Finance Form

Deposit/Advance Rental
Refund/Transfer Form
V180903

Please fulfill below information:

Form no: (by BDA/FM/CM)

Request date: 1-mar-2019 Agreement Number: UOB/TD/2019/01/001

Tenant name: Bening Amalia

Lease Period :

Location: UOB 34th Floor

Product Private Office Coworking Other (please state):

Room : _________

Refund/Transfer Reason: Agreement End Agreement Terminated Agreement/Payment Canceled WHT

v Relocation Extention Other (please state):

Refund/Transfer Calculation Attachment Requested: Finance Check List:

1. Paid by Tenant

- Upfront Rental IDR Payment slip Innitial

- Deposit IDR 1000000 v Payment slip Innitial

- WHT IDR Payment slip Innitial

- (please add description) IDR Payment slip Innitial

2. Deduction

- (please add description) IDR Leaving Member Form Innitial

- (please add description) IDR (please state) Innitial

- (please add description) IDR (please state) Innitial

- (please add description) IDR (please state) Innitial

Please Transfer / Allocate IDR 1000000 To Agreement Number : UOB/FD/2019/02/002

Or please refund the amount to bank with below details:

Beneficary Name : Bank Name :

Account Number : SWIFT/IBAN :

Notes:

COCOWORK Sales/PiC name: Bening Amalia Phone / email: gita@cohive.space

SIGNATURE SECTION
Prepared by Checked by Approved by

Name: Catarina Gita Name: Name: Name: Name: Jason Lee

BD / FM / CM BDA / FMA / CMA Finance AR Finance AP Title: CFO

Date: 1 Mar 2019 Date: Date: Date: Date: