Registrationform-smsbanking

  • May 2020
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APLIKASI INTERNET BANKING DAN SMS BANKING Application for Internet Banking and SMS Banking January 1 2002 CABANG .................................................. TANGGAL ......................... / ........ / ............

Branch

Date

HARAP DITULIS DENGAN HURUF CETAK / Fill in with Block Letter DATA NASABAH / Customer Data NAMA LENGKAP Full Name

:

NAMA GADIS IBU KANDUNG Mother’s Maiden Name

:

ALAMAT E-MAIL E-mail Address

:

NOMOR TELEPON SELULAR Celluler Phone Number

:

ALAMAT SURAT Mailing Address

: Kode Pos ...................... Postal Code

Nomor Telepon Phone Number

: Rumah ....................................................... Kantor ............................................. Faks .............................................. Home Office Fax

Nomor Kartu ATM

:

LAYANAN YANG DIINGINKAN / Internet Banking And SMS Banking Services INTERNET BANKING

SMS BANKING

DAFTAR REKENING SENDIRI My own account list Hapus Delete

Tambah Add

Kode Cabang Branch code

DAFTAR REKENING TUJUAN TRANSFER (KHUSUS SMS BANKING) Transfer destination account list (SMS Banking service only) Nomor Rekening Account Number

Hapus Delete

Tambah Add

1.





2.





3.





4.





5.





6.





7.





8.





Kode Cabang Branch Code

Nomor Rekening Account Number

Nama Name

PEMBERITAHUAN BANK MELALUI SMS BILA Bank’s notification over sms if No. No.

DEPOSITO JATUH TEMPO Time deposite is meture

Hari Sebelumnya Day Before

PENOLAKAN CEK/BG ATAS REKENING SENDIRI My own check/BG is bounced

1

2

3

4

5

6

7

8

(Harap dilingkari)

PENGKREDITAN LEBIH DARI Credited account more than

Rp. .....................................

1

2

3

4

5

6

7

8

(Harap dilingkari)

PENDEBITAN LEBIH DARI Debited account more than

Rp. .....................................

1

2

3

4

5

6

7

8

(Harap dilingkari)

SALDO KURANG DARI Account balance less than

Rp. .....................................

1

2

3

4

5

6

7

8

(Harap dilingkari)

BERSEDIA MENERIMA PESAN PROMOSI DARI BANK MELALUI E-MAIL/SMS Would like to receive bank’s promotional messages over e-mail/SMS**)

PERNYATAAN / Declaration Saya/kami menyatakan bahwa semua diatas adalah benar dan menyutujui serta tunduk pada ketentuan dan syarat-syarat layanan internet banking an atau sms banking yang telah saya baca pada lembar dibalik aplikasi ini maupun ketentuan lain yang berlaku dari waktu ke waktu di Bank Mandiri. I/we certify that above mentioned data is correct an i/we hereby approve and shall be subject to the terms and conditions internet banking and or sms banking on the back leaf application, or other terms and conditions from time to time at Bank Mandiri. 1. Tandatangan Signature

2. Tandatangan (hanya untuk aplikasi rekening gabungan) Signature (only for joint account application)

Nama/Name:...........................................................................................

Nama/Name:...........................................................................................

UNTUK BANK / For Bank Use Diproses Oleh

CIF NO PERORANGAN

Disetujui Oleh

REKENING GABUNGAN

Customer Service *) Maksimum 10 hari sebelum jatuh tempo / Maximum for 10 days before maturity **) Coret sesuai dengan aplikasi yang diinginkan / Delete where applicable

FFO 057

½