KETENTUAN DAN PERSYARATAN KHUSUS PEMBUKAAN REKENING INVESTOR
KETENTUAN DAN PERSYARATAN KHUSUS PEMBUKAAN REKENING INVESTOR
Ketentuan dan Persyaratan Khusus Pembukaan Rekening Investor ini (berikut semua lampiran, perubahan dan atau pembaharuannya selanjutnya disebut “KSK Rekening Investor”) adalah ketentuan khusus terkait dengan pembukaan Rekening Investor di PT Bank CIMB Niaga Tbk berkedudukan di Jakarta Selatan (“Bank”) yang dibuat dan ditandatangani pada hari dan tanggal sebagaimana tercantum pada akhir KSK Rekening Investor ini oleh Nasabah (selanjutnya disebut “Nasabah”).
Dengan ditandatanganinya KSK Rekening Investor ini, Nasabah menyatakan tunduk pada ketentuan-ketentuan yang tercantum dalam Ketentuan dan Syarat Umum Pembukaan Rekening pada Bank. Adapun isi ketentuan dari KSK Rekening Investor ini adalah sebagai berikut:
Pasal 1
PEMBUKAAN REKENING INVESTOR
1.1 INFORMASI & SPESIMEN NASABAH
1.1.1 Pembukaan Rekening Investor oleh Nasabah melalui Perusahaan Efek atau Bank Kustodian wajib memenuhi seluruh persyaratan yang telah ditetapkan dan atau akan ditetapkan kemudian oleh Bank, termasuk yang bersumber dari persyaratan yang telah dan atau akan ditetapkan kemudian oleh PT Kustodian Sentral Efek Indonesia dan atau pihak terkait lain, seperti namun tidak terbatas pada :
a) Memiliki dana minimum yang ditetapkan Bank.
b) Memiliki Sub Rekening Efek di C-BES.
c) Memiliki Single Investor Identification (SID) di AKses.
d) Menyerahkan dokumen-dokumen lain sebagaimana terlampir dan dokumen atau informasi-informasi lain yang ditetapkan kemudian oleh Bank.
Nasabah melalui Perusahaan Efek wajib menunjukkan serta menyerahkan semua dan setiap data, keterangan, informasi, pernyataan, dokumen atau segala sesuatu yang diminta dan diperlukan oleh Bank terkait pembukaan Rekening Investor atau Bank Kustodian, dan Nasabah dengan ini menyata- kan serta menjamin Bank bahwa segala data/dokumen/informasi apapun yang diberikan kepada Bank melalui Perusahaan Efek atau Bank Kustodian berkenaan dengan pembukaan Rekening Investor adalah lengkap, sesuai dengan aslinya, benar dan sesuai dengan keadaan yang sebenarnya serta tidak/belum ada perubahan atau merupakan data/dokumen/informasi yang terbaru. Xxxxxxx juga menjamin bahwa yang menandatangani KSK Rekening Investor berikut seluruh dokumen terkait adalah pihak yang berwenang mewakili Nasabah. Nasabah dengan ini setuju bahwa pembukaan Rekening Investor hanya akan berlaku efektif setelah seluruh persyaratan dipenuhi oleh Nasabah dan aplikasi pembukaan Rekening Investor disetujui oleh Bank.
Nasabah setuju dan dengan ini memberi kuasa kepada Bank untuk mencari, meminta dan menerima data, keterangan, informasi, pernyataan, dokumen dalam bentuk apapun dan dari pihak manapun yang diperlukan oleh Bank berkaitan dengan identitas Nasabah dan/atau kegiatan usaha dan/atau transaksi Nasabah.
Seluruh data, keterangan, informasi, pernyataan, dokumen yang diperoleh Bank melalui Perusahaan Efek dan atau Bank Kustodian berkenaan dengan Nasabah maupun kegiatan usaha atau transaksi Nasabah, akan menjadi milik Bank dan Bank berhak untuk mencocokkan, menilai, merahasiakan atau menggunakannya untuk kepentingan Bank sesuai dengan ketentuan hukum yang berlaku tanpa kewajiban Bank untuk memberitahukan atau meminta persetujuan terlebih dahulu dari Nasabah, memberikan jaminan atau ganti rugi apapun dan dengan alasan apapun kepada Nasabah.
Dalam hal Nasabah hendak melakukan perubahan data, termasuk namun tidak terbatas pada perubahan alamat, nomor telepon, faksimili, Kartu Tanda Penduduk (KTP), Nomor Pokok Wajib Pajak (NPWP), tandatangan, pejabat yang berwenang menandatangani (berikut contoh tanda tangan baru), susunan pengurus, status badan hukum, perizinan dan lain-lainnya, maka Nasabah wajib untuk melakukan perubahan tersebut dengan datang langsung ke Perusahaan Efek atau Bank Kustodian. Perubahan ini efektif berlaku sejak diterima dan dicatatnya perubahan dimaksud dalam catatan Bank.
1.1.2 Pembukaan Rekening Investor dilakukan melalui Perusahaan Efek atau Bank Kustodian atas kuasa dari Nasabah kepada Perusahaan Efek atau Bank Kustodian sebagaimana dituangkan dalam KSK Rekening Investor ini.
1.1.3 Bank berhak menolak permohonan pembukaan Rekening Investor, termasuk namun tidak terbatas apabila ditemukan informasi atau data yang tidak valid, tanpa adanya kewajiban dari Bank untuk mengemukakan alasannya.
1.2 KETENTUAN REKENING INVESTOR
1.2.1 Rekening Investor dapat berupa rekening tabungan atau rekening giro, dengan ketentuan bahwa rekening tabungan hanya khusus berlaku bagi Nasabah perorangan dan Rekening giro hanya khusus berlaku bagi Nasabah badan usaha atau individu yang sudah memiliki NPWP.
1.2.2 Bank tidak akan menerbitkan buku tabungan atau tanda kepesertaan tabungan atas nama Xxxxxxx dan tidak menerbitkan cek/bilyet giro sebagai media penarikan dana atas rekening giro.
1.2.3. Rekening Investor dapat berasal dari konversi atas rekening tabungan atau rekening giro yang sudah dimiliki oleh Nasabah. Dalam hal Rekening Investor berasal dari konversi rekening tabungan atau rekening giro, setelah dikonversi menjadi Rekening Investor akan tunduk pada syarat dan ketentuan dalam KSK Rekening Investor ini.
Dengan menandatangani KSK Rekening Investor ini, Nasabah menyatakan dan menjamin bahwa dengan dilakukannya konversi rekening sebagaimana dimaksud dalam sub pasal ini tidak terdapat cek dan atau bilyet giro dan atau media penarikan dana lain yang masih belum ditarik dan atau belum dipenuhi kewajibannya dan segera mengembalikannya ke Bank jika ada.
Namun demikian, Bank diberi kuasa untuk mendebit Rekening Investor dan menggunakan dana tersebut untuk membayar/memenuhi kewajiban yang timbul akibat penarikan dana melalui cek dan atau BG dan atau media penarikan lain yang belum dipenuhi kewajibannya.
1.3 PENANGANAN KELUHAN (PENGADUAN)
Dalam hal Nasabah akan menyampaikan keluhan/pengaduan kepada Bank sehubungan dengan Rekening Investor, keluhan/pengaduan hanya dapat disampaikan secara tertulis dengan melampirkan fotokopi identitas diri Nasabah dan dokumen pendukung kepada Perusahaan Efek atau Bank Kustodian, untuk selanjutnya Perusahaan Efek atau Bank Kustodian berkewajiban menindaklanjuti keluhan Nasabah tersebut kepada Bank. Bank tidak bertanggung jawab atas keterlambatan penanganan keluhan yang disebabkan karena kelalaian dan/atau keterlambatan Perusahaan Efek dan/atau Bank Kustodian dalam menyampaikan keluhan Nasabah kepada Bank.
Pasal 2
KUASA KEPADA PERUSAHAAN EFEK ATAU BANK KUSTODIAN
Nasabah dengan ini memberikan Kuasa kepada Perusahaan Efek atau Bank Kustodian untuk dan atas nama Nasabah untuk:
1. Membuka dan/atau mengurus pembukaan Rekening Investor atas nama Nasabah pada Bank yang digunakan khusus untuk penyelesaian transaksi efek baik atas transaksi penjualan maupun pembelian efek yang dilakukan oleh Nasabah melalui Perusahaan Efek atau Bank Kustodian dan untuk itu melakukan segala tindakan atas Rekening Investor terkait dengan tujuan tersebut, termasuk namun tidak terbatas pada pendebetan dan pengkreditan serta penutupan Rekening Investor dengan ketentuan bahwa pendebetan Rekening Investor hanya dapat dilakukan untuk mengkreditkan dana ke rekening sebagai berikut:
Nomor Rekening Giro Operasional Perusahaan Efek atau Bank Kustodian:
………………………………………...
Nomor Rekening Giro Penyelesaian Perusahaan Efek atau Bank Kustodian:
………………………………………...
Nomor Rekening Nasabah lainnya:
………………………………………...
atau rekening lain sebagaimana diberitahukan secara tertulis oleh Xxxxxxx dari waktu ke waktu.
Perusahaan Efek atau Bank Kustodian wajib memperhatikan hak Nasabah untuk tetap dapat menggunakan dana dalam Rekening Investor dan menutupnya dalam hal tidak ada lagi kewajiban penyelesaian transaksi efek Nasabah yang dilakukan melalui Perusahaan Efek atau Bank Kustodian sesuai dengan maksud dan tujuan dari Rekening Investor.
2. Melakukan kewenangan pada angka 1 di atas melalui layanan perbankan yang tersedia pada Bank saat ini atau di waktu yang akan datang, termasuk namun tidak terbatas melalui layanan BizChannel@CIMB.
3. Mendaftarkan Rekening Investor dan rekening-rekening lainnya sebagaimana tersebut pada angka 1 pada layanan BizChannel@CIMB atau layanan perbankan lainnya milik Nasabah (jika dipersyaratkan demikian).
Selanjutnya melakukan segala sesuatu yang baik dan perlu terkait dengan pelaksanaan kuasa yang diberikan atas Rekening Investor tersebut di atas.
Atas segala perselisihan dan akibatnya antara Nasabah dan Perusahaan Efek atau Bank Kustodian atau dengan siapapun, sepenuhnya menjadi tanggung jawab Nasabah dan atau Perusahaan Efek atau Bank Kustodian. Sehubungan dengan penggunaan layanan perbankan yang digunakan dalam menjalankan kuasa ini, termasuk namun tidak terbatas pada layanan BizChannel@CIMB, Nasabah dan Perusahaan Efek atau Bank Kustodian telah sepenuhnya mengetahui dan memahami layanan perbankan tersebut serta akan mentaati segala ketentuan yang berlaku atas layanan perbankan tersebut berikut perubahannya di kemudian hari.
Pasal 3 TRANSAKSI REKENING
3.1 PENARIKAN DAN PENYETORAN
Penarikan atas Rekening Investor dilakukan Perusahaan Efek atau Bank Kustodian berdasarkan Surat Kuasa Nasabah kepada Perusahaan Efek atau Bank Kustodian dan penarikan dana tersebut hanya dapat dilakukan untuk keperluan penyelesaian transaksi efek atau pemindahbukuan dana ke rekening tujuan. Nasabah setuju untuk membebaskan Bank dari segala tuntutan dan atau risiko dan atau kerugian yang mungkin timbul akibat penyalahgunaan kuasa yang dilakukan oleh Perusahaan Efek atau Bank Kustodian, terkait dengan dana pada Rekening Investor, dan bersedia untuk menanggung segala kerugian yang dialami Bank akibat penyalahgunaan kuasa tersebut. Penarikan dana dari Rekening Investor hanya dilakukan dengan menggunakan media penarikan yang memenuhi ketentuan Bank tanpa mengurangi hak Bank untuk menolak penarikan atas Rekening Investor, termasuk namun tidak terbatas bilamana dana dalam Rekening Investor tidak mencukupi dengan memperhatikan ketentuan/perjanjian yang berlaku.
3.2 INSTRUKSI
Apabila tidak ada kesepakatan lain, instruksi penyetoran dana dapat dilakukan oleh Nasabah atau Perusahaan Efek atau Bank Kustodian atau pihak ketiga lainnya, sedangkan instruksi penarikan dana dilakukan oleh Perusahaan Efek atau Bank Kustodian atas dasar Surat Kuasa Nasabah kepada Perusahaan Efek atau Bank Kustodian. Apabila Xxxxxxx mengingin- kan untuk melakukan tindakan terkait dengan Rekening Investor termasuk mengeluarkan dana hasil investasi di pasar modal dari Rekening Investor,
maka Nasabah setuju untuk terlebih dahulu harus menghubungi Perusahaan Efek atau Bank Kustodian di mana dananya diadministrasikan dalam Rekening Investor dan apabila hal ini disetujui oleh Perusahaan Efek atau Bank Kustodian maka Perusahaan Efek atau Bank Kustodian akan melakukannya untuk Nasabah.
Pasal 4 PEMBUKTIAN
Bank setiap saat berhak untuk memperbaiki kekeliruan yang dibuat oleh Bank atau pegawainya, baik dalam mengkredit atau mendebit Rekening Investor atau dalam menjalankan sebagai perintah yang berkaitan dengan hal tersebut dan Nasabah dengan ini menyatakan: (i) memberikan kuasa kepada Bank untuk mendebit Rekening Investor dalam hal Bank harus melakukan pendebitan untuk memperbaiki kekeliruan tersebut; (ii) melepaskan haknya untuk menuntut atau meminta ganti rugi kepada Bank atau pegawainya atas setiap kekeliruan yang akan diperbaiki Bank dalam jangka waktu yang layak sesudah Bank mengetahuinya, (iii) menyetujui serta mengakui bahwa hasil atau akibat yang timbul atas tindakan Bank dalam memper- baiki kekeliruan atas Rekening Investor akan berlaku dan mengikat Nasabah sebagai alat bukti yang sah dan sempurna.
Pasal 5 TANGGUNG JAWAB
5.1 Nasabah setuju untuk menanggung setiap risiko, kerugian atau akibat yang diderita Nasabah yang disebabkan antara lain; (i) kelalaian dan atau kesalahan Nasabah (ii) kesalahpahaman, kerusakan, keterlambatan, kehilangan atau kesalahan pengiriman perintah dan komunikasi, baik melalui pos, telepon, telegram, teleks atau faksimili atau sistem komunikasi lainnya;
(iii) keterbatasan pemakaian atau ketidaksediaannya atau tidak terbayarnya dana yang disebabkan adanya pembatasan pertukaran mata uang asing, tidak tersedianya mata uang asing yang dicari, atau sebab-sebab lain yang di luar kekuasaan Bank; (iv) laporan Rekening Investor atau pemberitahuan Bank yang dikirim kepada Nasabah diterima atau dibaca atau disalahgunakan oleh pihak yang tidak berwenang atas Rekening Investor.
5.2 Nasabah setuju untuk menanggung segala risiko, kerugian atau akibat yang diderita oleh Nasabah sendiri sehubungan dengan ketidak aslian, ketidak absahan, ketidak sempurnaan pengisian atau lain-lain aspek dari dokumen yang diterima Bank dari Nasabah melalui Perusahaan Efek atau Bank Kustodian, juga bila dokumen tersebut menyatakan hak kepemilikan atas barang, demikian pula bila dokumen tersebut membuktikan hak kepemilikan atas barang yang tercantum dalam dokumen tersebut. Bank tidak bertang- gung jawab terhadap pihak-pihak yang mengeluarkan atau mengendosemen dokumen-dokumen tersebut, termasuk namun tidak terbatas pada keaslian, keabsahan atau kebenaran wewenang dan tanda tangan yang terdapat dalam dokumen-dokumen tersebut.
5.3 Dalam hal transaksi atas Rekening Investor dilakukan oleh Perusahaan Efek atau Bank Kustodian berdasarkan Surat Kuasa Nasabah kepada Perusahaan Efek atau Bank Kustodian, melalui layanan perbankan apapun termasuk layanan perbankan elektronik, maka Nasabah setuju untuk membebaskan Bank dari segala risiko yang mungkin timbul akibat penggunaan layanan perbankan tersebut. Dalam hal transaksi atas Rekening Investor dilakukan melalui layanan perbankan elektronik, maka Nasabah setuju bahwa Bank tidak bertanggung jawab atas setiap bentuk kerugian yang dialami Nasabah akibat penggunaan layanan perbankan elektronik, termasuk namun tak terbatas pada kerugian akibat kelalaian/kesalahan Nasabah atau kuasa Nasabah (Perusahaan Efek atau Bank Kustodian) maupun kerugian akibat penggunaan atau intervensi penggunaan layanan perbankan elektronik oleh pihak lain yang tidak berhak, keterlambatan atau kegagalan akses atau pelaksanaan transaksi akibat gangguan atau perbaikan sistem atau kondisi apapun yang berada di luar kekuasaan Bank termasuk Force Majeure, atau penggunaan layanan perbankan elektronik yang menyimpang dari persyara- tan dan ketentuan serta Prosedur yang ditetapkan Bank.
5.4 Nasabah dengan ini setuju bahwa Nasabah akan menggunakan Rekening Investor untuk transaksi yang tidak bertentangan dengan ketentuan peraturan perundang-undangan dan atau kebijakan internal Bank yang berlaku dan atau peraturan-peraturan lainnya yang berlaku secara nasional maupun interna- sional yang terkait dengan pelaksanaan transaksi tersebut baik secara langsung maupun tidak yang langsung, dan Nasabah dengan ini bertanggung jawab atas segala klaim dan atau tuntutan dan akibat yang timbul akibat penggunaan Rekening Investor oleh Nasabah untuk transaksi yang dikatego- rikan sebagai transaksi mencurigakan dan/atau transaksi yang dilarang oleh ketentuan peraturan perundang-undangan yang berlaku.
Pasal 6 PENUTUPAN REKENING
6.1 Penutupan Rekening Investor tidaklah membebaskan Nasabah dari kewajiban yang belum dipenuhi, termasuk namun tidak terbatas pada adanya cerukan (saldo debit) atas Rekening Investor (bila ada) dan Bank tetap berhak untuk menagih/mendapatkan pembayaran dari Nasabah atas jumlah yang belum dipenuhi oleh Nasabah.
