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SI.

No : Date :

Vendor Master Form


Request Type V Change
Previous Vendor Number : ______________________________________________
Contract Number :
______________________________________________
Reason :
______________________________________________

Name Vendor Name Naqta Jaya Sempurna


Vendor Address Bumi Banjararum Blok AID No.3 Kec.Singosari Kab.Malang Jawa Timur 65153
Vendor Email yogidhaniramdhan@gmail.com
Contact Person Yogi Dhani
Office Number 0895 1641 4446
Mobile Number 0895 1641 4446
Email PIC yogidhaniramdhan@gmail.com
Entity Project :
Status PPN : PKP / Non PKP (Pilih salah satu)
Nama Direktur Yogi Dhani Ramdhan
No KTP Direktur 35070240508800012'
No NPWP Perusahaan 66.331.885.5-657.000
No NIB Perusahaan 1272001441054'

Vendor's Bank Country Indonesia


Vendor's Bank name Bank Central Asia (BCA)
Payment/ Bank Bank Branch Malang
Details Bank Account Number 3,681,620,573
SWIFT Code 14
Account Holders Name Yogi Dhani Ramdhan
Payment Terms 75% Down Payment Before Installation, 25% after Installation Finished
Nature of Business
Type of Service or Material Provided by Vendor
Vendor contract (YES / NO, If NO provide reason)

Notes :

Signature
Vendor Name Naqta Jaya Sempurna

Signator Name Yogi Dhani Ramdhan


Signator Name

Document to be attached :
1. Copy of KTP
2. Copy of company NPWP
3. Copy of company SPPKP
4. Copy of company NIB

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