CUSTOMER REGISTRATION FORM

Registration Type: New Customer Parent Account Number:

Customer Type: Conversion Account Number: 143R4W

Effective Date: 7/5/2021 Company Registration No. / Tax ID: 96.999.635.4-445.000

Expiry Date: 7/5/2026 VAT Exempted:

Segment: Direct VAT Zero Rated:

Remarks (if any):

Commodity Shipped: Retail Services
BILLING & PAYMENT INFORMATION
SHIPPER INFORMATION
(If Different from Shipper's Information)
Company Name Goni Merajut Bangsa, PT Company Name Goni Merajut Bangsa, PT
Company Name Goni Merajut Bangsa, PT Company Name Goni Merajut Bangsa, PT
(in local language) (in local language)
Address Perum Gading Tutuka 2 Blok K1 No. 23 Desa Ciluncat Kec. Cangkuang Kab Bandung
AddressJawa Barat 40238
Perum Gading Tutuka 2 Blok K1 No. 23 Desa Ciluncat Kec. Cangkuang Kab Bandung Jawa Barat 4

Address Address
Perum Gading Tutuka 2 Blok K1 No. 23 Desa Ciluncat Kec. Cangkuang Kab Bandung Jawa Barat 40238
Perum Gading Tutuka 2 Blok K1 No. 23 Desa Ciluncat Kec. Cangkuang Kab Bandung Jawa Barat 4
(in local language) (in local language)
Country Indonesia Country Indonesia
City Bandung City Bandung
Postal Code 40238 Postal Code 40238

Contact Person Ruby Perkasa Contact Person Ruby Perkasa Contact Person Ruby Perkasa Contact Person Ruby Perkasa
(in local language) (in local language)

Marketing Department Marketing Marketing Department Marketing

Department Department
(in local language) (in local language)

Title Manager Title Manager Title Manager Title Manager

(in local language) (in local language)
Telephone 081322729822 Telephone 081322729822
Fax Fax
Email admin@karunggoni.id Email admin@karunggoni.id Email 2:
Business Hours Bank Name BNI Syariah
Contract Person (in local
Contract Signee Ruby Perkasa language)
Bank Acct Number 2021888225
Ruby Perkasa
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accordance with UPS' Privacy Notice available on www.ups.com for your country / territory. By providing your email address , you consent to receiving transactional emails from UPS
(e.g. service-related updates or billing information). Your assigned sales representative / UPS may also send you emails on UPS offers, news or events, that may be of interest to you.
Please indicate which emails you wish to receive: Promotions / Offers Product News News and insights on shipping
For Official Use

Credit Detail (Export) Information

Credit Limit 0 Sales ID LZV2PLB
Credit Term 0 Days Sales Area Code 4013
Billing Cycle* Daily Center Code 4013
* indicate which day of month in Remarks if ( ) Day of Month option is selected
Payment Option Cash SIC Industry Apparel and Consumer Goods - Finishing Plants, Cotton

Invoice Option Invoice per Shipment SIC Code 2261

Credit Detail (Import) Special Shipping

Considerations
Credit Limit 0 Site Visit Date
Credit Term 0 days Physical Office
Billing Cycle* Daily Other Approvals
* indicate which day of month in Remarks if ( ) Day of Month option is selected F&A Approval
Payment Option Cash MKT Approval
Invoice Option Invoice per Shipment
Remarks
Acknowledgment
UPS Acknowledgment (INTERNAL USE only) Client Authorization
We understand the terms and conditions and agree to open an account with
United Parcel Service.

Signature /s2/ /s3/ Signature /s1/

Name /n2/ /n3/ Name /n1/

Date /d2/ /d3/ Date /d1/

Title Account Manager Area Sales Manager Title /t1/

Forms Attached Credit Term Application/Extension Form Additional Supporting Documentation

Terms & Conditions

You agree that all UPS services provided to you are governed by UPS Tariff / Rate and Service Guide and UPS Terms and Conditions of Service available on www.ups.com and effective
at the time of shipping (“UPS Terms”). Specifically, you acknowledge and agree with the following terms:
· Shipping rate is calculated based on the billable weight of a package, as defined in the UPS Terms to mean the greater of the package’s actual or dimensional weight.
· UPS’s measurement and determination of the package’s billable weight shall be deemed final and non-negotiable.
· You guarantee the payment of all charges payable to UPS by the receiver or third party of a package.
· UPS’s liability for the services is limited as stipulated in the UPS Terms.
All service charges (both unpaid and unbilled, including any surcharges, taxes and duties) will become immediately due for payment if the total sum reaches or exceeds the credit limit
granted to you under this form or any other documents. Until such sum is fully settled, notwithstanding any other rights that UPS may have under any applicable law and the UPS Terms,
UPS is entitled to suspend services, amend payment terms, adjust any discounts, terminate any and all of your UPS accounts, hold any and all of your goods on lien, or take a combination
of the aforesaid actions, without any liability to you. UPS may, at its sole discretion, request for a monetary deposit from you (amount to be determined solely by UPS) to continue or
resume services.
ver. 04072020