INFORMASI TRANSFER PEMBAYARAN
TRANSFER OF PAYMENT INFORMATION


 
No. Registrasi :
Registration No. :


Nama Lengkap :
Full Name :



Email Anda :
Your Email address :



No. Faktur/Invoice :
Invoice Number :



Jumlah setoran :
Transfer value :


Rp.


Asal Bank :
Bank originator :



Bank Tujuan :
Destination :


No. Slip setoran :
Slip Transfer No. :



No. Urut ATM
(bila pakai ATM) :
ATM identification No.
(if paid thru ATM) :



Tanggal transfer :
Date of Transfer :



Disetor oleh :
Deposited by :



Catatan / Note :




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