6.2 Apabila setelah ditutupnya Rekening Investor masih terdapat sisa dana dalam Rekening Investor, maka sisa dana dalam rekening yang ditutup (apabila ada) tetap menjadi milik Nasabah dan Bank akan mengkreditkan dana tersebut ke rekening lain milik Nasabah yang masih ada pada Bank atau rekening penampungan (dalam hal Nasabah tidak memiliki rekening lain pada Bank) setelah dipotong biaya penutupan Rekening Investor dan biaya-biaya lainnya yang dikenakan terkait dengan Rekening Investor tersebut serta kewajiban-kewajiban pembayaran yang belum dipenuhi oleh Nasabah (termasuk cerukan). Sepanjang tidak diatur lain oleh Bank, penarikan atas sisa dana pada Rekening Investor yang telah ditutup yang telah dikreditkan ke rekening lain milik Nasabah yang ada atau ke rekening penampungan sebagaimana dimaksud dalam butir ini hanya dapat dilakukan dengan media khusus yang ditentukan Bank.
6.3 Nasabah dan atau ahli waris dan atau pengganti haknya membebaskan Bank dari seluruh tanggung jawabnya berkenaan dengan penutupan Rekening Investor tersebut.
6.4 Sisa dana yang terdapat dalam rekening penampungan sebagaimana
mendapat bunga/ jasa giro atau kompensasi apapun, namun tanpa mengu- rangi hak Bank untuk membebani biaya administrasi atas sisa dana dalam rekening penampungan tersebut, demikian itu dengan ketentuan bahwa apabila dalam jangka waktu 3 (tiga) tahun sejak penutupan Rekening Investor, ternyata Xxxxxxx tidak melakukan pengambilan, penarikan atau pemberesan atas sisa dana pada rekening penampungan tersebut atau apabila karena sebab apapun Bank tidak dapat/ tidak diperkenankan menyer- ahkan sisa dana tersebut kepada negara sesuai dengan ketentuan perundang-undangan yang berlaku dan oleh karenanya Nasabah melepas- kan haknya atas sisa dana dalam Rekening Investor yang ditutup.
Pasal 7 KETENTUAN LAIN-LAIN
7.1 KETERBUKAAN INFORMASI
7.1.1 Sehubungan dengan Rekening Investor dan dengan tetap memperhatikan peraturan perundang-undangan yang berlaku dan kebijakan Bank, Nasabah dengan ini memberikan persetujuan kepada Bank untuk menyampaikan informasi data Nasabah berikut data simpanannya kepada Perusahaan Efek atau Bank Kustodian dan atau PT Kustodian Sentral Efek Indonesia untuk tujuan berkaitan dengan Rekening Investor ini. Sehubungan dengan hal ini, Nasabah secara khusus memberikan kuasa dan kewenangan kepada Bank untuk (i) memberikan kepada pihak manapun informasi mengenai atau sehubungan dengan Nasabah, dan/atau kegiatan Nasabah dan/atau rekening-rekening Nasabah maupun data keuangan Nasabah lainnya yang ada pada Bank kepada pihak lain termasuk tetapi tidak terbatas pada PT Kustodian Sentral Efek Indonesia dan Badan Pengawas Pasar Modal Republik Indonesia untuk tujuan yang dinilai wajar dan diperlukan oleh Bank, termasuk memberikan laporan/mengirimkan data kepada PT Kustodian Sentral Efek Indonesia terkait dengan pembukaan, penolakan permohonan pembukaan, pengelolaan, pemblokiran, pelepasan blokir maupun penutupan dan tindakan lain terkait dengan Rekening Investor serta informasi terkait dengan mutasi dana dan atau saldo pada Rekening Investor tersebut, (ii) melakukan pemblokiran Rekening Investor berdasarkan instruksi pemblokiran dari institusi yang berwenang sesuai dengan ketentuan perundang-undangan yang berlaku, dan (iii) melakukan pendebitan atas Rekening Investor sebesar jumlah kewajiban terhutang yang belum dipenuhi oleh Pemberi Persetujuan dan Kuasa, termasuk namun tidak terbatas pada adanya cerukan (saldo debit) atas Rekening Investor (bila ada).
7.1.2 Sehubungan Rekening Investor, maka dengan berlakunya KSK Rekening Investor ini ketentuan mengenai persetujuan Nasabah terhadap Bank untuk memberikan kepada pihak manapun informasi mengenai atau sehubungan dengan Nasabah, dan/atau kegiatan Nasabah dan/atau rekening-rekening Nasabah maupun data keuangan Nasabah lainnya yang ada pada Bank kepada pihak lain termasuk tetapi tidak terbatas pada anak perusahan, afiliasi atau perusahaan-perusahaan terkait lainnya sebagaimana disebutkan dalam Ketentuan dan Persyaratan Umum Pembukaan Rekening (KPUPR) dihapus- kan dan dianggap tidak berlaku.
7.3 PERUBAHAN
Dalam hal terdapat perubahan, penambahan, dan atau pengurangan ketentuan dalam KSK Rekening Investor maka Bank akan memberitahukan perubahan, penambahan dan atau pengurangan kepada Nasabah melalui Perusahaan Efek/ Bank Kustodian. Nasabah setuju bahwa dengan dipergunakannya/dilakukan akses/transaksi atas Rekening Investor setelah diberitahukan/diumumkannya perubahan atas ketentuan KSK Rekening Investor berarti bahwa Nasabah telah menyetujui perubahan atas ketentuan KSK Rekening Investor tersebut.
7.4 KEABSAHAN
Keabsahaan serta berlakunya ketentuan dalam KSK Rekening Investor tidak akan terpengaruh sekalipun satu atau lebih dari ketentuan dalam KSK Rekening Investor menjadi batal, tidak dapat diberlakukan atau tidak sah.
7.5 PILIHAN HUKUM DAN PENYELESAIAN SENGKETA
KSK Rekening Investor ini berikut dengan semua perubahannya dibuat, ditafsirkan dan dilaksanakan berdasarkan hukum Negara Republik Indonesia. Setiap sengketa yang timbul menurut atau berdasarkan KSK Rekening Investor Nasabah ini, yang tidak dapat diselesaikan secara musyawarah, akan diselesaikan melalui Badan Arbitrase Pasar Modal Indonesia (BAPMI). Kecuali disepakati lain oleh pihak-pihak dalam KSK-Rekening Investor, maka sidang arbitrase akan diadakan di Jakarta. Keputusan yang dibuat dan diberikan oleh para arbiter, yang telah berkekuatan hukum tetap, mutlak, mengikat dan tidak dapat diganggu gugat dan dapat digunakan sebagai dasar ketetapan dan eksekusi di dalam maupun di luar wilayah Republik Indonesia. Keputusan arbitrase harus memuat penetapan pihak yang harus membayar biaya-biaya yang timbul.
7.6 PENUTUP
7.6.1 Dalam hal terdapat perbedaan pengaturan dalam Ketentuan dan Persyaratan Umum Pembukaan Rekening dengan KSK Rekening Investor ini maka yang berlaku adalah pengaturan dalam KSK Rekening Investor ini.
7.6.2 Nasabah dengan ini menyatakan telah menerima Ketentuan dan Persyaratan Umum Pembukaan Rekening dan KSK Rekening Investor, membaca, memahami, menandatangani dan menyetujui isinya dan Bank telah memberi- kan penjelasan yang cukup mengenai karakteristik Rekening Investor yang akan Nasabah manfaatkan dan Nasabah telah mengerti dan memahami segala konsekuensi pemanfaatan Rekening Investor, termasuk manfaat, risiko, dan biaya-biaya yang melekat pada Rekening Investor tersebut.
Demikian setelah ketentuan–ketentuan ini telah dibaca dan dipelajari dengan seksama oleh Xxxxxxx dan isinya telah dimengerti Nasabah dengan penuh kesadaran dan tanggung jawab, Nasabah menandatangani KSK Rekening Investor ini pada tanggal sebagaimana disebutkan pada Perjanjian ini.
NASABAH,
dimaksud dalam butir 6.2 ini yang belum/ tidak ditarik oleh Xxxxxxx tidak
I. DEFINISI
1. Deposito adalah simpanan yang penarikannya hanya dapat dilakukan pada waktu tertentu berdasarkan kesepakatan Bank dan Nasabah.
2. Giro adalah simpanan yang penarikannya dapat dilakukan setiap saat dengan menggunakan cek, bilyet giro, media instruksi lainnya pada Bank.
3. Instruksi adalah setiap perintah Nasabah kepada Bank untuk membukukan suatu penambahan saldo (“Penyetoran Dana”) atau pengurangan saldo (“Penarikan Dana”) pada Rekening.
4. Rekening adalah rekening-rekening dana pada Bank yang telah ada maupun yang baru akan ada di kemudian hari, yang dibuka baik secara langsung maupun secara tidak langsung atas permintaan tertulis dari dan atau untuk kepentingan Nasabah, termasuk tetapi tidak terbatas pada Rekening Deposito, Giro, dan Tabungan.
5. Rekening Gabungan adalah Rekening yang dibuka oleh dan/atau dengan nama lebih dari 1 (satu) orang atau badan hukum. Setiap kata “Nasabah” dalam ketentuan ini diartikan sebagai sendiri-sendiri dan bersama-sama.
6. Tabungan adalah simpanan yang penarikannya hanya dapat dilakukan menurut syarat tertentu yang disepakati tetapi tidak dapat ditarik dengan cek, bilyet giro atau lainnya yang dipersamakan dengan itu.
In connection with the Account Opening by PT Bank CIMB Niaga Tbk (hereinafter referred to as the "Bank") based on the request of the applicant (hereinafter referred to as the Customer), the Customer agrees that the said Account is subject to and will be managed by the General Terms and Conditions of the Account Opening of CIMB Niaga ("GT&CGT&C") below:
I. DEFINITION
1. Time Deposits is deposits that can be withdrawn only at a specified time based on an agreement between Bank and the Customer.
2. Current Account is deposits which may be withdrawn at any time by Cheque, “Giro Bilyet”, other instruction media to the Bank.
3. Instruction is any Customer’s order/instruction to the Bank to book a balance increment ("Funds Deposit") or a balance deduction ("Funds Withdrawal") to the Account.
4. Account is accounts of funds at the Bank which have been registered or will be registered at a later date, which are opened directly or indirectly upon the written request of or for the benefit of the Customer, including but not limited to the Time Deposit Account , Current Account, and Savings Account.
5. Joint Account is an Account that is opened by and / or in the names of more than 1 (one) person or legal entity. The term "Customer" in this provision shall be construed as individually and jointly.
6. Savings Account is deposit that may only be withdrawn according to agreed certain conditions but can not be withdrawn by Cheque, “Giro Bilyet” or others which are equivalent.
II.
III.
REKENING
1. Rekening dapat dibuka dalam mata uang rupiah ataupun mata uang asing. Dalam hal rekening dibuka dalam mata uang asing, Xxxxxxx mengetahui bahwa terdapat risiko penurunan nilai tukar yang diakibatkan karena melemahnya nilai suatu mata uang terhadap mata uang lainnya. Penurunan nilai ini menjadi tanggung jawab Nasabah.
2. Pembukaan Rekening:
a. Didasarkan pada permohonan tertulis Nasabah dengan memenuhi segala persyaratan yang ditentukan oleh Bank ;
b. Efektif setelah disetujui oleh Bank; dan
c. Bank berhak untuk menolak permohonan pembukaan Rekening dengan memberitahukan alasannya kepada Nasabah, kecuali diatur lain oleh peraturan perundang- undangan yang berlaku.
3. Rekening Gabungan
a. Rekening Gabungan didasarkan pada kesepakatan di antara pihak-pihak khususnya berkenaan dengan penetapan pihak yang berwenang dan kewenangannya dalam melaksanakan Instruksi serta konsekuensi yang mungkin timbul berkaitan dengan Rekening Gabungan.
b. Nasabah pemilik Rekening Gabungan bertanggung jawab secara tanggung renteng terhadap segala kewajiban yang timbul dari Rekening Gabungan tersebut.
c. Pengaturan mengenai Rekening Gabungan akan diatur dalam perjanjian terpisah yang wajib ditandatangani oleh semua nama yang menjadi pemilik Rekening Gabungan.
4. Rekening dapat diakses melalui jasa perbankan elektronik (“Jasa”), dimana disepakati bahwa, walaupun terdapat ketentuan lainnya yang bertentangan dengan KPUPR ini, dalam melaksanakan transaksi terhadap Rekening:
a. Dapat dilaksanakan di setiap kantor cabang Bank maupun media Jasa Bank.
b. Tunduk kepada peraturan perundang-undangan yang berlaku dari waktu ke waktu dalam wilayah hukum di mana kantor cabang Bank maupun media Jasa Bank dan/atau Rekening berada, termasuk tapi tidak terbatas pada, kebijakan pemerintah setempat, keputusan atau peraturan yang berkaitan dengan pengawasan mata uang atau perubahan mata uang, dan apabila Jasa dipergunakan untuk melaksanakan setiap atau semua transaksi berkenaan dengan rekening pihak ketiga termasuk tetapi tidak terbatas pada pendebetan setiap rekening pihak ketiga pada Bank, Nasabah dengan ini setuju untuk melengkapi Bank dengan surat kuasa yang bentuk dan isinya disetujui Bank dan jika karena alasan apapun tidak dapat dilengkapi oleh Nasabah, atau Bank tidak menyetujui bentuk dan isi surat kuasa tersebut, maka Bank tidak berkewajiban menyediakan Jasa untuk transaksi tersebut.
INSTRUKSI
1. Media Instruksi
a. Media Instruksi Tertulis
i. Apabila tidak ada kesepakatan lain, Instruksi hanya dapat dilakukan melalui perintah tertulis kapada Bank seperti cek, bilyet giro, wesel, perintah pembayaran atau media lainnya yang dapat disetujui oleh Bank (“Media Instruksi”).
ii. Setiap Instruksi yang menggunakan cek, bilyet giro atau
II.
III.
ACCOUNT
1. The Account may be opened in Rupiah or foreign currency. In the case whereby account is opened in a foreign currency, the Customer is aware that there is a risk of depreciation of the value resulting from the weakening of the exchange value of a currency against the other currency. This depreciation of value shall be the responsibility of the Customer.
2. Account Opening:
a. Shall be based on a written request of the Customer by fulfilling all the requirements specified by the Bank;
b. Shall be effective after being agreed by the Bank; and
c. The Bank reserves the right to deny account opening application by notifying the reason to the Customer, unless otherwise regulated by the applicable legislation.
3. Joint Account
a. Joint Account shall be based on an agreement between the parties, particularly in relation with the provision of the authorized person and the authority to carry out the Instruction as well as the consequences that may arise relating to Joint Account.
b. The Customer who owns the Joint Account shall be responsible jointly and severally toward all obligations arising from the Joint Account.
c. The arrangement on the Joint Account will be regulated in a separate agreement that must be signed by all the names that are represented as the Joint Account holder.
4. The account can be accessed through the electronic banking services ("Services"), where it is agreed that, although there are other provisions contrary to this GT&CGT&C, in carrying out transactions on the account:
a. May be executed in any branch of Bank and Bank Services media,
b. Subject to the laws and regulations in force from time to time in the jurisdiction in which the branch office of the Bank or Bank Service media and / or Account are located, including but not limited to, local government policies, decisions or regulations relating to the supervision of currency or changes in currency, and If the service is used to execute any or all transactions relating to the Account of the third parties including, but not limited to, debit any account of a third party in the Bank, the Customer hereby agrees to complete the Bank with a power of attorney which its form and contents are approved by the Bank and if for any reason can not be furnished by the Customer, or the Bank does not approve the form and content of such power of attorney, the Bank shall not be obliged to provide any Services for the transaction.
INSTRUCTION
1. Instruction Media
a. Written Instruction Media
i. Unless determined otherwise, Instruction can only be done through a written order to the Bank such as a Cheque, “Giro Bilyet”, draft, payment orders or other media agreed by the Bank ("Instruction Media").
ii. Each instruction using a Cheque, “Giro Bilyet” or draft is
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xxxxx berlaku ketentuan peraturan perundangan yang mengatur mengenai hal tersebut.
iii. Nasabah setiap waktu wajib menjaga dengan baik Media Instruksi dan mencegah Media Instruksi tersebut untuk dikuasai oleh pihak yang tidak berwenang, dipalsukan atau digandakan sehingga dapat dimanfaatkan dalam suatu tindak kejahatan. Apabila Media Instruksi hilang atau tidak diketahui keberadaannya, maka Xxxxxxx wajib segera melaporkan secara tertulis kepada Bank dan pada instansi yang berwenang. Laporan ini wajib dilakukan dalam bentuk dan cara yang dapat diterima oleh Bank dan sesuai dengan ketentuan peraturan perundangan yang berlaku.
iv. Setiap penyalahgunaan Media Instruksi yang sudah diserah terimakan oleh Bank kepada Nasabah merupakan tanggung jawab sepenuhnya dari Nasabah.
v. Setiap permintaan blanko cek dan/atau bilyet giro oleh Nasabah, wajib mendapatkan persetujuan Bank dan dikenakan biaya yang ditetapkan dan diinformasikan kepada Nasabah oleh Bank. Penyerahan blanko cek dan/atau bilyet giro oleh Bank kepada Nasabah, wajib mempergunakan tanda terima resmi dari Bank.
vi. Nasabah bertanggung jawab penuh terhadap keabsahan dan keaslian Media Instruksi yang diserahkan kepada Bank.
b. Media Instruksi Jasa
i. Bank dapat memberikan layanan Jasa, seperti namun tidak terbatas pada penyediaan jasa Perbankan melalui perbankan elektronik, mesin faksimili dan/atau telepon.
ii. Ketentuan yang mengatur Jasa dapat ditetapkan secara lebih rinci dalam perjanjian penyediaan jasa yang terpisah dari KPUPR ini.
iii. Semua perjanjian penyediaan Jasa adalah merupakan satu-kesatuan dengan KPUPR, termasuk buku petunjuk (user guide), manual, data, proses, dan dokumen lainnya yang terkait (selanjutnya disebut “Materi”) yang dapat berubah dari waktu ke waktu.
Apabila terdapat ketidaksesuaian antara KPUPR dengan ketentuan dalam perjanjian penyediaan Jasa, maka yang berlaku adalah ketentuan dalam perjanjian yang berkaitan dengan penyediaan Jasa tertentu tersebut.
