Synnex Metrodata Indonesia

Page 1

Email to : Collection_SMI@metrodata.co.id Please include current and previous year financial statements

Date : ____________

Total Asset : IDR _________________ Total Current Asset : IDR _______________________

Total Liabilities IDR

Type of Account:

Others __________________________
Distributor Reseller Strategic Accounts

COMPANY INFORMATION

SELECT ONE: Partnership Sole Proprietorship

✘ Corporation
PUBLIC OR PRIVATE COMPANY: Public ✘ Private
BUSINESS NAME: PT RELIAPRO GLOBAL SOLUSI

ADDRESS: Jl. Trulek IV HG 16/07 Pondok Pucung Pondok Aren 15227

COUNTRY: Indonesia Telp : 021-50915015 FAX : ______________________

DELIVERY ADDRESS (IF DEFFERENT) : __________________________________________________________________________________

WEBSITE:

DATE COMPANY ESTABLISHED: ______________________________

ANNUAL SALES (IDR) : NO. OF EMPLOYEES : 15 Orang

NAME OF HOLDING COMPANY (IF ANY) : _______________________________________________________________________________

NAMES OF OFFICERS (Required for non-public companies)

PRESIDENT/CEO/OWNER : Aryo Budidarmo

Direct Phone Line : 0812-8811.5238 E-mail : aryo@reliapro.id

CFO/COO/CONTROLLER: Sandy Satria Kurnia

Direct Phone Line: E-mail: sandy@reliapro.id

ACCOUNTING CONTACT (Required)

ACCOUNTS PAYABLE CONTACT: Abdul Harits

Direct Fax Line: E-mail: harits@reliapro.id

REQUEST LIMIT& TOP (Required)

LIMIT : ______________________

TERM OF PAYMENT : _______________________

686789452.xls Review Form

 Synnex Metrodata Indonesia Credit Application
Page 2

TRADE REFERENCES (Required)

COMPANY NAME:

CONTACT: E-MAIL :
FAX:
PHONE:
CURRENT LINE OF CREDIT: _____________________
PAYMENT TERMS:

COMPANY NAME:

CONTACT: E-MAIL :
FAX:
PHONE:
CURRENT LINE OF CREDIT: _____________________
PAYMENT TERMS:

BANK REFERENCE (Required)

BANK NAME : PT Bank Negara Indonesia (persero)Tbk

CHECKING ACCOUNT #:

SAVINGS ACCOUNT #: 1265384066

CONTACT:

PHONE :

FAX :

CURRENT LINE OF CREDIT:

GENERAL AGREEMENT
As an inducement to grant credit, the applicant warrants that the information submitted is true and correct. Metrodata is authorized to
investigate the trade and bank references listed above. The Applicant further releases all banks, businesses, and persons identified
on this application to furnish any and all information requested by Metrodata or it’s representatives, by telephone or written
correspondence whichever Metrodata requests.

Aryo Budidarmo ___________________ Director

Name Signature Title Date

Document must be submitted Check list Check list

1 Akta Perusahaan* √ 8 Bank Referensi – Asli

2 KTP penanggung jawab/Direksi (* / **)
3 NPWP Perusahaan*
4 Surat Pengukuhan PKP*
5 Tanda Daftar Perusahaan*
6 Surat Izin Usaha Perdagangan*
7 Surat Izin Tempat Usaha
Note : * Mandatory for PKP
** Mandatory for Non PKP
√ 9 Rekening Koran – last three months
√ 10 Laporan Keuangan – last three years (audited)
√ 11 Bilyet Giro - Jaminan
√ 12 Foto lokasi kantor/toko (tampak luar)**
√ 13 Foto lokasi kantor/toko (tampak dalam)**
√

686789452.xls Review Form