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    Cis PT Janus

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    Hussen Tstj

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    © All Rights Reserved
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    Cis PT Janus

    Uploaded by

    Hussen Tstj
    11 views5 pages

    Original Title

    281220 CIS PT JANUS

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    11 views5 pages

    Cis PT Janus

    Uploaded by

    Hussen Tstj

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    © All Rights Reserved
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    PT, JAGAD NUSANTARA SEHAT

    Menara Batavia Lt. 8 JI. H.Mas Mansyur No.Kav 126 Karet Tengsin Tanah Abang,
    Jakarta Pusat, Indonesia 10250

    CLIENT INFORMATION SHEET

    IN ACCORDANCE WITH ARTICLES 2 AND 5 OF THE DUE DILIGENCE AND


    FEDERAL BANKING COMMISSION CIRCULAR OF DECEMBER 1999,
    CONCERNING THE PREVENTION OF MONEY LAUNDERING, AND
    ARTICLE 305 OF THE SWISS CRIMINAL CODE, THE FOLLOWING
    INFORMATION MAY BE SUPPLIED TO BANKS AND TO FINANCIAL
    INSTITUTIONS FOR PURPOSES OF VERIFICATION OF IDENTITY AND
    ACTIVITIES OF THE INVESTING MEMBER, AND THE NATURE AND
    ORIGIN OF THE FUNDS WHICH ARE TO BE UTILIZED.

    COMPANY NAME : PT. JAGAD NUSANTARA SEHAT

    DATE OF :
    25 OCTOBER 2018
    INCORPORATION
    INCORPORATED IN : JAKARTA, INDONESIA

    REGISTRATION : AHU-0054011.AH.01.01.TAHUN2018 & 13


    NOVEMBER 2018
    NUMBER
    REGISTRATION : Menara Batavia Lt. 8 JI. H.Mas Mansyur No.Kav 126
    Karet Tengsin Tanah Abang, Jakarta Pusat, Indonesia
    ADDRESS
    POST ADDRESS : Anho BioPrima, Aryaduta Semanggi. JI. Gamisun
    Dalam No.8. Jakata Selatan

    REPRESENTED BY : MS NG DEWI MARIANA

    TITLE : President
    PASSPORT NUMBER : C6380639
    NATIONALITY Indonesia

    ISSUED FROM : Indonesia


    ISSUING DATE : 21 JULY 2020

    EXPIRY DATE : 21 JULY 2025


    OPERATING : +62-21-66606615

    OPERATING FAX : +62-21-6601795

    MOBILE TELEPHON NO : +62-811-131-501

    OPERATING EMAIL : notarischandra@gmail.com


    BANK NAME PT BANK MANDIRI (PERSERO)

    BANK ADDRESS WISMA BISNIS INDONESIA


    1
    PT, JAGAD NUSANTARA SEHAT
    Menara Batavia Lt. 8 JI. H.Mas Mansyur No.Kav 126 Karet Tengsin Tanah Abang,
    Jakarta Pusat, Indonesia 10250

    ACCOUNT NAME PT Jagad Nusantara Sehat

    ACCOUNT NUMBER 121-0020089888


    SWIFT CODE BMRIIDJA
    BANK OFFICER Mr. Rudy Komarudin

    BANKER PHONE +62-21-57900645

    BANKER FAX +62-21-57900647

    BANK E-MAIL jkt_wismabisnisindonesia@bankmandiri.co.id

    DECLARATION: I declare that the information given above is both true and
    accurate. I am the signatory on the aforementioned bank account. I confirm and
    declare that the referenced funds are good, clean, and clear and of non-criminal
    origin and that said funds have been earned in the course of normal commercial
    business activity and legally generated.

    All parties have an obligation to respect professional secrecy and to take all
    appropriate precautions to protect the confidentiality of the information each holds
    in respect of the others’ activities. This legal obligation shall remain in full force
    and effect at all times.

    CONFIRMED AND SIGNED ON THIS DAY 16 AUGUST 2020


    FOR AND ON BEHALF OF RECEIVER

    Signature and Company Seal:

    Name : MS NG DEWI MARIANA


    Designation: PRESIDENT/DIRECTOR
    Passport No: C6380639
    Issue Date:21 JULY 2020
    Expiry Date: 21 JULY 2025
    Place of Issue: INDONESIA

    2
    PT, JAGAD NUSANTARA SEHAT
    Menara Batavia Lt. 8 JI. H.Mas Mansyur No.Kav 126 Karet Tengsin Tanah Abang,
    Jakarta Pusat, Indonesia 10250

    COPY OF PASSPORT

    3
    PT, JAGAD NUSANTARA SEHAT
    Menara Batavia Lt. 8 JI. H.Mas Mansyur No.Kav 126 Karet Tengsin Tanah Abang,
    Jakarta Pusat, Indonesia 10250

    COMPANY CERTIFICATE
    REGISTRATION

    4
    PT, JAGAD NUSANTARA SEHAT
    Menara Batavia Lt. 8 JI. H.Mas Mansyur No.Kav 126 Karet Tengsin Tanah Abang,
    Jakarta Pusat, Indonesia 10250

    ※※※※※※ END OF DOCUMENT※※※※※※

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