2. Penarikan Dana
a. Nasabah memberikan kewenangan kepada Bank untuk melaksanakan semua Instruksi Penarikan Dana oleh Nasabah melalui Media Instruksi yang diserahkan kepada Bank untuk dibebankan pada Rekening.
b. Dalam melaksanakan Instruksi Penarikan Dana, Nasabah wajib tunduk pada ketentuan Bank mengenai pembatasan maksimum penarikan dan/atau minimal saldo yang harus dipelihara.
c. Bank berhak menolak dan tidak melaksanakan Instruksi Penarikan Dana yang dapat menyebabkan Rekening bersaldo negative dan /atau kurang dari minimal saldo yang harus dipelihara. Bank atas kebijakannya sendiri dapat melaksanakan Penarikan Dana walaupun penarikan tersebut dapat menyebabkan rekening bersaldo negatif (overdraft). Dalam hal Rekening Nasabah bersaldo negatif, dengan ini Nasabah mengakui jumlah tersebut sebagai jumlah yang terhutang pada Bank dan oleh karenanya bertanggung jawab penuh atas pembayaran kembali jumlah terhutang berikut bunganya sebagaimana ditentukan oleh Bank.
d. Dalam hal Bank menerima lebih dari satu Instruksi Penarikan Dana yang secara keseluruhan melebihi jumlah saldo Rekening atau jumlah yang diperbolehkan untuk itu, maka Bank dapat berdasarkan kebijakannya sendiri untuk menentukan Instruksi mana yang akan dilaksanakan tanpa harus memperhatikan tanggal diterimanya atau waktu diterimanya Instruksi Nasabah untuk itu.
e. Bilamana Rekening dibuka dalam mata uang selain Rupiah, Penarikan Dana dalam mata uang yang sama tergantung pada ketersediaan dana pada Bank dalam mata uang tersebut dan tunduk pada ketentuan Bank mengenai biaya dan/atau nilai tukar mata uang tersebut.
f. Bank dapat mengenakan biaya untuk Instruksi Penarikan Dana yang rinciannya akan diatur secara terpisah dalam ketentuan tersendiri dan diberitahukan ke Nasabah.
3. Penyetoran Dana
a. Nasabah dengan ini meminta dan memberi kewenangan kepada Bank untuk melaksanakan Instruksi Penyetoran Dana baik tunai maupun non-tunai ke dalam Rekening. Namun demikian Bank atas kebijakannya sendiri berhak untuk menolak setiap setoran, membatasi jumlah setoran dan/atau mengembalikan seluruh atau sebagian dari setoran dimaksud.
b. Untuk penyetoran non-tunai berlaku ketentuan sebagai berikut:
i. Bank bertindak hanya sebagai wakil (kuasa) Nasabah untuk menagih dan tidak bertanggung jawab apabila terjadi penolakan atas penagihan setoran tersebut;
ii. Dalam pelaksanaan penagihan, Bank dapat meneruskan perintah Nasabah langsung kepada cabang Bank atau pihak ketiga lainnya yang dipilih oleh Bank yang mana ia untuk itu berhak menunjuk lagi pihak lain untuk melaksanakan perintah tersebut; dan
iii. Untuk setiap penyetoran non-tunai, penambahan saldo Rekening Nasabah baru akan berlaku efektif setelah Bank menerima dana.
c. Bilamana Rekening dibuka dalam mata uang selain Rupiah, Penyetoran Dana dalam mata uang yang sama tunduk pada ketentuan Bank mengenai biaya dan/atau nilai tukar mata uang tersebut.
d. Bank dapat mengenakan biaya untuk Instruksi Penyetoran Dana yang rinciannya akan diatur secara terpisah dalam ketentuan tersendiri dan diberitahukan ke Nasabah.
4. Koreksi Pembukuan
Nasabah dengan ini memberikan persetujuan kepada Bank bahwa Bank berhak, berdasarkan itikad baik, melakukan koreksi terhadap kesalahan pembukuan oleh Bank tanpa berkewajiban memberitahukan Nasabah.
5. Penolakan Pembayaran
subject to the provisions of laws and regulations governing such case.
iii. The customer shall at all times be obliged to maintain the Instruction Media properly and prevent such Instruction Media to be controlled by an unauthorized person, falsified or duplicated which may cause criminal action. If the Instruction Media is lost or unaccounted for, the Customer shall immediately notify in writing to the Bank and to the competent authority. The notification shall be in a form and manner which are acceptable to the Bank and in accordance with applicable laws.
iv. Any unauthorized use of Instruction Media that have already been delivered by the Bank to the Customer shall be the sole responsibility of the Customer.
v. Each request Cheque books and / or “Giro Bilyet” books by the Customer, shall be approved by the Bank and subject to fees set forth and communicated to the Customer by the Bank. The delivery of Cheque books and
/ or “Giro Bilyet” books by the Bank to the Customer, must use an official receipt from the Bank.
vi. The Customer shall be fully responsible for the validity and authenticity of the Instruction Media submitted to the Bank.
b. Service Instruction Media
i. The Bank may provide Services, such as, but not limited to, the provisions of banking services through electronic banking, facsimile and / or telephone.
ii. Provisions governing the Services may be set in more detail in a service agreement separated from this GT&CGT&C.
iii. All services agreement is an integral part with GT&C this GT&C, including each user guides, manuals, data, processes, and other related documents (hereinafter referred to as "Content") that may change from time to time.
Should there be nonconformities between GT&CGT&C with the provisions in the agreement of a certain service , provisions of the agreement relating to the provision of certain services shall apply.
2. Funds Withdrawal
a. The Customer authorizes the Bank to carry out all Instruction of Funds Withdrawal through Instruction Media submitted to the Bank to be charged to the Account.
b. In carrying out the Instruction of Funds Withdrawal, the Customer shall be subject to the provisions of the Bank on the withdrawal maximum restrictions and / or minimum balance that must be maintained.
c. The Bank reserves the right to deny and not carry out Instruction of Fund Withdrawal that may cause negative balance account and / or less than the minimum balance that must be be maintained. The Bank in its sole discretion may exercise the withdrawal of funds although it can lead to a negative balance accounts (overdraft). In the event that Customer's account has a negative balance, the Customer hereby acknowledges that the amount is as the amount owed to the bank and therefore fully responsible for the repayment of the amount owed with its interest as determined by the Bank.
d. In the event that the Bank receives more than one instruction of the Fund Withdrawal that overall exceeds the amount of the Account balance or the amount allowed for, the Bank may in its sole discretion determine which Instruction that will be carried out regardless the date and time of receipt of Customer's Instruction.
e. When the account is opened in currencies other than Rupiah, the withdrawal of funds in the same currency are subject to availability of such currency in and to the provisions of the Bank regarding fees and / or exchange rate.
f. The Bank may charge a fee for the Instruction of withdrawal of funds where its details will be set separately in separate provisions and notified to the Customer.
3. Funds Deposit
a. The Customer hereby requests and authorizes the Bank to carry out the Instruction of Funds Deposit either cash or non-cash into the Account. However, the Bank in its sole discretion reserves the right to deny any deposit, limit the amount of deposit and / or restore all or some of fund deposit.
b. For non-cash deposit, the following provisions apply:
i. The Bank shall only actas a representative of the Customer to collect and shall not be responsible in case of denial such payment collection;
ii. In the process of collecting fund, the Bank may continue the Customer orders directly to the bank branch or other third parties chosen by the Bank which then is entitled to reappoint other parties to execute such orders; and
iii. For any non-cash deposit, increment in Customer Account balance will be effective after Bank has duly receives funds.
c. When the account is opened in currencies other than Rupiah, the Funds Deposit in the same currency are subject to the provisions of the Bank regarding fees and / or exchange rate.
d. The Bank may charge a fee for instruction of Fund DepositPayment instruction where its details will be set separately in separate provisions and notified to the Customer.
4. Accounting Adjustments
The Customer hereby consent the Bank that the Bank reserves the right, in good faith, to conduct adjustments to the accounting errors by the Bank without any obligation to notify the Customer.
5. Stop Payment
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IV.
V.
a. Bank akan menerima perintah penolakan pembayaran (stop payment) atas setiap cek atau bilyet giro yang dapat diterima oleh Bank.
b. Bank tidak bertanggung jawab kepada Nasabah atau pihak lainnya apabila berdasarkan itikad baik Bank gagal untuk melaksanakan perintah tersebut.
c. Atas perintah penolakan pembayaran ini berlaku ketentuan yang ditetapkan oleh Bank Indonesia dan/atau Otoritas Jasa Keuangan dan ketentuan lain berkaitan dengan itu, termasuk tetapi tidak terbatas pada pemenuhan bukti laporan/pernyataan hilang dari instansi terkait.
6. Pembatalan atau Perubahan Instruksi
a. Nasabah tidak dapat membatalkan atau merubah Instruksi yang telah diterima oleh Bank.
b. Dalam hal Nasabah melakukan perubahan atau pembatalan Instruksi dan Instruksi tersebut telah dilaksanakan oleh Bank, Bank akan berusaha membantu untuk memenuhi permintaan Nasabah tersebut.
c. Nasabah mengetahui bahwa Bank tidak bertanggung jawab apabila terjadi penolakan atas pembatalan atau perubahan Instruksi
AKSES KE JASA DAN PROSEDUR
1. Akses ke Jasa
a. Jasa disediakan oleh Bank dengan cara sebagaimana tercantum dalam KPUPR.
b. Nasabah setuju untuk menggunakan Jasa dan Materi yang bersangkutan semata-mata untuk maksud yang sesuai dengan syarat, ketentuan dan prosedur yang tercantum dalam KPUPR dan maksud lain yang diperbolehkan oleh Bank, termasuk namun tidak terbatas pada prosedur untuk mengakses dan mengirim data dan Instruksi.
c. Bank tidak diwajibkan menerima Instruksi yang disampaikan melalui prosedur yang belum disepakati bersama secara tertulis. Namun, dalam hal tidak adanya kesepakatan tertulis demikian, Nasabah dengan ini setuju bahwa apabila Bank menerima permintaan Nasabah untuk melaksanakan Instruksi yang diberikan tanpa mengikuti suatu prosedur tertulis karena alasan apapun, maka Nasabah terikat oleh Instruksi khusus tersebut dan akan mengganti rugi dan membebaskan Bank dari segala tanggung jawab, tuntutan dan biaya (termasuk biaya kerugian dan biaya hukum), sehubungan dengan pelaksanaan Instruksi khusus, kode, dan perlengkapan pengamanan.
d. Bank berhak melakukan tindakan di luar yang disepakati secara tertulis untuk memverifikasi sumber atau isi dari suatu komunikasi atau Instruksi, termasuk asal-usul sumber dana sesuai peraturan perundangan yang berlaku.
e. Bank diberi kuasa dan wewenang melaksanakan instruksi dengan menggunakan sistem pembayaran atau Bank perantara yang dipilihnya sendiri, walaupun bila pilihan Bank tersebut berbeda dengan Instruksi dimaksud.
f. Prosedur dan perlengkapan pengamanan (termasuk tetapi tidak terbatas pada kode, password, PIN (Personal Identification Number), dan cara akses lainnya) adalah bersifat rahasia dan Nasabah setuju akan menggunakan dan menjaganya dengan sebaik-baiknya serta pada kesempatan pertama memberitahukan Bank apabila menemukan atau mencurigai bahwa ada di antara hal yang bersifat rahasia tersebut di atas telah atau mungkin telah terungkap kepada pihak yang tidak berhak atau berwenang.
g. Nasabah mengakui bahwa prosedur dan perlengkapan pengamanan yang diberikan Bank dimaksudkan untuk memverifikasi sumber suatu komunikasi dan bukan untuk mendeteksi kesalahan dalam pengiriman (transmisi) atau komunikasi, termasuk ketidaksesuaian antara nomor dan nama Rekening.
h. Bank, atau kuasa/wakilnya, dapat melaksanakan suatu Instruksi cukup dengan merujuk kepada nomor Rekening saja, bahkan bila nama pada Rekening yang bersangkutan juga diberikan, Bank tidak berkewajiban menemukan, dan tidak bertanggung jawab atas kesalahan yang dilakukan oleh Nasabah atau akibat duplikasi Instruksi yang dikeluarkan Nasabah.
i. Nasabah setuju untuk terikat pada dan akan menyelesaikan setiap perintah bayar yang dilaksanakan atas namanya sesuai dengan prosedur dan perlengkapan pengamanan yang telah disepakati.
j. Materi yang disediakan sehubungan dengan Jasa merupakan milik Bank dan merupakan rahasia Bank. Nasabah setuju menjaga kerahasiaan Materi dan membatasi akses hanya kepada kuasa/wakilnya (yang tunduk kepada kewajiban yang serupa dalam menjaga kerahasiaannya) yang memerlukan akses untuk keperluan pengguna Jasa.
2. Prosedur
a. Nasabah setuju untuk mematuhi Prosedur dalam menggunakan Jasa serta memberikan kuasa dan wewenang kepada Bank untuk bertindak sesuai dengan Prosedur yang berlaku, untuk mengirim dan memperlihatkan data dan melaksanakan setiap Instruksi dan sebagaimana layaknya, mendebet Rekening Nasabah yang bersangkutan.
b. Bank atas itikad baik mempunyai hak untuk sewaktu-waktu merubah Prosedur dengan tetap mengikuti ketentuan dalam butir XX.1 KPUPR ini.
MATERI. PERLENGKAPAN, DAN PERANGKAT
1. Nasabah setuju menggunakan semua Materi dengan cara yang ditetapkan dalam KPUPR ini dengan memperhatikan ketentuan peraturan perundangan yang berlaku.
2. Nasabah setuju tidak akan merubah Materi serta hanya akan menggunakan perangkat dan perlengkapan komputer yang memiliki lisensi dan telah disetujui oleh Bank dan/atau apabila Bank menyediakan perangkat dan perlengkapan tersebut, dengan cara yang ditentukan dalam Materi dan semata-mata sehubungan dengan Jasa.
3. Nasabah dilarang menggunakan tanpa izin atau melakukan
IV.
V.
a. The Bank will receive stop payment instruction for any Cheque or “Giro Bilyet” which can be accepted by the Bank.
b. The Bank shall not be liable to the Customer or other parties if based on its good faith the Bank fails to execute such orders.
c. Stop Payment instruction shall be subject to regulations set by Bank Indonesia and / or the Financial Services Authority and other provisions relating to it, including, but not limited to, the fulfillment of the evidence report / lost statement from the relevant agencies.
6. Instruction Cancellation or Revision
a. The Customer shall not be entitled to cancel or revise Instruction after been accepted by the Bank.
b. In the event that the Customer cancels or revised Instruction and the Instruction have been carried out by the Bank, the Bank will do its best effort to meet the Customer's request.
c. The Customer hereby agrees that the Bank shall not be responsible in the event of objection of the Instruction cancellation or revision.
ACCESS TO SERVICES AND PROCEDURES
1. Access to Service
a. The service is provided by the Bank in the manner stated in GT&CGT&C.
b. The Customer agrees to use the specified Services and Contents solely for the purpose in accordance with the terms, conditions and procedures set forth in GT&CGT&C and other purposes permitted by the Bank, including but not limited to the procedures for accessing and sending data and Instruction.
c. The Bank is not obliged to accept Instruction that are delivered through a procedure that has not been mutually agreed in writing. However, in the absence of such written agreement, the Customer hereby agrees that if the Bank accepts the Customer's request to carry out the Instruction given without following a written procedure due to any reason whatsoever, the Customer shall be bound by such special Instruction and shall indemnify and release the Bank of any liabilities, lawsuit, and expenses (including the cost of damages and legal fees), in relation to the implementation of specific Instruction, codes, and security tools.
d. The Bank reserves the right to take action beyond that agreed in writing to verify the source or content of a communication or instruction, including the origin of the source of funds according to applicable legislation.
e. The Bank is empowered and authorized to carry out Instruction using the payment system or intermediary bank of its own choosing, although it is different from the intended Instruction intended.
f. Procedures and security tools (including but not limited to code, password, PIN (Personal Identification Number), and other access ways) are confidential and the Customer agrees to properly use and maintain and to notify the Bank at the first opportunity upon discovery or suspicion that the confidential matters mentioned above have been or may have been exposed to unauthorized parties.
g. The Customer acknowledges that the procedures and security tools provided by the Bank are intended to verify the source of a communication and not to detect errors in the delivery (transmission) or communications, including the nonconformities between the number and account name.
h. The Bank, or its attorney / xxxxxxxxxxxxxxx, xxx carry out an Instruction simply by referring to the account number only, even if the name on the concerned account is also granted, the Bank is not obliged to find, and is not responsible for errors made by the Customer or due to duplication of Instruction issued customer.
i. The Customer agrees to be bound by and will resolve any payment instruction executed on in its name in accordance with the procedures and security tools that have been agreed.
j. The content provided in connection with the Services are the Bank’s property and the Bank confidential. The Customer agrees to maintain the confidentiality of Content and limit the access only for its attorney / representative (who are subject to the same obligations to maintain confidentiality) that require access for the service user needs.
2. Procedures
a. The Customer agrees to comply with the procedures of using the Services as well as provide power and authority to the Bank to act in accordance with the applicable procedures, to send and show the data and execute each Instruction and as deemed appropriate, to debit the Customer Account.
b. The Bank in good faith reserves the right at any time to change the Procedure by following the provisions of point
XX.1 of this GT&CGT&C.
MATERIALS, EQUIPMENT, AND DEVICES
1. The Customer agrees to use all the Materials in the manner prescribed in this GT&C, considering applicable laws and regulations.
2. The Customer agrees not to change the Materials and will only use device and computer equipments that are licensed and approved by the Bank and / or if the Bank provides devices and equipment, in a manner specified in the Materials and solely in connection with the Service.
3. The Customer is prohibited to use without permission or to
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VI.
modifikasi terhadap perangkat dan perlengkapan yang dimaksud.
4. Setelah berakhirnya pemberian Jasa, semua Materi, perangkat dan perlengkapan yang disediakan Bank harus dikembalikan kepada Bank dalam waktu selambat-lambatnya 5 (lima ) hari kerja.
5. Ketentuan dalam butir V ini berlaku, baik terhadap Materi yang disertai hak cipta maupun tidak, namun demikian KPUPR ini tidak dapat mempengaruhi status hak cipta dari Materi dimaksud.
PENGGUNA JASA
1. Nasabah (“Pengguna Jasa”) memberikan kuasa dan wewenang kepada Bank untuk melaksanakan Instruksi yang diberikan atau akan diberikan Nasabah atau oleh pihak yang mewakili Nasabah berdasarkan Surat Kuasa (“Kuasa Pengguna Jasa”).
2. Sepanjang Bank bertindak sesuai dengan prosedur, maka Bank tidak berkewajiban memverifikasi jati diri atau wewenang dari Pengguna Jasa atau Kuasa Pengguna Jasa yang memberikan atau mengkonfirmasikan Instruksi atau isi Instruksi.
3. Dalam hal Bank, meragukan keabsahan atau wewenang yang bersangkutan, Bank dengan segera akan menyampaikan pemberitahuan, yang dapat disampaikan melalui telepon atau media komunikasilainnya, kepada Nasabah mengenai penundaan atau penolakan Instruksi tersebut.
VI.
modify the concerned devices and equipment.
4. After the expiration of Service provisions, all Materials, devices and equipments provided by the Bank shall be returned to the Bank no later than five (5) working days.
5. The provisions in this point V applies both to the Material that is copyrighted or not, however GT&C shall not affect the copyright status from the Materials herein.
