BUYER LIST

General Data

Company's Name

Address

Postal Code Province

Telephone Fax

Website / Email *

NIB

Legal Number

NPWP

Products

Responsible Employee / Authorized Employee

Contact Person 1
Name Position Mobile

Email

Contact Person 2
Name Position Mobile

Email

I hereby certify that the information provided above and in all the annexes is correct and that no person in any
connection with this establishment, as a Buyer for providing material, Buy or services, or as a principal or employee, is
employed by PT. Sungai Pangean Jaya
I also understand that falsified or misleading information could result in disqualification of the company as a registered
potential Buyer for PT. Sungai Pangean Jaya

* stripe which is not applicable

SIGN & STAMP

( The statement below will be filled by PT. Sungai Pangean Jaya staff )

Approved By, Created By,

Director Marketing Dept.