PT Duit Sono Sini Remittance

Form Permohonan Pengiriman Uang Money Transfer Application Form

Lengkapi data penerima, pengirim, bank, sumber dana, dan rincian transaksi dengan format DSS. Complete beneficiary, remitter, bank, source of fund, and transaction details in DSS format.

No. Form DSS-20260901-0001

A. Penerima Beneficiary

Nomor Rekening Penerima Beneficiary Account Number

Nama Penerima Beneficiary Name

Tempat dan Tanggal Lahir Penerima Beneficiary Place and Date of Birth

NPWP Tax Number Identity

Pekerjaan Job

Bidang Usaha Type of Business

No. Identitas Identity No.

Kota City

Negara Bagian State

Negara Country

Alamat Penerima Beneficiary Address

B. Bank Penerima Beneficiary's Bank

Nama Bank Penerima Beneficiary Bank Name

Kota City

Negara Bagian State

Negara Country

Alamat Bank Bank Address

C. Pengirim Remitter

Nama Pengirim Remitter Name

Status Status

Tempat dan Tanggal Lahir Pengirim Remitter Place and Date of Birth

NPWP Tax Number Identity

Bidang Usaha Type of Business

No. Identitas Identity No.

Nama yang Dapat Dihubungi Contact Person

No. Handphone Mobile Phone No.

No. Telepon Phone No.

Kota City

Alamat Pengirim Remitter Address

D. Berita Message

Hubungan Keuangan Financial Relationship

Tujuan Transaksi Transaction Purpose

E. Sumber Dana Source of Fund

Tunai/Cash Transfer ke Rekening Debet BCA Lainnya

Detail Sumber Dana Lainnya Other Source of Fund Details

Transaksi Transaction

Mata Uang Currency

Jumlah yang Dikirim Amount Transferred

Jumlah Valuta Asing Amount in Foreign Currency

Kurs Exchange Rate

Provisi Provision

Biaya Charge

Jumlah Rupiah Amount in IDR

Jumlah Total

Terbilang Rupiah Amount in Words

Jika Jumlah Rupiah melebihi Rp100.000.000, sistem menandai kebutuhan lampiran fotokopi identitas. If the IDR amount exceeds IDR 100,000,000, the system marks the identity document attachment as required.

Pernyataan & Tanda Tangan Declaration & Signature

Tanggal Date

Teller Teller

Pemohon Applicant

Path Lampiran Identitas Identity Attachment Path