USERS OF SERVICE
1. The Customer ("Users of Service") provides the power and authority to the Bank to execute the Instruction given or will be given by the Customer or by the party representing the Customer under the Power of Attorney ("Users Attorney").
2. As long as the Bank acted in accordance with the procedure, the Bank shall not be obliged to verify identity or authority of the Service Users or Users Attorney to confirm the Instruction or Instruction contents.
3. In the case whereby the Bank has doubts concerning validity or authority, the Bank will promptly notify Customer, which can be submitted via telephone or other communication media, regarding the delay or rejection of the said Instruction.
VII.
PIHAK BERWENANG DAN CONTOH TANDA TANGAN
1. Nasabah wajib menyerahkan contoh tanda tangannya kepada Bank. Nasabah dapat menunjuk pihak yang berwenang mewakili Nasabah untuk melakukan Penarikan Dana berdasarkan Surat Kuasa dan menyerahkan kepada Bank contoh tanda tangan Pihak Berwenang tersebut beserta kewenangannya.
2. Dalam hal Nasabah berbentuk badan usaha, Nasabah wajib menunjuk pihak yang berwenang mewakili Nasabah untuk melakukan Penarikan Dana (“Pihak Berwenang”) dan menyerahkan kepada Bank contoh tanda tangan Pihak Berwenang tersebut beserta kewenangannya.
3. Setiap Media Instruksi Penarikan Dana atau Instruksi lainnya wajib ditandatangani oleh Pihak Berwenang sesuai dengan contoh tanda tangan yang ada pada Bank dan kewenangan yang berlaku sesuai dengan ketentuan pada saat itu
4. Bank berhak menunda dan/atau menolak setiap Instruksi Nasabah yang disebabkan:
a. Tidak memenuhi ketentuan sebagaimana ditetapkan dalam perundang-undangan yang berlaku termasuk namun tidak terbatas pada Undang-Undang mengenai pencucian uang.
b. Tanda tangannya tidak sesuai dengan contoh tanda tangan dan kewenangan yang ada pada Bank.
Atas penundaan dan/atau penolakan ini Nasabah melepaskan Bank dari segala tanggung jawab maupun tuntutan yang timbul dari manapun, termasuk dari Nasabah sendiri
VII. AUTHORIZED PARTY AND SIGNATURE SPECIMEN
1. The Customer is obliged to submit the signature specimen to the Bank. The Customer may designate the authority to represent the Customer to perform Funds Withdrawal by virtue of a Power of Attorney and submit to the Bank signature specimen of the Authorized Party as well as its authority.
2. In the event that the Customer is a business entity, the Customer shall designate the authority to represent the Customer to perform Funds Withdrawal ("Authorized Party") and submit to the Bank the signature specimen of the authorized parties and its authority.
3. Each Instruction Media of Funds Withdrawal or other Instruction shall be signed by the Authorized Party in accordance with the signature specimen and the prevailing authority.
4. The Bank reserves the right to suspend and / or reject any Customer Instruction caused by:
a. Does not meet the requirements as specified in the applicable law, including but not limited to the Act on Anti Money Laundering.
b. The signature does not match the signature specimen and the prevailing authority maintained in the Bank.
Upon delay and / or rejection of Instruction, the Customer indemnifies the Bank from any liabilities or claims arising from any party, including the Customer himself.
VIII. DAFTAR HITAM
Nasabah dengan ini menyatakan tidak berkeberatan Rekening-nya ditutup dan namanya dicantumkan dalam daftar hitam Bank Indonesia apabila terkena sanksi administratif di antaranya karena melakukan penarikan cek dan/atau bilyet giro kosong, sesuai dengan ketentuan yang berlaku pada Bank atau pada Perbankan di Indonesia. Cek dan/atau bilyet giro kosong adalah cek dan/atau bilyet giro yang ditolak karena dana Rekening tidak cukup.
VIII. BLACK LIST
The Customer hereby acknowledges shall not object if this Account is closed and his name is included in the black list of Bank Indonesia due to administrative sanctions for, among others, issuing unpayable Cheque or “Giro Bilyet”, in accordance with the
applicable provisions of the Bank or the banking system in Indonesia. Unpayable Cheques and/or “Giro Bilyet” is Cheques and/or “Giro Bilyet” which are rejected due to insufficient the funds.
IX.
X.
XI.
KEBIJAKAN DAN KETENTUAN BANK
Nasabah dari waktu ke waktu dengan ini tunduk pada kebijakan dan ketentuan Bank yang ditetapkan dengan itikad baik Bank berkaitan dengan:
1. Administrasi dan operasional Bank;
2. Standard pelayanan yang dapat diberikan oleh Bank kepada Nasabah;
3. Tarif seperti namun tidak terbatas pada nilai tukar, biaya ataupun tingkat bunga termasuk cara perhitungannya;
4. Pembatasan dalam melaksanakan Instruksi, seperti namun tidak terbatas pada jumlah saldo minimum, jumlah maksimum penarikan dalam satu transaksi ataupun dalam satu hari; serta Kebijakan dan ketentuan Bank lainnya mengenai Rekening.
BUNGA
1. Bank dapat memberikan bunga atau bentuk imbalan lainnya atas Rekening.
2. Apabila terjadi perubahan bunga atau imbalan, maka Bank akan memberitahukan kepada Nasabah melalui pengumuman di kantor cabang Bank atau media pemberitahuan lainnya yang dipandang layak oleh Bank dengan pemberhatikan ketentuan peraturan perundang-undangan yang berlaku.
3. Nasabah dengan ini mengetahui bahwa perubahan bunga atau imbalan bukan merupakan perubahan syarat dan ketentuan produk.
ONGKOS DAN BIAYA
IX. BANK POLICIES AND PROVISIONS
The Customer hereby commits to comply to the Bank's policies and provisions set by the Bank from time to time in good faith with regard to:
1. Bank Administration and Operations;
2. Services Standard that may be provided by the Bank to the Customer;
3. Tariffs such as but not limited to the exchange rate, fees or interest rates, including procedures of calculation;
4. Restrictions in carrying out Instruction, such as but not limited to the minimum balance amount, the maximum amount of withdrawal in one transaction or in a day; as well as the bank policies and provisions concerning the Account.
X. INTEREST
1. The Bank may give interest or other form of compensation on Account.
2. In the event of changes on interest or compensation, the Bank will notify the Customer through announcements in Bank branch Office or other notification media deemed appropriate by the Bank by considering applicable laws and regulations.
3. The Customer hereby acknowledges that changes in interest or compensation are not a change in the terms and conditions of the product.
1. Bank berhak membebankan ongkos, biaya dan tarif lainnya atas setiap aktifitas perbankan termasuk namun tidak terbatas pada pembukaan Rekening, atau pelaksanaan Instruksi, dimana Ketentuan mengenai ongkos, biaya, dan tarif lainnya sepenuhnya ditentukan oleh Bank dan diinformasikan kepada Nasabah.
2. Segala ongkos, biaya dan tarif termasuk biaya yang timbul karena pembukaan Rekening menjadi beban Nasabah dan Nasabah setuju membayar semua biaya yang akan ditetapkan oleh Bank dari waktu ke waktu atas jasa yang diberikan dengan
XI. CHARGES AND FEES
1. The Bank reserves the right to impose charges, fees and other tariffs on any banking activities, including but not limited to the Account opening, or execution of Instruction, whereby provisions regarding to the charges, fees and other tariffs are fully determined by the Bank and notified to the Customer.
2. All charges, fees and tariffs, including charges associated with account opening become the liability of the Customer and the
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memperhatikan ketentuan peraturan perundang-undangan yang berlaku.
3. Apabila tidak ada persetujuan lain, segala ongkos, biaya dan tarif akan dibebankan pada Rekening yang bersesuaian, tanpa mengurangi hak Bank untuk membebankannya pada Rekening Nasabah lainnya pada Bank. Untuk ini Bank setiap waktu diberi kuasa untuk melaksanakan pendebetan Rekening Nasabah dimaksud.
XII. MENINGGAL DUNIA/PAILIT/DIBUBARKAN
1. Dalam hal Nasabah meninggal dunia, Bank sewaktu-waktu berhak untuk memblokir Rekening dan hanya akan mengalihkan hak atas Rekening kepada ahli waris.
2. Dalam hal Nasabah dinyatakan pailit atau dibubarkan atau diletakkan di bawah pengawasan pihak yang ditunjuk oleh instansi yang berwenang, Nasabah dengan ini memberikan kuasa dan persetujuan kepada Bank untuk sewaktu-waktu untuk memblokir Rekening dan hanya akan mengalihkan hak atas Rekening kepada pihak pengganti haknya atau pihak yang ditunjuk tersebut
3. Bank berhak mensyaratkan dokumen sebagai dokumen pembuktian ahli waris atau pihak yang ditunjuk sebagaimana dimaksud dalam butir XII.1 atau XII.2 di atas.
Customer agrees to pay all charges to be determined by the Bank from time to time for Services provided with regards to the applicable laws and regulations.
3. Unless determined otherwise, all charges, fees and tariffs will be imposed to the corresponding Account, without inclination to the right of the Bank to impose it on other Customer Account with the Bank. For this purpose the Bank at all times is authorized to debit the Customer's account herein.
XII. DEATH / BANKRUPTCY / DISSOLUTION
1. In the event that the Customer passed away, the Bank may at all times reserves the right to block the Account and will only assign the account to the legal heirs.
2. In the event that the Customer is declared bankrupt or liquidated or placed under the supervision of the competent authority, the Customer hereby authorizes and consent to the Bank at all times to block the account and will only transfer the right of the Account to the legal assignee or designated parties.
3. The Bank reserves the rights to require the documentations to evidence the heirs or assigned party referred to in point XII.1 or
XII.2 above mentioned.
XIII. CATATAN BANK
1. Bank membukukan dan membuat catatan atas setiap mutasi yang terjadi sehubungan dengan Rekening beserta saldonya.
2. Apabila terdapat perbedaan antara pembukuan dan catatan Bank dengan pembukuan dan catatan yang dibuat oleh Nasabah, Nasabah dengan ini menyatakan tunduk dan setuju atas pembukuan dan Catatan yang dibuat oleh Bank tersebut dan mengakui bahwa pembukaan dan Catatan yang dibuat oleh Bank tersebut merupakan alat bukti yang sah dan mengikat Nasabah.
3. Nasabah dengan ini menerima, setuju dan mengakui bahwa bukti-bukti termasuk namun tidak terbatas pada catatan tertulis maupun tidak tertulis, seperti hasil rekaman transaksi yang ada pada Bank akan diterima, diakui dan berlaku sebagai alat bukti yang sah.
4. Cara pemberian laporan mengenai catatan Bank tersebut kepada Nasabah tergantung pada standar pelayanan yang berlaku pada Bank yang akan ditentukan oleh Bank dari waktu ke waktu, antara lain melalui Rekening Koran, Jasa Perbankan Elektronik, atau pencetakan pada buku tabungan milik Nasabah.
5. Bank menurut kebijakannya sendiri dapat menentukan suatu periode jangka waktu catatan yang tersedia bagi Nasabah.
XIII. BANK RECORDS
1. The Bank records and take notes of any movements that occur in connection with the Account as well as its balances.
2. In case of a difference between the records and notes of the Bank with records and notes made by the Customer, the Customer hereby represents and agrees with the records and notes provided by the Bank, and acknowledges that the records and notes provided by the Bank, shall be valid evidence and legally binding to the Customer.
3. The Customer hereby accepts, agrees and acknowledges that the evidences, including but not limited to written or unwritten notes, such as the recording of transactions in the Bank will be accepted, acknowledged and valid as evidence.
4. The procedures on reporting Bank's records to the Customer shall be subject to the standard of service which is applicable to the Bank which will be determined by the Bank from time to time, among others, through the Current Account, Electronic Banking Services, or notes on the Customer's pass book.
5. The Bank in its sole discretion may determine a period of records available to the Customer.
XIV. PEMBERITAHUAN
1. Setiap pemberitahuan oleh Bank dianggap telah diterima oleh Nasabah apabila dikirim ke alamat yang diberikan oleh Xxxxxxx secara tertulis kepada Bank atau ke alamat terakhir yang diketahui Bank sesuai dengan catatan pada Bank.
2. Setiap pemberitahuan melalui pos harus dianggap telah disampaikan pada saat diposkan. Setiap pemberitahuan melalui telex atau faksimili atau media elektronik lainnya dianggap telah disampaikan saat dikirimkan.
3. Nasabah wajib melakukan pemeriksaan atas setiap pemberitahuan yang disampaikan oleh Bank berkaitan dengan Catatan mutasi Rekening. Isi pemberitahuan dianggap diterima oleh Xxxxxxx apabila dalam waktu 7 (tujuh) hari kerja Bank tidak menerima pernyataan keberatan secara tertulis dari Nasabah.
XIV. NOTIFICATION
1. Any notification by the Bank shall be deemed received by the Customer, if it is sent to the address provided by the Customer in writing to the Bank or to the last address known by the Bank in accordance with the Bank's notes.
2. Any notice by mail shall be deemed to have been delivered at the time of posting. Any notice by telex or facsimile or other electronic media deemed to have been delivered when mailed.
3. The Customer shall check any notification delivered by the Bank relating to the Notes of Account mutation. The notification content shall be deemed accepted by the Customer if within seven (7) working days the Bank does not receive a written statement of objection from the Customer.
XV.
PERJUMPAAN HUTANG
Atas seluruh dana yang terdapat dalam Rekening, Nasabah setuju untuk dilakukan perjumpaan (kompensasi) dengan segala hutang nasabah kepada Bank dalam bentuk apapun baik yang sekarang ada maupun yang akan ada kemudian. Untuk itu Xxxxxxx memberikan kuasa kepada Bank untuk melakukan pencairan dan/atau pendebetan Rekening guna pelunasan kewajiban Nasabah yang terutang pada Bank tersebut.
XV.
SET OFF
On all funds available in the Account, the Customer agrees to be compensated/ set off with all customer obligations to the Bank in any form both currently exist and shall exist in the future. Therefore, the Customer shall authorize the Bank to conduct liquidation and / or debit the Customer's Account for settlement of obligations owed to the Bank.
XVI. KETERBUKAAN INFORMASI
1. Nasabah setuju untuk memberikan dan/atau mengkonfirmasikan informasi yang diperlukan Bank sehubungan dengan Nasabah, Rekening maupun data keuangan Nasabah lainnya.
2. Nasabah dengan ini memberikan persetujuan dan kewenangan kepada Bank untuk :
a. Menghubungi Nasabah melalui sarana komunikasi pribadi,
termasuk tetapi tidak terbatas pada telepon selular, layanan pesan singkat (Short Message Service/SMS) dan surat elektronik (e-mail) dalam rangka melakukan penawaran produk dan/atau layanan kepada Nasabah.
b. Memberikan kepada pihak lain, termasuk namun tidak terbatas pada anak perusahaan atau pihak terafiliasi dari Bank, informasi mengenai data dan/atau kegiatan Nasabah sebagaimana diperbolehkan berdasarkan hukum yang berlaku untuk tujuan komersial atau untuk tujuan lain yang dinilai wajar dan diperlukan oleh Bank.
3. Dengan menyetujui ketentuan butir 2 diatas,
a. Nasabah memahami penjelasan yang diberikan oleh Bank termasuk konsekuensinya.
b. Nasabah tidak berkeberatan untuk dihubungi oleh Bank atau pihak lain dalam rangka, antara lain untuk memasarkan produk.
XVI. INFORMATION DISCLOSURE
1. Customer agrees to provide and/or confirm the necessary information required by the Bank in connection with the Customer's Account or other financial data.
2. Customer hereby give consent and authorizes the Bank to:
a. Contact Customer by means of private communication, including but not limited to the mobile phone, short message service (SMS) and electronic mail (e-mail) in order to offer products and/or services to the Customer.
b. Give to the other party, including but not limited to subsidiaries or affiliated parties of the Bank, information about the data and/or activities Customer as permitted by applicable law for commercial purposes or for any other purpose which is considered reasonable and necessary by the Bank.
3. By agreeing to the provisions of item 2 above,
a. Customers understand the explanation given by the Bank,including the consequences.
b. Customer has no objection to be contacted by the Bank or other parties in order to market the product.
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XVII. PEMBLOKIRAN SEMENTARA DAN PENUTUPAN
1. Bank atas pertimbangannya sendiri setiap saat berhak memblokir untuk sementara, melepaskan blokir dan/atau menutup Rekening.
2. Nasabah setiap saat dapat memblokir untuk sementara dan/atau menutup Rekening melalui permintaan tertulis. Permintaan untuk melepaskan blokir oleh Nasabah wajib dilakukan secara tertulis.
3. Dalam hal Rekening telah ditutup, Nasabah berkewajiban untuk sesegera mungkin mengembalikan kepada Bank semua dokumen milik Bank, termasuk Media Instruksi yang belum dipakai dan masih ada padanya.
4. Saldo Rekening yang telah ditutup, apabila tidak diambil oleh Xxxxxxx dalam 6 (enam) bulan setelah tanggal penutupannya, maka Bank berhak membebankan biaya administrasi yang ditetapkan dan diinformasikan kepada Nasabah oleh Bank.
5. Pemutusan dan Pengalihan Hak Jasa Perbankan Elektronik
a. Nasabah dapat memutuskan penggunaan Jasa dengan pemberitahuan tertulis kepada Bank paling lambat 30 (tiga puluh) hari kalender sebelum tanggal pemutusan.
b. Nasabah tidak boleh mengalihkan penggunaan Jasa, sebagian atau keseluruhan, tanpa izin tertulis lebih dahulu dari Bank
c. Mengingat sifat Jasa yang diberikan, maka Bank mempunyai hak untuk setiap waktu memutuskan atau mengalihkan penyediaan Jasa, sebagian atau keseluruhan, kepada perusahaan afiliasi Bank.
6. Bank berhak untuk membatalkan dan atau menutup hubungan usaha dengan Nasabah dalam hal Nasabah tidak memenuhi ketentuan sebagaimana ditetapkan dalam perundang- undangan yang berlaku.
XVII. TEMPORARY BLOCKING AND CLOSURE
1. The Bank at its sole discretion reserves the right to block temporarily, release the block and / or close the account.
2. The Customer may at any time temporarily blocks and / or close the account through a written request. Request to release a block by the Customer shall also be in writing.
3. In the event that the Account has been closed, the Customer is obliged to immediately refund to the Bank all documents belonging to the Bank, including unused Instruction Media and still available to the Customer.
