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Member - Payment Confirmation Form

If you have made payment via bank transfer (including ATM), please notify us by filling the following form.

Customer ID	:
User ID / Login Name	:
E-mail	:
Amount Transferred	: Rp
Method	:
From Bank	:
To	: (If paying through ATM BCA, please input the Sequence No. from the ATM receipt below) Sequence No.
Date of Transfer	:
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