CIS Document — PT Ateka Coin Jaya

CIS — RECEIVER

Customer Information Sheet · Beneficiary Information

REF: CIS/ATEKA/2025-001 ISSUED: 2025

Receiver Profile

Individual

Company

Full Legal Name (as per Bank Account)	PT ATEKA COIN JAYA
Nationality / Country of Incorporation	INDONESIA
Date of Birth / Date of Incorporation	28 Oktober 2025
ID / Registration Number	AHU-0091345.AH.01.01.TAHUN 2025

Receiver Address

Registered Address	Street, City, Postal Code, Country
Phone Number	—
Email Address	admin@kongali1720.com

Receiver Bank Details

Account 1 — IDR

Beneficiary Name	PT ATEKA COIN JAYA
Bank Name	PT BANK MANDIRI (PERSERO) TBK
Bank Branch	—
Bank Address	—
Account Number	1520099788875
SWIFT / BIC Code	BMRIIDJA
Currency to Receive	IDR

Account 2 — USD

Beneficiary Name	PT ATEKA COIN JAYA
Bank Name	PT BANK MANDIRI (PERSERO) TBK
Bank Branch	—
Bank Address	—
Account Number	1520037323082
SWIFT / BIC Code	—
Currency to Receive	USD

Authorized Contact Person

(Jika rekening perusahaan)

Full Name	DJAYA WIJAYA OJONG
Passport / ID Number	X1142805
Position	DIRECTOR
Contact Number	+62 821-9673-5238
Email Address	admin@kongali1720.com

Bank Officer Email

—

Bank Phone

—

Bank Website

—

Source of Funds (From Sender)

Investment Funds

Business Payment

Loan / Financing

Donation / Grant

Trade Settlement

Purpose of Receiving Funds

TO RECEIVE LEGITIMATE FUNDS FOR BUSINESS DEVELOPMENT, INVESTMENT COOPERATION, OR CONTRACTUAL OBLIGATION IN COMPLIANCE WITH INTERNATIONAL BANKING REGULATIONS

AML & KYC Declaration

WE CONFIRM THAT THE FUNDS RECEIVED ARE FOR LAWFUL PURPOSES AND THAT ALL PROVIDED INFORMATION IS TRUE AND ACCURATE IN ACCORDANCE WITH AML, KYC AND INTERNATIONAL BANKING REGULATIONS

Receiver Signature

Djaya Wijaya Ojong

Full Name DJAYA WIJAYA OJONG

Date 10 June 2026

Place JAKARTA

Reserved for Official Use

I / We swear under Penalty of Perjury, the information provided above is both true and accurate. I am the signatory on the aforementioned Bank Account. All monies engaged in this transaction are derived from non-criminal origin and are good, clean and cleared. The Origin of Funds is in compliance with anti-money laundering policies as set forth by the Financial Action Task Force [FATF] 6/01.