4. The Bank reserves the right to charge an administration fee that is determined and communicated to the Customer by the Bank.The Account Balance thaat has been closed, if not taken by the Customer within 6 (six) months after the closing date,
5. Termination and Assignment of the Electronic Banking Services
a. The Customer may terminate the use of the Service by written notice to the Bank not later than 30 (thirty) calendar days prior to the date of termination.
b. The Customer is not allowed to assign the use of the Services, in part or in whole, without the prior written consent of the Bank.
c. Given the nature of the services provided, the Bank reserves the right to at all times terminate or assign the provision of services, in part or in whole, to affiliated company of the Bank.
6. The Bank reserves the right to cancel or terminate business relationship with the Customer in the event that the Customer does not meet the requirements as specified in the applicable legislation.
XVIII. PERNYATAAN, JAMINAN, DAN JANJI TAMBAHAN
1. Nasabah menyatakan dan menjamin, sejak saat KPUPR ini ditandatangani dan selanjutnya sejak Jasa digunakan atau diserahkan menurut KPUPR ini, bahwa:
a. Semua persetujuan, izin, kuasa dan Instruksi yang diperlukan (jika ada) telah diberikan oleh pihak ketiga sehubungan dengan Jasa;
b. Semua permohonan atau pendaftaran yang diperlukan telah dilakukan (dan permohonan atau pendaftaran termasuk akan diperbaharui bila perlu) seperti disyaratkan instansi pemerintah atau sehubungan dengan penandatanganan dan pelaksanaan KPUPR ini;
c. Pelaksanaan KPUPR serta penyerahan dan penggunaan Jasa tidak melanggar, ketentuan peraturan perundangan yang berlaku;
d. Bila diminta Bank, Nasabah setuju memberikan kepada Bank salinan dari persetujuan, izin, kuasa Instruksi dimaksud. Nasabah selanjutnya setuju untuk dengan segera memberitahukan kepada Bank bila mencurigai atau mengetahui adanya keadaan yang dapat atau akan menyebabkan dilanggarnya pernyataan atau jaminan bersangkutan;
e. Nasabah telah menjalankan usahanya dan didirikan secara sah berdasarkan Undang-Undang Republik Indonesia;
f. KPUPR ini telah ditandatangani oleh pihak yang berwenang mewakili Nasabah dan diserahkan sebagaimana mestinya serta merupakan kewajiban yang dapat dilaksanakan, sah, berlaku, dan mengikat Nasabah;
g. Pada saat ditandatanganinya KPUPR ini, Nasabah wajib menyerahkan dari waktu ke waktu, nama dan contoh tanda tangan dari pihak yang diberi wewenang mewakili Nasabah dalam menandatangani segala dokumen yang diperlukan untuk mengakses data dan memberikan Instruksi sehubungan dengan Rekening, pemindahan dana dan transaksi keuangan dan non-keuangan lainnya secara elektronik atau dengan cara lain atas nama Nasabah sehubungan dengan penggunaan Jasa, disertai dengan surat kuasa, atau surat/dokumen yang sejenis yang menyatakan mengenai pemberian kuasa dari masing-masing pihak yang diberi wewenang dan pembatasannya, jika ada, dan mengenai keabsahan tanda tangannya;
h. Nasabah dengan ini memberi kuasa, dan wewenang kepada Bank untuk bertindak berdasarkan ketentuan tersebut pada butir XVIII.1.g di atas dalam melaksanakan instruksi;
i. Setiap perubahan nama atau keterangan lainnya mengenai Pihak Berwenang yang mewakili Nasabah harus disampaikan kepada Bank sekurang-kurangnya 1 (satu) hari kerja sebelum tanggal berlakunya perubahan; dan
j. Setiap kuasa yang diberikan Nasabah kepada Bank tidak dapat dibatalkan karena sebab apapun termasuk karena sebab sebagaimana disebutkan dalam Pasal 1813 Kitab Undang-Undang Hukum Perdata Indonesia.
k. Dalam hal Nasabah memberikan instruksi secara lisan dan para pihak setuju untuk melaksanakan instruksi dimaksud, maka setiap kesepakatan antara Nasabah dengan Bank untuk melaksanakan instruksi secara lisan akan menjadi risiko Nasabah.
l. Nasabah wajib memberitahukan Bank setiap adanya perubahan data, termasuk namun tidak terbatas pada perubahan alamat, nomor telepon, faksimili, Kartu Tanda Penduduk (KTP), Nomor Pokok Wajib Pajak (NPWP), tandatangan, pejabat yang berwenang menandatangani (berikut contoh tandatangan baru), susunan pengurus, status badan hukum, perizinan dan lain-lainnya. Perubahan ini efektif berlaku sejak diterima dan dicatatnya perubahan dimaksud dalam catatan Bank.
2. Tanpa Pelepasan Hak
Kegagalan atau keterlambatan suatu pihak dalam meminta ditaatinya suatu persyaratan atau dalam melaksanakan suatu hak atau tindakan menurut KPUPR bukan merupakan pelepasan hak atas persyaratan, hak atau tindakan tersebut.
3. Penyelesaian Sengketa
Setiap sengketa yang timbul menurut atau berdasarkan
XVIII. REPRESENTATIONS, WARRANTIES, AND ADDITIONAL UNDERTAKINGS
1. The Customer represents and warrants, as of the signing date of this GT&C and so long as the Service is used or delivered under this GT&C, that:
a. All the required approvals, permits, power and the Instruction (if any) have been provided by third parties in connection with the Service;
b. All the required application or registration that have been obtained (and application or registration will be updated if necessary) as required by the Government agencies or in relation with the signing and implementation of this GT&C;
c. The GT&C implementation as well as the delivery and use of the Service do not violate, the applicable law;
d. Upon request by the Bank, the Customer agrees to provide the Bank copies of the approvals, permit, referred Instruction authority. The Customer further agrees to immediately notify the Bank if suspect or aware of any circumstances that may or will cause a violation of the relevant representations or warranties;
e. The Customer has implemented its business and legally established under the Act of the Republic of Indonesia;
f. This GT&C has been signed by the authorized person representing the Customer and duly submitted as well as the obligation that can be implemented, legitimated, valid, and binding to the Customer;
g. At the time of signing of this GT&C, the Customer must submit from time to time, name and signature specimen of the person authorized to represent the Customer in signing all documents necessary to access the data and give Instruction with respect to the Account, transfer of funds and financial and other non- financial transactions electronically or by other means on behalf of the Customer in connection with use of the Service, accompanied by a power of attorney, or a letter / similar document stating about giving power of each party who is authorized and restrictions, if any, and the validity of his signature;
h. The Customer hereby authorizes the Bank to act based on these provisions in point XVIII.1.g above in executing the Instruction;
i. Any change of name or other information about the Authorized Party that represents the Customer shall be submitted to the Bank at least 1 (one) working day prior to the date of entry into force of the change; and
j. Any authority given by the Customer to the Bank may not be canceled due to any reason whatsoever, including for reasons as mentioned in Article 1813 Code Civil Code Indonesia.
k. In the event that the Customer gives oral Instruction and the parties agree to execute the referred Instruction, each arrangement between the Customer and the Bank to carry out oral Instruction will be the risk of the Customer.
l. The Customer must notify the Bank of any changes of the data, including but not limited to changes in address, telephone number, facsimile, ID Card (KTP), Taxpayer registration Number (TRN), signatures, authorized officials to sign (following the example of new signatures), board of management, legal status, licensing and others. The change shall be effective from the time of receipt and recorded by the Bank.
2. Waiver of Rights
The failure or delay of a party in requesting compliance of a requirement or in implementing a right or action according to GT&C shall not become the waiver of rights of such requirements, rights or actions.
3. Dispute Settlement
Any dispute arising in accordance with or under the provisions of
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ketentuan dalam KPUPR ini akan diselesaikan dengan cara sebagai berikut :
a. Para pihak setuju bahwa setiap perselisihan atau perbedaan pendapat yang timbul dari dan atau berkenaan dengan pelaksanaan KPUPR ini sepanjang memungkinkan akan diselesaikan dengan cara musyawarah.
b. Setiap perselisihan atau perbedaan pendapat yang tidak dapat diselesaikan secara musyawarah oleh para pihak, akan diselesaikan melalui mediasi di bidang Perbankan sesuai dengan ketentuan perundang-undangan yang berlaku.
c. Setiap perselisihan atau perbedaan pendapat yang tidak dapat diselesaikan baik secara musyawarah dan/atau mediasi di bidang perbankan, akan diselesaikan melalui salah satu Pengadilan Negeri di wilayah Republik Indonesia dengan tidak mengurangi hak dari Bank untuk mengajukan gugatan kepada Nasabah melalui Pengadilan lainnya baik di dalam maupun di luar wilayah Republik Indonesia dan Nasabah dengan ini menyatakan melepaskan haknya untuk mengajukan eksepsi mengenai kekuasaan relatif terhadap Pengadilan yang dipilih oleh pihak Bank.
4. Undang-Undang Yang Berlaku
a. KPUPR ini tunduk kepada Hukum Negara Republik Indonesia.
b. Apabila Nasabah memiliki atau memperoleh kekebalan yuridiksi suatu pengadilan atau proses hukum untuk dirinya sendiri atau harta bendanya, maka Nasabah dengan ini mutlak melepaskan hak atas kekebalan tersebut sehubungan dengan kewajibannya menurut KPUPR ini dan selanjutnya melepaskan hak atas pembelaan diri sehubungan dengan kekebalan yang dimiliki atau diperoleh terhadap suatu keputusan pengadilan sehubungan dengan KPUPR ini.
c. Disamping melalui cara-cara lain yang diizinkan Undang-Undang yang berlaku, proses hukum dapat disampaikan ke alamat untuk penyampaian pemberitahuan tersebut dibawah ini.
XIX. TANGGUNG JAWAB DAN FORCE MAJEURE
1. Tanggung Jawab Bank
a. Berdasarkan KPUPR ini Bank hanya bertanggung jawab terbatas terhadap kegagalan bertindak dalam melakukan instruksi Nasabah, kegagalan mana ditentukan menurut standar komersial yang berlaku di Bank dan dalam industri Perbankan pada lazimnya.
b. Bank tidak bertanggung jawab atas keterlambatan atau kegagalan pelaksanaan atau atas ketepatan (begitu juga Bank tidak bertanggung jawab memverifikasi ketetapan) setiap data atau instruksi yang diberikan oleh Nasabah karena kelalaian Nasabah sendiri atau pihak ketiga.
c. Dalam keadaan apapun Bank sama sekali tidak bertanggung jawab atas kerugian tidak langsung (konsekuensional), insidentil atau khusus bahkan bila telah diberitahu mengenai kemungkinan terjadinya ganti rugi tersebut.
2. Force Majeure
Bank tidak bertanggung jawab atas setiap tuntutan ataupun kerugian yang disebabkan karena keadaan segala sesuatu di luar kekuasaan Bank termasuk tetapi tidak terbatas pada perang, pemberontakan, pemogokan, huru-hara, bencana alam, maupun ketentuan pihak yang berwenang yang ada saat ini maupun yang akan datang.
XX. PERUBAHAN DAN KEBERLAKUAN SEBAGIAN KPUPR
1. Bank dapat sewaktu-waktu merubah KPUPR ini maupun ketentuan khusus yang berlaku untuk setiap jenis rekening. Dalam hal terjadi perubahan KPUPR, maka sebelum perubahan tersebut diberlakukan, Bank akan menyampaikan perubahan tersebut melalui media pemberian informasi/pengumuman yang lazim digunakan Bank untuk keperluan tersebut, seperti pemberitahuan melalui pengumuman pada kantor Bank atau melalui media lain yang mudah diakses Nasabah seperti media perbankan elektronik dengan memperhatikan ketentuan peraturan perundang-undangan yang berlaku.
2. Dalam hal terdapat ketentuan dalam KPUPR ini menjadi tidak berlaku atau tidak dapat diberlakukan karena suatu peraturan perundangan yang berlaku atau karena sebab lainnya maka keadaan tersebut tidak mempengaruhi atau berakibat terhadap ketentuan lainnya.
XXI. PENANGANAN KELUHAN/PENGADUAN
1. Dalam hal terdapat pertanyaan dan/atau keluhan/pengaduan terkait dengan transaksi yang dilakukan, maka Nasabah dapat mengajukan keluhan baik secara tertulis ke cabang Bank dan/atau secara lisan melalui Phone Banking 14041 dan/atau email 00000@xxxxxxxxx.xx.xx dengan memenuhi persyaratan dan prosedur pengaduan yang ditetapkan Bank.
2. Bank akan melakukan pemeriksaan/investigasi atas pengaduan Nasabah sesuai dengan kebijakan dan prosedur yang berlaku di Bank.
this GT&C will be settled in the following manners:
a. The parties agree that any dispute or disagreement arising out of or relating to the implementation of this GT&C will be solved in mutual deliberation as long as possible.
b. Any dispute or disagreement that cannot be settled amicably by the parties, will be settled through mediation in the field of Banking in accordance with applicable laws.
c. Any dispute or disagreement cannot be settled either by mutual deliberation and / or banking mediation , will be resolved through one of the District Court in the territory of the Republic of Indonesia with no inclination to the right of the Bank to file a lawsuit against the Customer by other courts both inside and in outside the territory of the Republic of Indonesia and the Customer hereby declares to waive his right to apply for an exception regarding the relative power of the Court chosen by the Bank.
4. Applicable Law
a. This GT&C is subject to the Laws of the Republic of Indonesia.
b. If the Customer has acquired immunity of jurisdiction of a court or legal process to himself or his properties, then the Customer hereby release the right on such immunity in connection to its obligations under this GT&C and release the right on self-defense in connection with the immunity possessed or acquired to a court decision in connection with this GT&C.
c. Aside from other means permitted by the applicable law, the legal process can be delivered to the address for the delivery of the notification mentioned below.
XIX. LIABILITIES AND FORCE MAJEURE
1. The Bank Liabilities
a. In accordance to this GT&C, the Bank shall only be liable limited to failure to act in conducting the Customer instruction, failure of which is determined according to the applicable commercial standards in the Bank and the banking industry.
b. The Bank shall not be responsible for any delay or failure of implementation or the accuracy (as well as the Bank is not responsible for verifying the decision) of any data or Instruction given by the Customer for Customer's own negligence or third party.
c. In any event the Bank shall not be liable for any indirect (consequence), incidental or special loss although the possibility of such remedies has been notified.
2. Force Majeure
The Bank shall not be responsible for any claims or losses due to any situations beyond the control of the Bank including but not limited to war, insurrection, strikes, riots, natural disasters, as well as the provisions of the authorities currently exist or in the future.
XX. CHANGES AND APPLICABILITY OF SOME GT&C
1. The Bank may at any time change this GT&C and special provisions which are applicable to each type of account. In the event of change to GT&C, before the change is implemented, the Bank will deliver these changes through the media providing information / announcements are commonly used by the Bank for this purpose, such as announcement on the Bank's office or through other media that are easily accessed by the Customer such as electronic banking media regarding to the provisions of the applicable law.
2. In the event that any provision of this GT&C becomes invalid or unenforceable for any applicable laws and regulations or for other reasons, this said situation does not influence or affect any other provisions.
XXI. COMPLAINT HANDLING
1. In case of any questions and / or grievances / complaints related to the executed transactions, the Customer may submit a complaint in writing to the Bank branch and / or verbally through Phone Banking 14041 and / or email 00000@xxxxxxxxx.xx.xx by fulfilling the requirements and complaints procedures established by the Bank.
2. The Bank will carry out inspection / investigation into complaints of the Customer in accordance with the applicable policies and procedures in the Bank.
XXII. KETENTUAN TAMBAHAN
1. Deposito
a. Deposito hanya dapat dibayarkan kembali (dicairkan) pada saat jatuh tempo dalam mata uang Rupiah di kantor bank dimana Deposito pertama kali dibuka. Bilamana Deposito dibuka dalam mata uang selain rupiah, pembayaran dengan mata uang yang sama saat jatuh tempo tergantung pada ketersediaan dana pada Bank dalam mata uang tersebut dan tunduk pada ketentuan Bank mengenai komisi/nilai tukar mata uang tersebut.
b. Pembayaran kembali pada saat jatuh tempo, akan dilakukan sesuai dengan Instruksi.
XXII. ADDITIONAL PROVISIONS
1. Time Deposits
a. Time deposits may only be re-paid (liquidated) on the due date in Rupiah at the Bank office where the deposits were first opened. If time deposit is opened in currencies other than Rupiah, repayment of the same currency on the due date will subject on the availability of such currency at the Bank and subject to the Bank provisions regarding to the commission / exchange rate of the currency.
b. The Repayment at the due date, will be conducted in accordance with the Instruction.
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c. Apabila jatuh tempo Deposito jatuh pada hari libur atau hari dimana Bank tidak beroperasi, pencairan akan dilakukan pada hari kerja berikutnya.
d. Penarikan sebagian atau seluruhnya atas jumlah Deposito sebelum jatuh waktu tidak diperkenankan.
e. Deposito dapat dibuka dalam kondisi perpanjangan secara otomatis atau automatic roll over (ARO).
f. Dalam hal Deposito dibuka dalam kondisi perpanjangan secara otomatis atau automatic roll over (ARO) :
- Bank tidak akan menerbitkan pemberitahuan dan konfirmasi penempatan Deposito untuk setiap kali perpanjangan kecuali apabila ada permintaan nasabah untuk itu.
- Dalam hal perpanjangan konfirmasi penempatan Deposito harus diterbitkan oleh Bank, maka Bank hanya akan menerbitkan konfirmasi penempatan Deposito perpanjangan tersebut apabila Deposan menyerahkan konfirmasi penempatan yang pernah diterbitkan dan diserahkan kepada Nasabah sebelumnya;
- Pencairan dapat langsung dilakukan di kantor bank. Bunga atas Deposito tidak akan diperhitungkan sesudah tanggal jatuh tempo, kecuali bila diperpanjang.
g. Bunga atas Deposito tidak akan diperhitungkan sesudah tanggal jatuh tempo, kecuali bila diperpanjang.
h. Bila Deposito diperpanjang, suku bunga atas Deposito tersebut sesuai dengan suku bunga yang berlaku pada saat tanggal perpanjangan.
i. Ketentuan khusus yang melekat pada setiap Rekening Deposito diatur tersendiri tapi tidak terpisah dari KPUPR.
j. Untuk Deposito yang dibuka melalui perbankan elektronik berlaku ketentuan khusus yang mengatur hal tersebut.
