Registration

User Information

Title

First Name

Last Name

Place of Birth

Date of Birth

Identity Card Type

Identity Card No

Card Expiry Date--

Nationality

Company Name

Occupation

Job Title

Type of Industry

Marital Status

Spouse Information

Spouse name

Occupation

Job Title

Company Name

Type of Industry

Maiden Name

Tax Registration #

I have read, understand and agree with Customer Agreement of PT. Panca Global Securities Tbk

Contact Information

Permanent Address / as in ID Card

Address

City

Country

Postcode

Telephone

Fax Number

Personal Email@

Current Address

Same as Permanent Address

Address

City

Country

Postcode

Telephone

Fax Number

Working Address

Address

City

Country

Postcode

Telephone

Fax Number

Office Email@

Correspondence

Correspondence by

Account Information

Account Type

Account Ownership Type

Transfer Information In Case Of Money Withdrawal, Please Transfer To (bank 1 Or Bank 2):

Bank 1 Account Information

Account Name

Account Number

Bank Name

Branch

Bank 2 Account Information

Account Name

Account Number

Bank Name

Branch

Joint Account

Info Only for Joint Account Purpose

Joint Account Owner

Title

First Name

Last Name

Place of Birth

Date of Birth

Identity Type

Identity Card No

Card Expiry Date--

Nationality

Tax Registration #

Marital Status

Spouse Name

Maiden Name

Nationality

Country of Residence

Company Name

Occupation

Job Title

Type of Industry

Joint Account Contact

Permanent Address

Address

City

Country

Postcode

Telephone

Fax Number

Current Address

Same As Permanent Address

Address

City

Country

Postcode

Telephone

Fax Number

Working Address

Address

City

Country

Postcode

Telephone

Fax Number

Investment Information

Annual Net Income

Portfolio Net Worth

Investment Amount (Rp.)