PT BLACK BEAR RESOURCES INDONESIA

NEW VENDOR REGISTRATION FORM

Location : Jakarta/ Bontang

Purchase Nature Raw Material (Chemical/ Spares) Maintenance Travel

SHE Related Assets Others, please specify

Vendor Detail Company Name CV. GOLDEN FURNITURE

Office Address JL. KS TUBUN 80 RT 16 KEL BONTANG KUALA KEC BONTANG UTARA
Postal Address JL. KS TUBUN 80 RT 16 KEL BONTANG KUALA KEC BONTANG UTARA
State INDONESIA
Post Code 75312 Country BONTANG
Phone 0548-3036261 / 0811587828
Fax
Business Registration Number 171234700347
Tax ID Number 03 349 338 8 - 724 000 7
VAT Registration Number PEM-00160/WPJ,14/KP,03,03,/2014
Director ABDUL GOFAR
Director ABDUL GOFAR

Bank Details: Currency BANK RAKYAT INDONESIA

BSB (Branch Code) 0 333
Swift Code BRINIDJA
Beneficiary Name CV. GOLDEN FURNITURE
Bank Account Name CV. GOLDEN FURNITURE
Bank Account Number 0333 0100 1069 306
Bank Branch BONTANG
Payment Terms 30 HARI

Reason for Vendor Appointment (PLEASE COMPLETE) KAMI MEMBERIKAN FURNITURE KANTOR TERBAIK UNTUK PERUSAHAAN TERBAIK
PT. BLACK BEAR RESOURCES INDONESIA

Additional Information

Vendor Contact Person (Mr/Ms) MR. ABDUL GOFAR Job Title DIREKTUR
Email - Vendor Contact Person gofaryum@yahoo.com
Vendor - Accounting / Finance Contact Person SURYA DARMAWAN Job Title ADMINISTRASI
Email - Vendor Accounting/Finance Contact Person

Copy of (MUST BE ATTACHED)

Notary Deed (Akte Notaris) Yes
TDP (Tanda Dafter Persh) Yes
IUT (Ijin Usaha Terbatas) Yes
Tax ID (No PKP) Yes
VAT (PPN) Certificate Yes
List Of Supply Product Yes

Prepared By, Checked By Approved By

Technical & Commercial Finance

Procurement Finance Manager Director Director

Date : Date : Date : Date :

Vendor Registration in SAP B1

Gita Lestari SAP B1 Vendor Master Data Number :

Finance Staff
Date :