PT REKSO NASIONAL FOOD (McDONALD's INDONESIA)

SUPPLIER REGISTRATION FORM

(All questions must be answered. Please do not leave blanks. You may use NONE or N/A where appropriate)

GENERAL
Company Name *) CV.PUTRI PRATAMA TEKNIK

Company Address (sesuai Akta Pendirian) *) Btn Kelapa Gading Blok C0-05,Kota Palu,Sulawesi Tengah

Company Address (Korespondensi) *) Jl.Juanda,Lolu Utara,Kec.Palu Sel.,Kota Palu,Sulawesi Tengah 94111

Telephone Number 082399440626

Fax Number

E-mail Address (Company) putripratamateknik12@gmail.com

Website Address

Date of Establishment/ Incorporation 17 Februari 2017

Registered Number of Company

Registered Address (if different from above)

Please provide copy of Surat Keterangan Terdaftar, Kartu NPWP and Surat Pengukuhan Pengusaha Kena Pajak (PKP)
Tax ID/ NPWP Number *)

Type of Company (please select one) PERSEROAN KOMANDITIER (CV)

Provide a brief description of your Company Please provide current and valid copy of certificate of incorporation/ business certificate
Penyediaan,pemeriksaan,dan perawatan Air Conditioner

GOODS AND SERVICES OFFERED

List the goods and services offered by your
Company
1) BARANG BERUPA SPARE PART AC
2) MAINTENANCE AC DUCTING,CASSETTE,AND SPLIT
3) PERBAIKAN AC
4) PENGGANTIAN SPARE PART
5) PENGADAAN AC SPLIT

Does your Company have Quality Assurance

Certification (e.g. ISO certification) YES/ NO (if yes, please provide copy of certificate)

FINANCIAL

Bank Name *)

Bank Address *)

Account Name *)

Bank Account Number *)

Note : *) Data yang di isi dalam kolom ini harus sama dengan data dalam Invoice

Page 1 of 3
 PT REKSO NASIONAL FOOD (McDONALD's INDONESIA)
SUPPLIER REGISTRATION FORM
(All questions must be answered. Please do not leave blanks. You may use NONE or N/A where appropriate)

CUSTOMER RELATIONSHIP MANAGEMENT

(wajib diisi & dikirim ke RNF setiap ada perubahan)

Data of Key Contact (Owner atau level tertinggi)

Name IBRAHIM

Telephone

Mobile 082399440626

Fax

E-mail Address putripratamateknik12@gmail.com

Data of Sales Contact (Marketing Dept)

Name IBRAHIM

Telephone

Mobile 082399440626

Fax

E-mail Address putripratamateknik12@gmail.com

Data of Technical / Operational Contact (untuk dicantumkan di PO & konfirmasi PO)

Name IBRAHIM

Telephone

Mobile 082399440626

Fax

E-mail Address putripratamateknik12@gmail.com

Data of Finance/ Accounting Contact (untuk konfirmasi pengiriman bukti transfer pembayaran)

Name IBRAHIM

Telephone

Mobile 082399440626

Fax

E-mail Address putripratamateknik12@gmail.com

Is your Company currently involved in any legal
disputes? YES/ NO (if yes, please explain)

Page 2 of 3
 PT REKSO NASIONAL FOOD (McDONALD's INDONESIA)
SUPPLIER REGISTRATION FORM
(All questions must be answered. Please do not leave blanks. You may use NONE or N/A where appropriate)

CERTIFICATION
I, the undersigned, warrants that the information provided in this form is correct and, in the event of changes, details will be
provided as soon as possible

Name : IBRAHIM Title / Function :DIREKTRIS

Signature Date: 28 Juni 2023

Company Stamp

PT REKSO NASIONAL FOOD - PROCUREMENT DEPT

Review by :Name Ibrahim Title / Function: Buyer Signature……………...Date:………………………

Review by :Name Ratna Supriyati Title / Function: Manager Signature……………...Date:………………………..

Review by :Name Duddy S Lasmana Title / Function: Ass. Dir Signature……………...Date:………………………..

Review by :Name Ronni Rombe Title / Function: Director Signature……………...Date:………………………..

COMPLIANCE OFFICER

Review by :Name………………..…… Title / Function: Director Signature……………...Date:………………………

KATEGORI PENDAFTARAN VENDOR

Request by : Department : Signature……………………Date:…….………..

Jasa Yang diberikan: Perawatan dan Perbaikan AC

Alasan pendaftaran Vendor :

Kelengkapan Dokumen : Masa Aktif Pendaftaran :

Tanggal Pendaftaran Vendor 28 Juni 2023 Req Temr Of payment (TOP) :

Page 3 of 3