2. Tabungan
a. Bank akan menerbitkan buku tabungan atau kartu tabungan atau tanda kepesertaan tabungan atas nama Nasabah yang merupakan bukti kepemilikan Rekening.
b. Kecuali secara khusus diatur berbeda, Nasabah setuju untuk mencantumkan contoh tanda tangan pada bukti kepemilikan Rekening yang dipergunakan untuk media pencocokan dalam melakukan Pencairan Dana atau Instruksi lainnya.
c. Nasabah setiap waktu wajib menjaga dengan baik bukti kepemilikan Rekening dan mencegah bukti kepemilikan Rekening dikuasai oleh pihak yang tidak berwenang, dipalsukan, atau digandakan sehingga dapat menyebabkan tindakan kejahatan. Apabila bukti kepemilikan Rekening hilang atau tidak diketahui keberadaannya, maka Xxxxxxx wajib memberitahukan Bank segera setelah diketahuinya.Pemberitahuan ini wajib dilakukan secara tertulis disertai surat keterangan kehilangan dari Kepolisian atau dalam bentuk dan cara lain yang dapat diterima oleh Bank.
d. Setiap penyalahgunaan bukti kepemilikan Rekening merupakan tanggung jawab sepenuhnya dari Nasabah.
e. Nasabah wajib menunjukkan bukti kepemilikan Rekening setiap kali melakukan Penarikan Dana melalui kasir atau memberikan instruksi lainkepada Bank berkaitan dengan Rekening tabungan.
3. Giro
a. Bank akan menerbitkan cek, bilyet giro atau sarana perintah lainnya sesuai permintaan Nasabah (“Media Penarikan”).
b. Nasabah setuju untuk mencantumkan contoh tanda tangan sebagai media pencocokan dalam melakukan Penarikan Dana atau instruksi lainnya.
c. Nasabah setiap waktu wajib menjaga dengan baik media penarikan dan mencegah Media Penarikan dikuasai oleh pihak yang tidak berwenang, dipalsukan, atau digandakan sehingga dapat menyebabkan tindakan kejahatan.
d. Apabila Media Penarikan hilang atau tidak diketahui keberadaannya, maka Xxxxxxx wajib memberitahukan Bank segera setelah diketahuinya. Pemberitahuan ini wajib dilakukan secara tertulis disertai surat keterangan kehilangan dari Kepolisian atau dalam bentuk dan cara lain yang dapat diterima oleh Bank.
e. Setiap penyalahgunaan Media Penarikan merupakan tanggung jawab sepenuhnya dari nasabah.
4. Ketentuan dan persyaratan masing-masing produk/layanan yang belum diatur dalam KPUPR ini, akan diatur tersendiri dan merupakan satu-kesatuan yang tidak terpisahkan dengan KPUPR ini. Apabila terdapat perbedaan antara ketentuan yang diatur dalam KPUPR ini dengan aplikasi maupun ketentuan dan persyaratan masing-masing produk/layanan, maka yang berlaku adalah ketentuan yang diatur dalam aplikasi maupun ketentuan dan persyaratan masing-masing produk/layanan dimaksud.
5. KPUPR ini dibuat dalam Bahasa Indonesia dan Bahasa Inggris, dalam hal terdapat perbedaan penafsiran maka yang berlaku adalah klausula yang dibuat dalam Bahasa Indonesia.
6. KPUPR ini telah disesuaikan dengan ketentuan peraturan perundang-undangan termasuk ketentuan Peraturan Otoritas Jasa Keuangan.
Dengan ditandatanganinya KPUPR ini oleh Nasabah, maka Nasabah menyatakan telah membaca, mengerti, memahami dan menyetujui segala sesuatu yang tertulis dan dimaksud dalam KPUPR ini, dan oleh karenanya Nasabah berjanji serta mengikatkan diri kepada Bank untuk tunduk dan mematuhi seluruh ketentuan yang tercantum dalam KPUPR.
c. If the deposit due date falls on a holiday or a day on which the Bank is not in operation, the disbursements will be made on the next business day.
d. Withdrawal of some or as a whole on the amount of time deposit before the due date shall not be allowed.
e. Time deposits can be opened with automatic extension or automatic roll over (ARO).
f. In case whereby time deposit is opened condition automatic extension or automatic roll over (ARO):
- The Bank will not issue a notification and confirmation of placement of Time Deposits for each time of extension unless Customer requests for such confirmation.
- In case whereby confirmation of extension must be issued by the Bank, the Bank will only issue a confirmation of the extension only if the Depositor submit confirmation of placement that ever published and submitted to the Customer in advance;
- Liquidation may be directly performed in the office of the bank. The interest on deposits will not be taken into account after the due date, unless extended.
g. The Interest on Deposits will not be taken into account after the due date, unless it is extended.
h. When the deposits is extended, the interest rate on the deposits in accordance with the prevailing interest rates at the time of the execution date.
i. Special provisions which are attached to each Deposit Account is set up individually but not separated from GT&C.
j. Time deposits opened via electronic banking shall be subject to separate provisions.
2. Savings
a. The Bank will issue a pass book or savings card or saving membership card on behalf of the Customer which shall be evidence of Account ownership.
b. Unless specifically regulated, the Customer agrees to include signature specimen on the account ownership which will be used for verification media in conducting Fund Withdrawal or other Instruction.
c. The Customer is obliged at all times to properly maintain the evidence of Account ownership and prevent it to be possessed by an unauthorized party, falsified, or duplicated so that it may cause a criminal action. If evidence of Account ownership becomes missing or misplaced, the Customer must immediately notify the Bank . The notification shall be in writing accompanied by a loss statement from the Police or in other form and manner which are acceptable to the Bank.
d. Any misuse of Account ownership evidence is the sole responsibility of the Customer.
e. The Customer must present evidence of Account ownership every time conducting Funds Withdrawal or provide other Instruction to the Bank relating to the savings account through cashier.
3. Current Account
a. The Bank will issue a Cheque, “Giro Bilyet” or other means of instruction in accordance with the Customer demand (" Withdrawal Media").
b. The Customer agrees to submit a signature specimen as Bank’s means of verification upon receiving Funds Withdrawal or other Instruction.
c. The Customer shall at all times maintain the withdrawal media properly and prevent the withdrawal Media to be possessed by an unauthorized person, falsified, or duplicated so that it can lead to criminal action.
d. If the Withdrawal Media becomes missing or unknown, the Customer must immediately notify the Bank . This notification shall be in writing accompanied by a loss statement from the Police or in other form and manner that can be accepted by the Bank.
e. Any misuse of withdrawal media are the sole responsibility of the Customer.
4. The terms and conditions of each of the products / services that have not been regulated in this GT&C, will be regulated separately and shall be stipulated as an integral part of this GT&C. In case of differences between the provisions set forth in this GT&C and the application and the terms and conditions of each product / service, the provisions set forth in the application as well as the terms and conditions of each product / service herein will prevail.
5. This GT&C is provided in Bahasa Indonesia and in English, in the event of interpretation differences , the duly executed Bahasa Indonesian version of this contract shall prevail.
6. This GT&C has been adapted to the provisions of the law, including the provisions of the Financial Services Authority Regulation.
By signing of this GT&C, the Customer declares to have read, understood, comprehend and agreed to everything written and referred to in this GT&C, and therefore the Customers undertake and commit to bind themselves to the Bank to subject and comply with all provisions set forth in GT&C.
, Materai
Rp 6.000,-
, IDR 6,000
Stamp Duty
Tempat, tanggal, tandatangan, nama jelas Place, date, signature, Full Name
8/8
Pernyataan Mengenai Pengendali Akhir Perusahaan (Individual Ultimate Beneficial Owner(s))
Kepada : PT Bank CIMB Niaga Tbk
Nama Perusahaan | |
Alamat Perusahaan |
Saya, (Nama Lengkap), (Jabatan) pada perusahaan di atas, dengan ini menyatakan bahwa pada saat dokumen ini ditanda tangani, nama-nama berikut adalah individu yang mempunyai kepemilikan saham pada perusahaan tersebut sebesar minimal 25% atau lebih, baik secara langsung, maupun tidak langsung.
Nama Lengkap Individual Beneficial Owner (s) | Nama Alias (Jika Ada) | Alamat Tempat Tinggal | Kewarganegaraan | Tempat & Tanggal lahir | Persentase kepemilikan Saham (%) |
Catatan : Kolom dapat ditambahkan jika ada keterangan tambahan.
Saya, atas nama Perusahaan juga menyatakan bahwa akan segera menginformasikan PT Bank CIMB Niaga Tbk jika terdapat perubahan data terkait informasi kepemilikan saham tersebut di atas.
Atas Nama Perusahaan
Tanda Tangan : |
|
Nama Lengkap : | |
Posisi: | (Diisi oleh pejabat yang berwenang mewakili Perusahaan) |
Tanggal: |
|
FORMULIR DEKLARASI FATCA – Nasabah Non-Individu
FATCA DECLARATION FORM – Non Individual Account
Silahkan diisi dengan HURUF KAPITAL/ Please complete in BLOCK LETTERS
Nama Perusahaan / Name of Company | |
Bentuk Perusahaan /Type of Company |
Silahkandiisi dengan membubuhkan tanda “√ ”pada setiap jawaban Ya atau Tidak pada setiap pertanyaan di bawah ini /
Please check “√ ” Yes or No for each of the following questions :
Bagian A / Section A
1 | Apakah Perusahaan incorporated in U.S.? | didirikan | di | Amerika | Serikat? | Is | the | Company | □Ya /Yes □Tidak / No |
Jika salah satu jawaban di atas adalah “Ya”, silahkan melengkapi Formulir W-9 / Please complete the W-9 Form, if any answer of above question is “Yes”
Bagian B/ Section B
1 | Apakah Perusahaan memiliki identitas kependudukan dan/atau alamat korespondensi dan/atau PO BOX dan/atau nomor telepon di Amerika Serikat? / Does the Company have a U.S residence and/or U.S correspondence and/or U.S. X.X.Xxx and/or U.S telephone number? | □Ya /Yes □Tidak / No |
2 | Apakah Perusahaan memiliki Direktur yang berasal dari Amerika Serikat dan/atau pemegang saham perseorangan dan/atau badan hukum Amerika Serikat dengan kepemilikan lebih dari 10%? / Does the Company have any US directors and/or shareholders with more than 10% ownership or equivalent? | □Ya /Yes □Tidak / No |
3 | Apakah Perusahaan memberikan Surat Kuasa atau kewenangan tandatangan yang masih berlaku kepada seseorang yang memiliki alamat di Amerika Serikat? Does the Company grant any effective Power of Attorney (POA) or signatory authority to person with U.S. address? | □Ya /Yes □Tidak / No |
4 | Apakah Perusahaan memberikan instruksi otomatis untuk melakukan transfer dana ke rekening yang dikelola di Amerika Serikat? Does the Company give standing instructions to transfer funds to U.S accounts? | □Ya /Yes □Tidak / No |
Jika salah satu jawaban di atas adalah “Ya”, silahkan melengkapi form W-8BEN-E / Please complete the Form W-8BEN-E, if any answer of above question is “Yes”
Pernyataan & Jaminan / Representation & Warranty
Dengan menandatangani formulir ini, saya menyatakan bahwa informasi yang tercantum di atas adalah benar, akurat dan lengkap. Dengan mengacu pada peraturan perundang-undangan yang berlaku di Indonesia, dengan ini saya memberikan persetujuan kepada CIMB Niaga (selanjutnya disebut sebagai BANK) untuk memberikan informasi mengenai atau sehubungan dengan saya kepada perusahaan induk atau pihak terafiliasinya, regulator atau otoritas pajak di dalam maupun di luar negeri jika diperlukan guna memenuhi kewajiban perpajakan saya sesuai dengan peraturan perundang-undangan yang berlaku. Apabila disyaratkanoleh regulator atau otoritas pajak di dalam maupun di luar negeri, saya memahami dan menyetujui bahwa BANK mungkin memerlukan dokumen dan/atau formulir tambahan, yang akansaya tanda- tangani, apabila saya termasuk dalam pihak yang diatur oleh peraturan perundang-undangan tersebut. Saya juga memahami dan menyetujui bahwa BANK dapat memblokir, mendebet, dan membayarkan dari rekening(-rekening) saya sejumlah dana sebagaimana ditentukan oleh peraturan perundang-undangan tersebut atau ditentukan dalam perjanjian antara regulator maupun otoritas.
Saya bersedia dan menjamin untuk memberitahukan BANK (dalam waktu 30 hari kalender) apabila terdapat perubahan informasi yang telah saya berikan kepada BANK. Saya menyatakan bahwa saya merupakan pihak yang berwenang untuk menandatangani pernyataan dan mengisi formulir ini.
By signing this form, I declare that the information provided above is true, accurate and complete. Subject to the applicable Indonesian laws, I hereby consent for CIMB Niaga, (hereinafter referred to as “BANK”) to share my information with its parent or ultimate holding company or any of its affiliates, domestic or overseas regulators or tax authorities where necessary to establish my tax liability in any/or the relevant jurisdiction. Where required by domestic or overseas regulators or tax authorities, I understand and agree that BANK may be required to obtain additional documents and/or forms, which I will sign, if I am subject to the relevant jurisdiction’s requirements. I also understand and agree that BANK may withhold, withdraw and pay out, from my account(s) such amounts as may be required according to applicable laws, regulations, guidelines and/or agreements with regulators or authorities and directives.
I agree and undertake to notify the BANK within 30 calendar days if there is a change in any information which I have provided to the Bank. I hereby declare that I am fully authorized to sign and complete this form.
TandaTangan/Signature: Tanggal/ Date:
Jabatan / Designation :
Form W-9 (Rev. August 2013) Department of the Treasury Internal Revenue Service
Request for Taxpayer Identification Number and Certification
Give Form to the requester. Do not send to the IRS.
Name (as shown on your income tax return)
Print or type
See Specific Instructions on page 2.
Business name/disregarded entity name, if different from above
Check appropriate box for federal tax classification:
Individual/sole proprietor C Corporation S Corporation Partnership Trust/estate Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) a
Other (see instructions) a
Exemptions (see instructions):
Exempt payee code (if any)
Exemption from FATCA reporting code (if any)
Address (number, street, and apt. or suite no.) Requester’s name and address (optional)
City, state, and ZIP code
List account number(s) here (optional)
Part I Taxpayer Identification Number (TIN)
Employer identification number | |||||||||||
– | |||||||||||
Part II | Certification | ||||||||||
Enter your TIN in the appropriate box. The TIN provided must match the name given on the “Name” line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter.
Social security number
– –
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and
3. I am a U.S. citizen or other U.S. person (defined below), and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 3.
Sign Here
Signature of
U.S. person a
Date a
General Instructions
Section references are to the Internal Revenue Code unless otherwise noted.
Future developments. The IRS has created a page on XXX.xxx for information about Form W-9, at xxx.xxx.xxx/x0. Information about any future developments affecting Form W-9 (such as legislation enacted after we release it) will be posted on that page.
Purpose of Form
A person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, payments made to you in settlement of payment card and third party network transactions, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA.
Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the
withholding tax on foreign partners’ share of effectively connected income, and
4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct.
Note. If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are:
• An individual who is a U.S. citizen or U.S. resident alien,
• A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States,
• An estate (other than a foreign estate), or
• A domestic trust (as defined in Regulations section 301.7701-7).
Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax under section 1446 on any foreign partners’ share of effectively connected taxable income from such business. Further, in certain cases where a Form W-9 has not been received, the rules under section 1446 require a partnership to presume that a partner is a foreign person, and pay the section 1446 withholding tax. Therefore, if you are a
U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid section 1446 withholding on your share of partnership income.
Cat. No. 10231X Form W-9 (Rev. 8-2013)
In the cases below, the following person must give Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States:
• In the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not the entity,
• In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally, the U.S. grantor or other U.S. owner of the grantor trust and not the trust, and
• In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a grantor trust) and not the beneficiaries of the trust.
Foreign person. If you are a foreign person or the U.S. branch of a foreign bank that has elected to be treated as a U.S. person, do not use Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities).
Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a “saving clause.” Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items:
1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien.
2. The treaty article addressing the income.
3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions.
4. The type and amount of income that qualifies for the exemption from tax.
5. Sufficient facts to justify the exemption from tax under the terms of the treaty article.
Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes if his or her stay in the United States exceeds 5 calendar years.
However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption.
If you are a nonresident alien or a foreign entity, give the requester the appropriate completed Form W-8 or Form 8233.
What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS a percentage of such payments. This is called “backup withholding.” Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, payments made in settlement of payment card and third party network transactions, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding.
You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return.
Payments you receive will be subject to backup withholding if:
1. You do not furnish your TIN to the requester,
2. You do not certify your TIN when required (see the Part II instructions on page 3 for details),
3. The IRS tells the requester that you furnished an incorrect TIN,
4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or
5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only).
Certain payees and payments are exempt from backup withholding. See Exempt payee code on page 3 and the separate Instructions for the Requester of Form
W-9 for more information.
Also see Special rules for partnerships on page 1.
What is FATCA reporting? The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all United States account holders that are specified United States persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code on page 3 and the Instructions for the Requester of Form W-9 for more information.
Updating Your Information
You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Form W-9 if the name or TIN changes for the account, for example, if the grantor of a grantor trust dies.
Penalties
Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty.
Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment.
Misuse of TINs. If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties.
Specific Instructions
Name
If you are an individual, you must generally enter the name shown on your income tax return. However, if you have changed your last name, for instance, due to marriage without informing the Social Security Administration of the name change, enter your first name, the last name shown on your social security card, and your new last name.
If the account is in joint names, list first, and then circle, the name of the person or entity whose number you entered in Part I of the form.
Sole proprietor. Enter your individual name as shown on your income tax return on the “Name” line. You may enter your business, trade, or “doing business as (DBA)” name on the “Business name/disregarded entity name” line.
Partnership, C Corporation, or S Corporation. Enter the entity's name on the “Name” line and any business, trade, or “doing business as (DBA) name” on the “Business name/disregarded entity name” line.
Disregarded entity. For U.S. federal tax purposes, an entity that is disregarded as an entity separate from its owner is treated as a “disregarded entity.” See Regulation section 301.7701-2(c)(2)(iii). Enter the owner's name on the “Name” line. The name of the entity entered on the “Name” line should never be a disregarded entity. The name on the “Name” line must be the name shown on the income tax return on which the income should be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a single owner that is a U.S. person, the U.S. owner's name is required to be provided on the “Name” line. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity's name on the “Business name/disregarded entity name” line. If the owner of the disregarded entity is a foreign person, the owner must complete an appropriate Form W-8 instead of a Form W-9. This is the case even if the foreign person has a U.S. TIN.
Note. Check the appropriate box for the U.S. federal tax classification of the person whose name is entered on the “Name” line (Individual/sole proprietor, Partnership, C Corporation, S Corporation, Trust/estate).
