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Financial Responsibility Form Template for Indonesia

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Key Requirements PROMPT example:

Financial Responsibility Form

"I need a Financial Responsibility Form for a private hospital in Jakarta, to be used for international patients who will be receiving treatment throughout 2025, with payment terms allowing for installments and including provisions for insurance coverage."

Document background
The Financial Responsibility Form is a critical document used in Indonesian business and financial transactions to formally establish and document financial obligations between parties. This document is typically required when there is a need to clearly define and enforce financial commitments, whether in banking relationships, educational institutions, healthcare services, or corporate settings. The form ensures compliance with Indonesian financial regulations, particularly those established by the Financial Services Authority (OJK) and Bank Indonesia. It includes detailed information about payment obligations, terms, schedules, and consequences of default, while incorporating consumer protection requirements under Indonesian law. The document can be adapted for various scenarios, from individual financial commitments to corporate financial responsibilities, and may include provisions for guarantors or joint liability arrangements.
Suggested Sections

1. Parties: Identification of the primary party accepting financial responsibility and the institution/organization to whom the responsibility is owed

2. Background: Context of the financial responsibility arrangement and the relationship between the parties

3. Definitions: Key terms used in the form, including financial obligations, payment terms, and relevant legal terminology in both English and Bahasa Indonesia

4. Financial Obligations: Detailed description of the financial responsibilities being assumed, including specific amounts or calculation methods

5. Payment Terms: Schedule, method, and conditions of payments or financial fulfillment

6. Duration of Responsibility: Time period or conditions during which the financial responsibility remains in effect

7. Default and Consequences: Actions constituting default and resulting consequences or penalties

8. Representations and Warranties: Statements confirming the party's ability and authority to assume the financial responsibilities

9. Governing Law: Confirmation of Indonesian law as the governing law and relevant jurisdiction

10. Execution: Signature blocks, witness requirements, and execution date

Optional Sections

1. Guarantee Provisions: Required when a guarantor is involved in backing the financial responsibility

2. Asset Declaration: Used when specific assets are pledged as security for the financial responsibility

3. Insurance Requirements: Included when insurance coverage is required as part of the financial responsibility arrangement

4. Electronic Execution Provisions: Required when the form will be executed electronically under Law No. 11 of 2008

5. Force Majeure: Optional clause defining circumstances that may temporarily excuse performance of financial obligations

6. Dispute Resolution: Detailed dispute resolution procedures, required for high-value or complex financial responsibilities

Suggested Schedules

1. Schedule A - Payment Schedule: Detailed breakdown of payment amounts, dates, and methods

2. Schedule B - Asset Schedule: List and description of any assets pledged as security

3. Schedule C - Financial Disclosure: Required financial information and current obligations of the responsible party

4. Appendix 1 - Required Documents: List of supporting documents required (e.g., ID cards, proof of income, bank statements)

5. Appendix 2 - Contact Information: Detailed contact information for notices and payment processing

6. Appendix 3 - Calculation Methods: Detailed explanation of how variable financial obligations are calculated

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok成人版 | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Relevant legal definitions








































Clauses






























Relevant Industries

Banking & Financial Services

Education

Healthcare

Insurance

Real Estate

Corporate Services

Retail

Manufacturing

Professional Services

Technology

Telecommunications

Relevant Teams

Finance

Legal

Compliance

Risk Management

Credit Control

Treasury

Customer Service

Collections

Account Management

Administrative Services

Relevant Roles

Chief Financial Officer

Finance Manager

Compliance Officer

Risk Manager

Legal Counsel

Credit Manager

Account Manager

Financial Controller

Treasury Manager

Corporate Secretary

Banking Officer

Collections Manager

Financial Analyst

Admissions Officer

Patient Services Manager

Industries







Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks, 聽Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination, 聽Severance Pay, Governing Law, Entire Agreemen

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