PT.

MORA TELEMATIKA INDONESIA No

Grha 9, 6th floor, Jalan Panataran No.9 Proklamasi, Jakarta Pusat 10320, Indonesia Ref
Ph: +62-21-3199 8600 Fax: +62-21-314 2882 www.moratelindo.co.id Date 28-09-2021

INTERNET REGISTRATION FORM

SERVICE SuperNET (IP Transit) SuperNET Mix (Blended Internet: IX and IIX)
Please tick one Mora-IX (Moratelindo Internet eXchange)

■ Company Information
Subscriber ID (filled by Moratelindo) Existing Subscriber ID (filled by Moratelindo)
Name of Company PT SOLO TRANS LOGISTIK
Correspondence Address THE KENSINGTON OFFICE TOWER 9C
Phone Ext Mobile Fax
Name of Authorized Officer ANDRI WAHYUDIN Designation
ID Number/Passport
Tax Registration Number
Name of Director ARIS NURYANTO

■ Billing Information
Name of Finance Officer
Billing Address
Phone Ext Mobile Fax
Email

■ Requirement Information
Link Destination Payment in IDR USD

No Description Capacity-Type* Installation Cost Total Monthly Total

* Type of Service : Mbps Total Amount

VAT 10%
Up Grade Link From to Type of connection Grand Total
Date of service required Gbic
Contact Period (month) Ethernet

■ Site and PIC Information

No Name of Site Address PIC Mobile Email

We hereby confirm that the foregoing information herein given to be true and correct, and will follow the Terms and Conditions Internet Subscription.
We agree to be bound by the Terms and Conditions Internet Subscription as attached with this form.

Subscriber Approval By
PT. Mora Telematika Indonesia
(Moratelindo)

ANDRI WAHYUDIN
. . . .
Date of Received : . Date of Received : .