Limited Liability Company (LLC). If the person identified on the “Name” line is an LLC, check the “Limited liability company” box only and enter the appropriate code for the U.S. federal tax classification in the space provided. If you are an LLC that is treated as a partnership for U.S. federal tax purposes, enter “P” for partnership. If you are an LLC that has filed a Form 8832 or a Form 2553 to be taxed as a corporation, enter “C” for C corporation or “S” for S corporation, as appropriate. If you are an LLC that is disregarded as an entity separate from its owner under Regulation section 301.7701-3 (except for employment and excise tax), do not check the LLC box unless the owner of the LLC (required to be identified on the “Name” line) is another LLC that is not disregarded for U.S. federal tax purposes. If the LLC is disregarded as an entity separate from its owner, enter the appropriate tax classification of the owner identified on the “Name” line.
Other entities. Enter your business name as shown on required U.S. federal tax documents on the “Name” line. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on the “Business name/disregarded entity name” line.
Exemptions
If you are exempt from backup withholding and/or FATCA reporting, enter in the Exemptions box, any code(s) that may apply to you. See Exempt payee code and Exemption from FATCA reporting code on page 3.
Exempt payee code. Generally, individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends. Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions.
Note. If you are exempt from backup withholding, you should still complete this form to avoid possible erroneous backup withholding.
The following codes identify payees that are exempt from backup withholding: 1—An organization exempt from tax under section 501(a), any IRA, or a
custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2)
2—The United States or any of its agencies or instrumentalities
3—A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or instrumentalities
4—A foreign government or any of its political subdivisions, agencies, or instrumentalities
5—A corporation
6—A dealer in securities or commodities required to register in the United States, the District of Columbia, or a possession of the United States
7—A futures commission merchant registered with the Commodity Futures Trading Commission
8—A real estate investment trust
9—An entity registered at all times during the tax year under the Investment Company Act of 1940
10—A common trust fund operated by a bank under section 584(a) 11—A financial institution
12—A middleman known in the investment community as a nominee or custodian
13—A trust exempt from tax under section 664 or described in section 4947 The following chart shows types of payments that may be exempt from backup
withholding. The chart applies to the exempt payees listed above, 1 through 13.
IF the payment is for . . . | THEN the payment is exempt for . . . |
Interest and dividend payments | All exempt payees except for 7 |
Broker transactions | Exempt payees 1 through 4 and 6 through 11 and all C corporations. S corporations must not enter an exempt payee code because they are exempt only for sales of noncovered securities acquired prior to 2012. |
Xxxxxx exchange transactions and patronage dividends | Exempt payees 1 through 4 |
Payments over $600 required to be reported and direct sales over $5,0001 | Generally, exempt payees 1 through 52 |
Payments made in settlement of payment card or third party network transactions | Exempt payees 1 through 4 |
1 See Form 1099-MISC, Miscellaneous Income, and its instructions.
2 However, the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup withholding: medical and health care payments, attorneys' fees, gross proceeds paid to an attorney, and payments for services paid by a federal executive agency.
Exemption from FATCA reporting code. The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign financial institutions. Therefore, if you are only submitting this form for an account you hold in the United States, you may leave this field blank.
Consult with the person requesting this form if you are uncertain if the financial institution is subject to these requirements.
A—An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section 7701(a)(37)
B—The United States or any of its agencies or instrumentalities
C—A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or instrumentalities
D—A corporation the stock of which is regularly traded on one or more established securities markets, as described in Reg. section 1.1472-1(c)(1)(i)
E—A corporation that is a member of the same expanded affiliated group as a corporation described in Reg. section 1.1472-1(c)(1)(i)
F—A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures, forwards, and options) that is registered as such under the laws of the United States or any state
G—A real estate investment trust
H—A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940
I—A common trust fund as defined in section 584(a) J—A bank as defined in section 581
K—A broker
L—A trust exempt from tax under section 664 or described in section 4947(a)(1) M—A tax exempt trust under a section 403(b) plan or section 457(g) plan
Part I. Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer identification number (ITIN). Enter it in the social security number box. If you do not have an ITIN, see How to get a TIN below.
If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. However, the IRS prefers that you use your SSN.
If you are a single-member LLC that is disregarded as an entity separate from its owner (see Limited Liability Company (LLC) on page 2), enter the owner’s SSN (or EIN, if the owner has one). Do not enter the disregarded entity’s EIN. If the LLC is classified as a corporation or partnership, enter the entity’s EIN.
Note. See the chart on page 4 for further clarification of name and TIN combinations.
How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local Social Security Administration office or get this form online at xxx.xxx.xxx. You may also get this form by calling 0-000-000-0000. Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at xxx.xxx.xxx/xxxxxxxxxx and clicking on Employer Identification Number (EIN) under Starting a Business. You can get Forms W-7 and SS-4 from the IRS by visiting XXX.xxx or by calling 1-800- TAX-FORM (0-000-000-0000).
If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN and write “Applied For” in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester.
Note. Entering “Applied For” means that you have already applied for a TIN or that you intend to apply for one soon.
Caution: A disregarded U.S. entity that has a foreign owner must use the appropriate Form W-8.
Part II. Certification
To establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if items 1, 4, or 5 below indicate otherwise.
For a joint account, only the person whose TIN is shown in Part I should sign (when required). In the case of a disregarded entity, the person identified on the “Name” line must sign. Exempt payees, see Exempt payee code earlier.
Signature requirements. Complete the certification as indicated in items 1 through 5 below.
1. Interest, dividend, and xxxxxx exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification.
2. Interest, dividend, broker, and xxxxxx exchange accounts opened after 1983 and broker accounts considered inactive during 1983. You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form.
3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification.
4. Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. “Other payments” include payments made in the course of the requester’s trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments made in settlement of payment card and third party network transactions, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations).
5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), IRA, Coverdell ESA, Archer MSA or HSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification.
What Name and Number To Give the Requester
For this type of account: | Give name and SSN of: |
1. Individual 2. Two or more individuals (joint account) 3. Custodian account of a minor (Uniform Gift to Minors Act) 4. a. The usual revocable savings trust (grantor is also trustee) b. So-called trust account that is not a legal or valid trust under state law 5. Sole proprietorship or disregarded entity owned by an individual 6. Grantor trust filing under Optional Form 1099 Filing Method 1 (see Regulation section 1.671-4(b)(2)(i)(A)) | The individual The actual owner of the account or, if combined funds, the first individual on the account 1 The minor 2 The grantor-trustee 1 The actual owner 1 The owner 3 The grantor* |
For this type of account: | Give name and EIN of: |
7. Disregarded entity not owned by an individual 8. A valid trust, estate, or pension trust 9. Corporation or LLC electing corporate status on Form 8832 or Form 2553 10. Association, club, religious, charitable, educational, or other tax-exempt organization 11. Partnership or multi-member LLC 12. A broker or registered nominee 13. Account with the Department of Agriculture in the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural program payments 14. Grantor trust filing under the Form 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see Regulation section 1.671-4(b)(2)(i)(B)) | The owner Legal entity 4 The corporation The organization The partnership The broker or nominee The public entity The trust |
1 List first and circle the name of the person whose number you furnish. If only one person on a joint account has an SSN, that person’s number must be furnished.
2 Circle the minor’s name and furnish the minor’s SSN.
3 You must show your individual name and you may also enter your business or “DBA” name on the “Business name/disregarded entity” name line. You may use either your SSN or EIN (if you have one), but the IRS encourages you to use your SSN.
4 List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account title.) Also see Special rules for partnerships on page 1.
*Note. Grantor also must provide a Form W-9 to trustee of trust.
Note. If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed.
Secure Your Tax Records from Identity Theft
Identity theft occurs when someone uses your personal information such as your name, social security number (SSN), or other identifying information, without your permission, to commit fraud or other crimes. An identity thief may use your SSN to get a job or may file a tax return using your SSN to receive a refund.
To reduce your risk:
• Protect your SSN,
• Ensure your employer is protecting your SSN, and
• Be careful when choosing a tax preparer.
If your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter.
If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity or credit report, contact the IRS Identity Theft Hotline at 0-000-000-0000 or submit Form 14039.
For more information, see Publication 4535, Identity Theft Prevention and Victim Assistance.
Victims of identity theft who are experiencing economic harm or a system problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance. You can reach TAS by calling the TAS toll-free case intake line at
0-000-000-0000 or TTY/TDD 0-000-000-0000.
Protect yourself from suspicious emails or phishing schemes. Phishing is the creation and use of email and websites designed to mimic legitimate business emails and websites. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private information that will be used for identity theft.
The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank, or other financial accounts.
If you receive an unsolicited email claiming to be from the IRS, forward this message to xxxxxxxx@xxx.xxx. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration at 0-000-000-0000. You can forward suspicious emails to the Federal Trade Commission at: xxxx@xxx.xxx or contact them at xxx.xxx.xxx/xxxxxxx or 1-877- IDTHEFT (0-000-000-0000).
Visit XXX.xxx to learn more about identity theft and how to reduce your risk.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with the IRS to report interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information. Xxxxxxx uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information.
Form W-8BEN-E
(February 2014)
Department of the Treasury Internal Revenue Service
Certificate of Status of Beneficial Owner for United States Tax Withholding and Reporting (Entities)
a For use by entities. Individuals must use Form W-8BEN. a Section references are to the Internal Revenue Code.
a Information about Form W-8BEN-E and its separate instructions is at xxx.xxx.xxx/xxxxx0xxxx.
a Give this form to the withholding agent or payer. Do not send to the IRS.
OMB No. 1545-1621
Do NOT use this form for: Instead use Form:
• U.S. entity or U.S. citizen or resident W-9
• A foreign individual W-8BEN (Individual)
• A foreign individual or entity claiming that income is effectively connected with the conduct of trade or business within the U.S.
(unless claiming treaty benefits) W-8ECI
• A foreign partnership, a foreign simple trust, or a foreign grantor trust (unless claiming treaty benefits) (see instructions for exceptions) . . W-8IMY
• A foreign government, international organization, foreign central bank of issue, foreign tax-exempt organization, foreign private foundation, or government of a U.S. possession claiming that income is effectively connected U.S. income or that is claiming
the applicability of section(s) 115(2), 501(c), 892, 895, or 1443(b) (unless claiming treaty benefits) (see instructions) W-8ECI or W-8EXP
• Any person acting as an intermediary W-8IMY
Part I | Identification of Beneficial Owner | |
1 Name of organization that is the beneficial owner | 2 Country of incorporation or organization | |
3 Name of disregarded entity receiving the payment (if applicable)
4 Chapter 3 Status (entity type) (Must check one box only): Simple trust Grantor trust
Central Bank of Issue Tax-exempt organization
Corporation Complex trust Private foundation
Disregarded entity Estate
Partnership Government
If you entered disregarded entity, partnership, simple trust, or grantor trust above, is the entity a hybrid making a treaty
claim? If "Yes" complete Part III. Yes No
5 Chapter 4 Status (FATCA status) (Must check one box only unless otherwise indicated). (See instructions for details and complete the certification below for the entity's applicable status).
Nonparticipating FFI (including a limited FFI or an FFI related to a Reporting IGA FFI other than a registered deemed-compliant FFI or participating FFI).
Participating FFI. Reporting Model 1 FFI. Reporting Model 2 FFI.
Registered deemed-compliant FFI (other than a reporting Model 1 FFI or sponsored FFI that has not obtained a GIIN).
Sponsored FFI that has not obtained a GIIN. Complete Part IV.
Certified deemed-compliant nonregistering local bank. Complete Part V.
Certified deemed-compliant FFI with only low-value accounts. Complete Part VI.
Certified deemed-compliant sponsored, closely held investment vehicle. Complete Part VII.
Certified deemed-compliant limited life debt investment entity. Complete Part VIII.
Certified deemed-compliant investment advisors and investment managers. Complete Part IX.
Owner-documented FFI. Complete Part X. Restricted distributor. Complete Part XI.
Nonreporting IGA FFI (including an FFI treated as a registered deemed-compliant FFI under an applicable Model 2 IGA).
Complete Part XII.
Foreign government, government of a U.S. possession, or foreign central bank of issue. Complete Part XIII.
International organization. Complete Part XIV. Exempt retirement plans. Complete Part XV.
Entity wholly owned by exempt beneficial owners. Complete Part XVI. Territory financial institution. Complete Part XVII.
Nonfinancial group entity. Complete Part XVIII.
Excepted nonfinancial start-up company. Complete Part XIX. Excepted nonfinancial entity in liquidation or bankruptcy.
Complete Part XX.
501(c) organization. Complete Part XXI. Nonprofit organization. Complete Part XXII.
Publicly traded NFFE or NFFE affiliate of a publicly traded corporation. Complete Part XXIII.
Excepted territory NFFE. Complete Part XXIV. Active NFFE. Complete Part XXV.
Passive NFFE. Complete Part XXVI.
Excepted inter-affiliate FFI. Complete Part XXVII. Direct reporting NFFE.
Sponsored direct reporting NFFE. Complete Part XXVIII.
6 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address (other than a registered address).
City or town, state or province. Include postal code where appropriate.
Country
7 Mailing address (if different from above)
City or town, state or province. Include postal code where appropriate. | Country | |||
8 U.S. taxpayer identification number (TIN), if required | 9a GIIN | b Foreign TIN | 10 Reference number(s) (see instructions) | |
Note. Please complete remainder of the form including signing the form in Part XXIX.
For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 59689N Form W-8BEN-E (2-2014)
Part II
Disregarded Entity or Branch Receiving Payment. (Complete only if disregarded entity or branch of an FFI in a country other than the FFI's country of residence.)
11 Chapter 4 Status (FATCA status) of disregarded entity or branch receiving payment
Limited Branch. Participating FFI.
Reporting Model 1 FFI. Reporting Model 2 FFI.
U.S. Branch.
12 Address of disregarded entity or branch (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address (other than a registered address).
City or town, state or province. Include postal code where appropriate.
Country
Part III
13 GIIN (if any)
Claim of Tax Treaty Benefits (if applicable). (For chapter 3 purposes only)
14 I certify that (check all that apply):
a The beneficial owner is a resident of within the meaning of the income tax treaty between the United States and that country.
b The beneficial owner derives the item (or items) of income for which the treaty benefits are claimed, and, if applicable, meets the
requirements of the treaty provision dealing with limitation on benefits (see instructions).
c The beneficial owner is claiming treaty benefits for dividends received from a foreign corporation or interest from a U.S. trade or business of a foreign corporation and meets qualified resident status (see instructions).
15 Special rates and conditions (if applicable—see instructions): The beneficial owner is claiming the provisions of Article
of the treaty identified on line 14a above to claim a % rate of withholding on (specify type of income): . Explain the reasons the beneficial owner meets the terms of the treaty article:
Part IV
Sponsored FFI That Has Not Obtained a GIIN
16 Name of sponsoring entity:
17 Check whichever box applies.
I certify that the entity identified in Part I:
• Is an FFI solely because it is an investment entity;
• Is not a QI, WP, or WT; and
• Has agreed with the entity identified above (that is not a nonparticipating FFI) to act as the sponsoring entity for this entity. I certify that the entity identified in Part I:
• Is a controlled foreign corporation as defined in section 957(a);
• Is not a QI, WP, or WT;
• Is wholly owned, directly or indirectly, by the U.S. financial institution identified above that agrees to act as the sponsoring entity for this entity; and
• Shares a common electronic account system with the sponsoring entity (identified above) that enables the sponsoring entity to identify all account holders and payees of the entity and to access all account and customer information maintained by the entity including, but not limited to, customer identification information, customer documentation, account balance, and all payments made to account holders or payees.
Certified Deemed-Compliant Nonregistering Local Bank
Part V
18 I certify that the FFI identified in Part I:
• Operates and is licensed solely as a bank or credit union (or similar cooperative credit organization operated without profit) in its country of incorporation or organization;
• Engages primarily in the business of receiving deposits from and making loans to, with respect to a bank, retail customers unrelated to such bank and, with respect to a credit union or similar cooperative credit organization, members, provided that no member has a greater than five percent interest in such credit union or cooperative credit organization;
• Does not solicit account holders outside its country of organization;
• Has no fixed place of business outside such country (for this purpose, a fixed place of business does not include a location that is not advertised to the public and from which the FFI performs solely administrative support functions);
• Has no more than $175 million in assets on its balance sheet and, if it is a member of an expanded affiliated group, the group has no more than $500 million in total assets on its consolidated or combined balance sheets; and
• Does not have any member of its expanded affiliated group that is a foreign financial institution, other than a foreign financial institution that is incorporated or organized in the same country as the FFI identified in Part I and that meets the requirements set forth in this Part V.
Form W-8BEN-E (2-2014)
Part VI
Certified Deemed-Compliant FFI with Only Low-Value Accounts
19 I certify that the FFI identified in Part I:
• Is not engaged primarily in the business of investing, reinvesting, or trading in securities, partnership interests, commodities, notional principal contracts, insurance or annuity contracts, or any interest (including a futures or forward contract or option) in such security, partnership interest, commodity, notional principal contract, insurance contract or annuity contract;
• No financial account maintained by the FFI or any member of its expanded affiliated group, if any, has a balance or value in excess of
$50,000 (as determined after applying applicable account aggregation rules); and
Part VII
• Neither the FFI nor the entire expanded affiliated group, if any, of the FFI, have more than $50 million in assets on its consolidated or combined balance sheet as of the end of its most recent accounting year.
Certified Deemed-Compliant Sponsored, Closely Held Investment Vehicle
20 Name of sponsoring entity:
21 I certify that the entity identified in Part I:
• Is an FFI solely because it is an investment entity described in §1.1471-5(e)(4);
• Is not a QI, WP, or WT;
• Has a contractual relationship with the above identified sponsoring entity that agrees to fulfill all due diligence, withholding, and reporting responsibilities of a participating FFI on behalf of this entity; and
• Twenty or fewer individuals own all of the debt and equity interests in the entity (disregarding debt interests owned by U.S. financial institutions, participating FFIs, registered deemed-compliant FFIs, and certified deemed-compliant FFIs and equity interests owned by an entity if that entity owns 100 percent of the equity interests in the FFI and is itself a sponsored FFI).
Part VIII Certified Deemed-Compliant Limited Life Debt Investment Entity
22 I certify that the entity identified in Part I:
• Was in existence as of January 17, 2013;
• Issued all classes of its debt or equity interests to investors on or before January 17, 2013, pursuant to a trust indenture or similar agreement; and
• Is certified deemed-compliant because it satisfies the requirements to be treated as a limited life debt investment entity (such as the restrictions with respect to its assets and other requirements under § 1.1471-5(f)(2)(iv)).
Part IX Certified Deemed-Compliant Investment Advisors and Investment Managers
23 I certify that the entity identified in Part I:
• Is a financial institution solely because it is an investment entity described in §1.1471-5(e)(4)(i)(A); and
• Does not maintain financial accounts.
