| Formulir Pendaftaran HMETD |
| Rights Registration Form |
|
Nomor :______________ |
Number |
|
| A. Data HMETD |
| Rights Data |
|
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|
4. |
| Tanggal Listing (dd/mm/yy) |
| Issue Date |
|
: |
|
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5. |
| Tanggal Jatuh Tempo (dd/mm/yy) |
| Maturity Date |
|
: |
|
|
6. |
| Jumlah HMETD yang Dikeluarkan |
| Number 0f Rights |
|
: |
|
|
|
7. |
| Nama BAE |
| Transfer Agent's Name |
|
: |
|
|
8. |
| Harga Pelaksanaan |
| Exercise Price |
|
: |
|
|
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| B. Dokumen*) |
| Document |
1. |
| Surat/Pengumuman dari Emiten |
| Letter/Announcement from Issuer |
|
|
|
| C. Pengesahan |
| Validation |
Dengan menandatangani Formulir Pendaftaran HMETD ini, kami menyatakan telah membaca dan memahami seluruh peraturan KSEI tentang penitipan kolektif di KSEI serta setuju untuk tunduk dan mematuhi peraturan tersebut. |
By signing this Rights Registration Form, we declare that we have read and understood all KSEI regulation regarding the collective custody in KSEI, as well as we are subject to and abide by those KSEI regulation. |
Kami menyatakan bahwa semua keterangan dan dokumen yang kami berikan kepada KSEI adalah lengkap dan benar. |
We declare that all information and documents submitted to KSEI are correct and complete. |
Jakarta___/___/___ |
|
Petugas KSEI*) |
| KSEI Officer |
|
|
(.......................) |
Nama & Tanda Tangan Pejabat berwenang 1 |
Name & Signature of 1st Authorized Signature |
|
(.......................) |
| Nama & Tanda Tangan Pejabat berwenang 2 |
| Name & Signature of 2nd Authorized Signature |
|
(.......................) |
| Nama, Tanda Tangan dan Cap |
| Name, Signature and Stamp |
|
|
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