah Client’s Name No. Rekening Account No. Nama Bank Bank Name No. Rekening Bank Account Bank No. Atas Nama On behalf Jenis Rekening Account types Tanda Tangan Signature
_________________________________________________________________ __________________________________________________________________ __ ________________________________________________________________
No. Telp. _________________________________________________ Phone No. No. HP/Faks. _________________________________________________ Mobile/Fax No. Kepemilikan Ownership
□ Sendiri Personal
□ Perusahaan Company
________________________________________________________________ ________________________________________________________________ □ Tabungan Savings
□ Giro Giro
Syarat Tanda Tangan □ Satu Signature requirement One
□ Dua Two
□ ____________________
□ Lainnya__________________________________ Others Tanda Tangan Signature
Nama Name Tanda Tangan Signature
_____________________________________________________
Nama Name Tanda Tangan Signature
_______________________________________________________
Nama Name Stempel Perusahaan Company Stamp
_____________________________________________________
Nama Name
_______________________________________________________
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 Fotokopi KTP/identitas /Copy of ID Card/Identity Fotokopi NPWP / Copy of Tax ID Number Fotokopi bukti transfer / Copy of proof of transfer
Perorangan / Individual
PT/ Company
BUMN/ State-owned Companies
Yayasan/ Foundation
Dana Pensiun/ Pension Fund
Koperasi/ Co-operative
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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
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