Part X Owner-Documented FFI
Note. This status only applies if the U.S. financial institution or participating FFI to which this form is given has agreed that it will treat the FFI as an owner-documented FFI (see instructions for eligibility requirements). In addition, the FFI must make the certifications below.
24a (All owner-documented FFIs check here) I certify that the FFI identified in Part I:
• Does not act as an intermediary;
• Does not accept deposits in the ordinary course of a banking or similar business;
• Does not hold, as a substantial portion of its business, financial assets for the account of others;
• Is not an insurance company (or the holding company of an insurance company) that issues or is obligated to make payments with respect to a financial account;
• Is not owned by or in an expanded affiliated group with an entity that accepts deposits in the ordinary course of a banking or similar business, holds, as a substantial portion of its business, financial assets for the account of others, or is an insurance company (or the holding company of an insurance company) that issues or is obligated to make payments with respect to a financial account; and
• Does not maintain a financial account for any nonparticipating FFI.
Form W-8BEN-E (2-2014)
Part X
Owner-Documented FFI (continued)
Check box 24b or 24c, whichever applies.
b I certify that the FFI identified in Part I:
• Has provided, or will provide, an FFI owner reporting statement that contains:
• The name, address, TIN (if any), chapter 4 status, and type of documentation provided (if required) of every individual and specified U.S. person that owns a direct or indirect equity interest in the owner-documented FFI (looking through all entities other than specified U.S. persons);
• The name, address, TIN (if any), chapter 4 status, and type of documentation provided (if required) of every individual and specified U.S. person that owns a debt interest in the owner-documented FFI (including any indirect debt interest, which includes debt interests in any entity that directly or indirectly owns the payee or any direct or indirect equity interest in a debt holder of the payee) that constitutes a financial account in excess of $50,000 (disregarding all such debt interests owned by participating FFIs, registered deemed-compliant FFIs, certified deemed-compliant FFIs, excepted NFFEs, exempt beneficial owners, or U.S. persons other than specified U.S. persons); and
• Any additional information the withholding agent requests in order to fulfill its obligations with respect to the entity.
c I certify that the FFI identified in Part I has provided, or will provide, an auditor's letter, signed within four years of the date of payment,
from an independent accounting firm or legal representative with a location in the United States stating that the firm or representative has reviewed the FFI's documentation with respect to all of its owners and debt holders identified in §1.1471-3(d)(6)(iv)(A)(2), and that the FFI meets all the requirements to be an owner-documented FFI. The FFI identified in Part I has also provided, or will provide, an FFI owner reporting statement of its owners that are specified U.S. persons and Form(s) W-9, with applicable waivers.
Check box 24d if applicable.
Part XI
d I certify that the entity identified in line 1 is a trust that does not have any contingent beneficiaries or designated classes with unidentified beneficiaries.
Restricted Distributor
25a (All restricted distributors check here) I certify that the entity identified in Part I:
• Operates as a distributor with respect to debt or equity interests of the restricted fund with respect to which this form is furnished;
• Provides investment services to at least 30 customers unrelated to each other and less than half of its customers are related to each other;
• Is required to perform AML due diligence procedures under the anti-money laundering laws of its country of organization (which is an FATF- compliant jurisdiction);
• Operates solely in its country of incorporation or organization, has no fixed place of business outside of that country, and has the same country of incorporation or organization as all members of its affiliated group, if any;
• Does not solicit customers outside its country of incorporation or organization;
• Has no more than $175 million in total assets under management and no more than $7 million in gross revenue on its income statement for the most recent accounting year;
• Is not a member of an expanded affiliated group that has more than $500 million in total assets under management or more than $20 million in gross revenue for its most recent accounting year on a combined or consolidated income statement; and
• Does not distribute any debt or securities of the restricted fund to specified U.S. persons, passive NFFEs with one or more substantial U.S. owners, or nonparticipating FFIs.
Check box 25b or 25c, whichever applies.
I further certify that with respect to all sales of debt or equity interests in the restricted fund with respect to which this form is furnished that are made after December 31, 2011, the entity identified in Part I:
b Has been bound by a distribution agreement that contained a general prohibition on the sale of debt or securities to U.S. entities and U.S. resident individuals and is currently bound by a distribution agreement that contains a prohibition of the sale of debt or securities to any specified U.S. person, passive NFFE with one or more substantial U.S. owners, or nonparticipating FFI.
Part XII
c Is currently bound by a distribution agreement that contains a prohibition on the sale of debt or securities to any specified U.S. person, passive NFFE with one or more substantial U.S. owners, or nonparticipating FFI and, for all sales made prior to the time that such a restriction was included in its distribution agreement, has reviewed all accounts related to such sales in accordance with the procedures identified in §1.1471-4(c) applicable to preexisting accounts and has redeemed or retired any, or caused the restricted fund to transfer the securities to a distributor that is a participating FFI or reporting Model 1 FFI securities which were sold to specified U.S. persons, passive NFFEs with one or more substantial U.S. owners, or nonparticipating FFIs.
Nonreporting IGA FFI
26 I certify that the entity identified in Part I:
• Meets the requirements to be considered a nonreporting financial institution pursuant to an applicable IGA between the United States and
;
• Is treated as a under the provisions of the applicable IGA (see instructions); and
• If you are an FFI treated as a registered deemed-compliant FFI under an applicable Model 2 IGA, provide your GIIN:
Form W-8BEN-E (2-2014)
Part XIII Foreign Government, Government of a U.S. Possession, or Foreign Central Bank of Issue
27 I certify that the entity identified in Part I is the beneficial owner of the payment and is not engaged in commercial financial activities of a type engaged in by an insurance company, custodial institution, or depository institution with respect to the payments, accounts, or obligations for which this form is submitted (except as permitted in §1.1471-6(h)(2)).
Part XIV International Organization
Check box 28a or 28b, whichever applies.
28a I certify that the entity identified in Part I is an international organization described in section 7701(a)(18).
b I certify that the entity identified in Part I:
• Is comprised primarily of foreign governments;
• Is recognized as an intergovernmental or supranational organization under a foreign law similar to the International Organizations Immunities Act;
• The benefit of the entity's income does not inure to any private person;
• Is the beneficial owner of the payment and is not engaged in commercial financial activities of a type engaged in by an insurance company, custodial institution, or depository institution with respect to the payments, accounts, or obligations for which this form is submitted (except as permitted in §1.1471-6(h)(2)).
Part XV Exempt Retirement Plans
Check box 29a, b, c, d, e, or f, whichever applies. 29a I certify that the entity identified in Part I:
• Is established in a country with which the United States has an income tax treaty in force (see Part III if claiming treaty benefits);
• Is operated principally to administer or provide pension or retirement benefits; and
• Is entitled to treaty benefits on income that the fund derives from U.S. sources (or would be entitled to benefits if it derived any such income) as a resident of the other country which satisfies any applicable limitation on benefits requirement.
b I certify that the entity identified in Part I:
• Is organized for the provision of retirement, disability, or death benefits (or any combination thereof) to beneficiaries that are former employees of one or more employers in consideration for services rendered;
• No single beneficiary has a right to more than 5% of the FFI's assets;
• Is subject to government regulation and provides annual information reporting about its beneficiaries to the relevant tax authorities in the country in which the fund is established or operated; and
• Is generally exempt from tax on investment income under the laws of the country in which it is established or operates due to its status as a retirement or pension plan;
• Receives at least 50% of its total contributions from sponsoring employers (disregarding transfers of assets from other plans described in this part, retirement and pension accounts described in an applicable Model 1 or Model 2 IGA, other retirement funds described in an applicable Model 1 or Model 2 IGA, or accounts described in §1.1471-5(b)(2)(i)(A));
• Either does not permit or penalizes distributions or withdrawals made before the occurrence of specified events related to retirement, disability, or death (except rollover distributions to accounts described in §1.1471-5(b)(2)(i)(A) (referring to retirement and pension accounts), to retirement and pension accounts described in an applicable Model 1 or Model 2 IGA, or to other retirement funds described in this part or in an applicable Model 1 or Model 2 IGA); or
• Limits contributions by employees to the fund by reference to earned income of the employee or may not exceed $50,000 annually.
c I certify that the entity identified in Part I:
• Is organized for the provision of retirement, disability, or death benefits (or any combination thereof) to beneficiaries that are former employees of one or more employers in consideration for services rendered;
• Has fewer than 50 participants;
• Is sponsored by one or more employers each of which is not an investment entity or passive NFFE;
• Employee and employer contributions to the fund (disregarding transfers of assets from other plans described in this part, retirement and pension accounts described in an applicable Model 1 or Model 2 IGA, or accounts described in §1.1471-5(b)(2)(i)(A)) are limited by reference to earned income and compensation of the employee, respectively;
• Participants that are not residents of the country in which the fund is established or operated are not entitled to more than 20 percent of the fund's assets; and
• Is subject to government regulation and provides annual information reporting about its beneficiaries to the relevant tax authorities in the country in which the fund is established or operates.
d I certify that the entity identified in Part I is formed pursuant to a pension plan that would meet the requirements of section 401(a), other than the requirement that the plan be funded by a trust created or organized in the United States.
e I certify that the entity identified in Part I is established exclusively to earn income for the benefit of one or more retirement funds
described in this part or in an applicable Model 1 or Model 2 IGA, accounts described in §1.1471-5(b)(2)(i)(A) (referring to retirement and pension accounts), or retirement and pension accounts described in an applicable Model 1 or Model 2 IGA.
Form W-8BEN-E (2-2014)
Exempt Retirement Plans (Continued)
f
I certify that the entity identified in Part I:
Part XV
• Is established and sponsored by a foreign government, international organization, central bank of issue, or government of a U.S. possession (each as defined in §1.1471-6) or an exempt beneficial owner described in an applicable Model 1 or Model 2 IGA to provide retirement, disability, or death benefits to beneficiaries or participants that are current or former employees of the sponsor (or persons designated by such employees); or
• Is established and sponsored by a foreign government, international organization, central bank of issue, or government of a U.S. possession (each as defined in §1.1471-6) or an exempt beneficial owner described in an applicable Model 1 or Model 2 IGA to provide retirement, disability, or death benefits to beneficiaries or participants that are not current or former employees of such sponsor, but are in consideration of personal services performed for the sponsor.
Part XVI Entity Wholly Owned by Exempt Beneficial Owners
30 I certify that the entity identified in Part I:
• Is an FFI solely because it is an investment entity;
• Each direct holder of an equity interest in the investment entity is an exempt beneficial owner described in §1.1471-6 or in an applicable Model 1 or Model 2 IGA;
• Each direct holder of a debt interest in the investment entity is either a depository institution (with respect to a loan made to such entity) or an exempt beneficial owner described in §1.1471-6 or an applicable Model 1 or Model 2 IGA.
• Has provided an owner reporting statement that contains the name, address, TIN (if any), chapter 4 status, and a description of the type of documentation provided to the withholding agent for every person that owns a debt interest constituting a financial account or direct equity interest in the entity; and
• Has provided documentation establishing that every owner of the entity is an entity described in §1.1471-6(b), (c), (d), (e), (f) and/or (g) without regard to whether such owners are beneficial owners.
Part XVII Territory Financial Institution
31 I certify that the entity identified in Part I is a financial institution (other than an investment entity) that is incorporated or organized under the laws of a possession of the United States.
Part XVIII Excepted Nonfinancial Group Entity
32 I certify that the entity identified in Part I:
• Is a holding company, treasury center, or captive finance company and substantially all of the entity's activities are functions described in
§1.1471-5(e)(5)(i)(C) through (E);
• Is a member of a nonfinancial group described in §1.1471-5(e)(5)(i)(B);
• Is not a depository or custodial institution (other than for members of the entity's expanded affiliated group); and
• Does not function (or hold itself out) as an investment fund, such as a private equity fund, venture capital fund, leveraged buyout fund, or any investment vehicle with an investment strategy to acquire or fund companies and then hold interests in those companies as capital assets for investment purposes.
Part XIX Excepted Nonfinancial Start-Up Company
33 I certify that the entity identified in Part I:
• Was formed on (or, in the case of a new line of business, the date of board resolution approving the new line of business) (date must be less than 24 months prior to date of payment);
• Is not yet operating a business and has no prior operating history or is investing capital in assets with the intent to operate a new line of
business other than that of a financial institution or passive NFFE;
• Is investing capital into assets with the intent to operate a business other than that of a financial institution; and
• Does not function (or hold itself out) as an investment fund, such as a private equity fund, venture capital fund, leveraged buyout fund, or any investment vehicle whose purpose is to acquire or fund companies and then hold interests in those companies as capital assets for investment purposes.
Part XX Excepted Nonfinancial Entity in Liquidation or Bankruptcy
34 I certify that the entity identified in Part I:
• Filed a plan of liquidation, filed a plan of reorganization, or filed for bankruptcy on ;
• During the past 5 years has not been engaged in business as a financial institution or acted as a passive NFFE;
• Is either liquidating or emerging from a reorganization or bankruptcy with the intent to continue or recommence operations as a nonfinancial entity; and
• Has, or will provide, documentary evidence such as a bankruptcy filing or other public documentation that supports its claim if it remains in bankruptcy or liquidation for more than three years.
Part XXI 501(c) Organization
35
I certify that the entity identified in Part I is a 501(c) organization that:
• Has been issued a determination letter from the IRS that is currently in effect concluding that the payee is a section 501(c) organization that is dated ; or
• Has provided a copy of an opinion from U.S. counsel certifying that the payee is a section 501(c) organization (without regard to whether the payee is a foreign private foundation).
Form W-8BEN-E (2-2014)
Part XXII Non-Profit Organization
36 I certify that the entity identified in Part I is a non-profit organization that meets the following requirements:
• The entity is established and maintained in its country of residence exclusively for religious, charitable, scientific, artistic, cultural or educational purposes;
• The entity is exempt from income tax in its country of residence;
• The entity has no shareholders or members who have a proprietary or beneficial interest in its income or assets;
• Neither the applicable laws of the entity's country of residence nor the entity's formation documents permit any income or assets of the entity to be distributed to, or applied for the benefit of, a private person or non-charitable entity other than pursuant to the conduct of the entity's charitable activities or as payment of reasonable compensation for services rendered or payment representing the fair market value of property which the entity has purchased; and
• The applicable laws of the entity's country of residence or the entity's formation documents require that, upon the entity's liquidation or dissolution, all of its assets be distributed to an entity that is a foreign government, an integral part of a foreign government, a controlled entity of a foreign government, or another organization that is described in this Part XXII or escheats to the government of the entity's country of residence or any political subdivision thereof.
Part XXIII Publicly Traded NFFE or NFFE Affiliate of a Publicly Traded Corporation
Check box 37a or 37b, whichever applies. 37a I certify that:
• The entity identified in Part I is a foreign corporation that is not a financial institution; and
• The stock of such corporation is regularly traded on one or more established securities markets, including (name one securities exchange upon which the stock is regularly traded).
b I certify that:
• The entity identified in Part I is a foreign corporation that is not a financial institution;
• The entity identified in Part I is a member of the same expanded affiliated group as an entity the stock of which is regularly traded on an established securities market;
• The name of the entity, the stock of which is regularly traded on an established securities market, is ; and
• The name of the securities market on which the stock is regularly traded is .
Part XXIV Excepted Territory NFFE
38 I certify that:
• The entity identified in Part I is an entity that is organized in a possession of the United States;
• The entity identified in Part I:
• Does not accept deposits in the ordinary course of a banking or similar business,
• Does not hold, as a substantial portion of its business, financial assets for the account of others, or
• Is not an insurance company (or the holding company of an insurance company) that issues or is obligated to make payments with respect to a financial account; and
• All of the owners of the entity identified in Part I are bona fide residents of the possession in which the NFFE is organized or incorporated.
Part XXV Active NFFE
39 I certify that:
• The entity identified in Part I is a foreign entity that is not a financial institution;
• Less than 50% of such entity's gross income for the preceding calendar year is passive income; and
• Less than 50% of the assets held by such entity are assets that produce or are held for the production of passive income (calculated as a weighted average of the percentage of passive assets measured quarterly) (see instructions for the definition of passive income).
Part XXVI Passive NFFE
40a I certify that the entity identified in Part I is a foreign entity that is not a financial institution (other than an investment entity organized in a possession of the United States) and is not certifying its status as a publicly traded NFFE (or affiliate), excepted territory NFFE, active NFFE, direct reporting NFFE, or sponsored direct reporting NFFE.
Check box 40b or 40c, whichever applies.
b
c
I further certify that the entity identified in Part I has no substantial U.S. owners, or
I further certify that the entity identified in Part I has provided the name, address, and TIN of each substantial U.S. owner of the NFFE in Part XXX.
Part XXVII Excepted Inter-Affiliate FFI
41 I certify that the entity identified in Part I:
• Is a member of an expanded affiliated group;
• Does not maintain financial accounts (other than accounts maintained for members of its expanded affiliated group);
• Does not make withholdable payments to any person other than to members of its expanded affiliated group that are not limited FFIs or limited branches;
• Does not hold an account (other than a depository account in the country in which the entity is operating to pay for expenses) with or receive payments from any withholding agent other than a member of its expanded affiliated group; and
• Has not agreed to report under §1.1471-4(d)(2)(ii)(C) or otherwise act as an agent for chapter 4 purposes on behalf of any financial institution, including a member of its expanded affiliated group.
Form W-8BEN-E (2-2014)
Part XXVIII Sponsored Direct Reporting NFFE
42 Name of sponsoring entity:
43 I certify that the entity identified in Part I is a direct reporting NFFE that is sponsored by the entity identified in line 42.
Part XXIX Certification
Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. I further certify under penalties of perjury that:
• The entity identified on line 1 of this form is the beneficial owner of all the income to which this form relates, is using this form to certify its status for chapter 4 purposes, or is a merchant submitting this form for purposes of section 6050W,
• The entity identified on line 1 of this form is not a U.S. person,
• The income to which this form relates is: (a) not effectively connected with the conduct of a trade or business in the United States, (b) effectively connected but is not subject to tax under an income tax treaty, or (c) the partner’s share of a partnership's effectively connected income, and
• For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions.
Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which the entity on line 1 is the beneficial owner or any withholding agent that can disburse or make payments of the income of which the entity on line 1 is the beneficial owner.
I agree that I will submit a new form within 30 days if any certification on this form becomes incorrect.
F
Sign Here
Signature of individual authorized to sign for beneficial owner Print Name Date (MM-DD-YYYY)
I certify that I have the capacity to sign for the entity identified on line 1 of this form.
Part XXX Substantial U.S. Owners of Passive NFFE
As required by Part XXVI, provide the name, address, and TIN of each substantial U.S. owner of the NFFE. Please see instructions for definition of substantial U.S. owner.
Name | Address | TIN |
Form W-8BEN-E (2-2014)