Username and Password Request Form Rev#:……

Supplier Data Digital Center

Requester Name Date (DD/MMM/YYYY)

Company Name Company Tax ID
Company Code ID Company Phone Num
Requester Position Email Address

Change Type: New User / Forgot Password**)

Business Application E-billing Platform
Access of Menu

*)akses hanya diberikan apabila supplier sudah menandatangani perjanjian

**)coret salah satu

Reason of Request (* Filled by Requester)

Username :……………………………………………………….

Password :……………………………………………………….

Reason :

Note for Platform (* Filled by SD2C – Administrator)

a Emergency change indicator (* check if yes)

Requester Name Requester Approval 1 Approval 2
Director/Manager

(………………………………………………) (………………………………………………) (………………………………………………) (………………………………………………)

Position : Position : Position : Position :

Catatan :
Formulir ini merupakan satu kesatuan yang tidak terpisahkan dengan perjanjian Supplier Data Digital Center (SD2C)