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VENDOR / CUSTOMER REGISTRATION FORM

15 November, 2023
Name KITAN
Company Code SSMJ
Department OPERATIONAL
Type of Form ☒ Vendor ☐ Customer

Vendor/Customer Details
Title ☐ Company ☒ Mr. ☐ Mrs.
Name PT. SUNGAI SEMBILAN MEGAH JAYA
Local/Overseas ☒ Local ☐ Overseas
Group/ Account/ Type 3RD PARTY TRADE MATERIAL
Address
Country INDONESIA
Street Jl. Peringgan / RT 011 Lubuk Gaung, Kec. Sei Sembilan, Kota Dumai
City DUMAI KODE POS -
Telephone +62 823-9000-7606 - -
Tax & Payment Transaction
PKP (Pengusaha Kena Pajak) ☒ Yes ☐No NPWP : 03.301.865.6-212.000
Payment Method ☒Bank ☐Cash ☐ Check
Payment Terms BANK
Bank Information
Bank Name BNI DUMAI 8526529802
Account Holder PT SINMA LINE

DATA PENDUKUNG
DOKUMEN CHECK BY MDM
SIUP/ SIUPAL ☒
AKTA PENDIRIAN ☒
NPWP ☒
SURAT PPPKP ☒
SURAT PERNYATAAN REKENING ☒
KET LAIN2 ☒

REQUESTOR DIKETAHUI MDM DISETUJUI

( KITAN ) ( DOLI DAHANA ) ( ) ( )

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