Version date: 10/11/2016

Dear Sir/Madam,
In order to transfer payments to your company/institution, our system requires the following information:
FORM MUST BE COMPUTER TYPE ONLY

Supplier detail information

Name (base on the

PT ALDMIC INDONESIA
invoice for company)*

Full Address (with Jl. Panjang No.64, RT.6/RW.1, Kedoya Sel., Kec. Kb. Jeruk, Kota
postcode and city)* Jakarta Barat, Daerah Khusus Ibukota Jakarta 11520

Email Address*
accounts@floweradvisor.com

Bank account detail

Beneficiary name* PT ALDMIC INDONESIA

Bank name* BCA

Jl. Panjang 79 EF, RT.1/RW.3, Klp. Dua, Jakarta Barat, Kota Jakarta
Bank address*
Barat, Daerah Khusus Ibukota Jakarta 11520
Account number : 7550333168

Account number & Bank

Kode bank : 014
code & Branch code*
Kode Cabang : -
Rupiah
Currency*

IBAN (only applied for

banks in the Netherlands
and SEPA countries with
Euro account)

Swift code*

IFSC code for India **

* MANDATORY fields

NOTE : By signing this form, you confirm that the above information is correct.

NOTE : PLEASE FILL IN ALL INFOMATION IN ENGLISH. FOR CHINESE CHARACTERS PLEASE EITHER
FILL IN AFTER ENGLISH OR NEW PAGE

** IFSC code is for India - a mandatory field

JAKARTA, 13 September 2019

( Arindita )