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Ertaan Nama Pemberi Kerja Penarikan Iuran Jumlah Iuran yang ditarik Rp atau % dari akumulasi iuran Terbilang Rincian Iuran yang ditarik % dari akumulasi Iuran Rupiah Paket Investasi Rupiah Paket Investasi US$ Paket Investasi Pendapatan Tetap Paket Investasi Saham Paket Investasi Kombinasi Rupiah & US$ Paket Investasi Kombinasi Rupiah dan Saham Paket Investasi Campuran Mohon ditransfer ke rekening : Bank Cabang Nomor rekening Atas nama Tempat & Tanggal / Tanda tangan Peserta Rincia.

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