THE ASIAN LEASING & FINANCE ASSOCIATION



MEMBERSHIP APPLICATION FORM

|Type of Membership |Description |Initial Fee |Annual Dues |Total |

| | |US$ |US$ |US$ |

| | | | | |

| | |500 |1,500 |2,000 |

|Institutional |Any organization or association of Financial Services | | | |

|Individual |Individual corporations or companies engaged in Financial Services |500 |250 |750 |

|Associate |Professional bodies and business entities with an interest in leasing and/or finance but |100 |300 |400 |

| |which do not fall in any of the above categories of members | | | |

Payment should be made by telegraphic transferring the full amount Using MT103 with the following instructions:

 

56A:  Intermediary Institution Bank Negara Indonesia (Persero) PT, NY (formerly known as Wells Fargo Bank, USA) Swift Code:  BNINUS33

 

57A:  Account with Institution PT BANK INDEX SELINDO, Jakarta – Indonesia Swift Code: BIDXIDJA

 

59:     Beneficiary Customer - Name & Account Number Account No: 900-616-1231 Name: ASIAN FINANCIAL SERVICES ASSOCIATION

 

|Country |: | |

|Type of Membership Applied |: |( Institutional |( Individual |( Associate |

|Name of Company or Institution |: | |

|Address |: | |

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|Telephone Number (s) |: | Facsimile Number (s): |

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|Contact Person |: |Name |Designation | |E-Mail |

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|Representative in AFSA |: | | | | |

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|PIC for correspondence |: | | | | |

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|Finance |: | | | | |

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|Website |: | | | | |

|Line of Business |: | |

|Date Incorporated |: | |

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|Principal Officers |: |Name |Title | |Company |

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|Number of Members |: | |or |Total Staff Strength: | |

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|Membership in Trade in Business |: | | | | |

We hereby apply for Membership of the Asian Financial Services Association and hereby undertake to abide by the Constitution and By-Laws of the Association and we are willing to pay the initial fee and annual membership dues.

Please find our logo attached

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ASIAN FINANCIAL SERVICES ASSOCIATION will contact you as soon as possible.

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