New Supplier Account Registration Form

Company Name : PT Quicktest Laboratorium Indonesia

Address : Jl. Prof. Dr. Soepomo No.15 A, Tebet Barat, Tebet

City : Jakarta Selatan Postal code : 12810

Telephone : 021 21383999 Fax :-
NPWP : 410140586015000 KTP\SIM\Passport : -
(for taxable company) (for individual)
Supplier Business Type : FOOD / BEVERAGE / OTHERS Company Email : info@quicktest.id
Term of Payment : 30 days
Contact Person : 08118993950

Company's Bank Account Information :

Name in Bank Record : PT. Quicktest Laboratorium Indonesia
Bank : Bank Central Asia (BCA)
Bank address : Komp. Gudang Peluru Blok A No. 23, Jl. Kampung Melayu Besar, RT.1/RW.3, Kb. Baru, Jakarta, Kota
Jakarta Selatan
Bank Account No : 2720189766
Currency : IDR
Swift Code :
Payment Method : Electronic Fund Transfer (EFT)
By submitting this form and any supporting documents, I confirm that I have read and agreed to the use of the personal
(Supplier)

Name, Signature, Date , Company stamp

Please attached : 1. Quotation on Supplier Letterhead; 2. Surat Izin Usaha Perusahaan (SIUP); 3. Tanda Daftar Perusahaan (TDP)
4. Tax ID (NPWP) ; 5. ID Card (KTP)/Passport ;
6. Statement Letter or Photocopy of Bank Account Details (Surat Pernyataan Nomor Rekening Bank atau Fotokopi Buku Tabung
Additional Information : Purchasing / requestor must supply answers to each section
How was this vendor selected?

Scope of Work or Service to be Provided :

What is the estimated annual spend with this vendor?

Achknowledged by, Approved by:

Purchasing Department Requestor Head of Department Director of Finance

(Name, Signature & Date) (Name, Signature & Date) (Name, Signature & Date)

To be filled by Finance

Registration ID :
BS Supplier ID :_ _
PS Vendor Request # :
PS Vendor Code :
PS Location Code :
Appendix 2. MGP Supplier Conduct Guidelines

Marriott International Global Procurement

Supplier Conduct Guidelines

Below is a summary of key standards in the Marriott International (MI) Business Conduct Guide applicable to
all Marriott officers, managers and employees in MI’s global operations. As an MI supplier it is expected that
you and your employees will strive to stay within comparable standards of conduct and will respect the
obligations of Marriott associates to adhere to these standards and other Marriott policies. Failure to do so
could jeopardize MI’s ability to continue doing business with you.

Be Accurate, Honest, and Fair.

 Avoid even the appearance of wrongdoing.
 Treat all customers fairly and with respect.
 Follow and obey the law at all times.
 Report all pertinent financial information and invoices accurately and honestly.
 Never falsify or distort any information or documents related to your work for MI.
 Accurately document the purpose of transactions.
 Comply with antitrust and fair competition laws.
 Ensure gifts and entertainment are modest and within MI guidelines when dealing with MI
contracts and MI associates.
 Respect the trade secrets and nonpublic information of others.
 Never compromise ethical standards to gain a competitive advantage or to meet a business
objective. This includes making or receiving improper payments or gifts.

Understand that MI strictly forbids giving or promising anything of value to a government official or
employee, whether to influence that person in his or her official duties or to encourage unlawful conduct.

Safeguard MI’s Assets and Reputation by never using MI assets for personal gain or in a manner that could
create a conflict of interest.

Provide a Fair and Safe Workplace that is harassment-free, safe, secure, and that creates a hospitable
environment.
 MI strives to create an inclusive environment that fosters mutual respect, diversity, and
equal opportunity for workplace advancement.
 There are strict policies concerning the disclosure of information about Marriott guests
and associates.

Focus on MI’s commitment to diversity, social responsibility, and community engagement for the
greater good of the community.
 MI supports human rights around the world and works to protect human rights within our sphere
of influence.
 MI condemns all forms of exploitation of children. All labor must be voluntary.
 MI supports a supplier diversity program to encourage spend through diverse suppliers.
 MI is committed to minimizing the impact of its operations on the environment and to promote
environmental sustainability in partnership with conservation organizations around the
world.