VENDOR REGISTRATION FORM

All mandatory fields marked in red should be filled.

Please send scanned or faxed stamped form together with completed electronic form to Purchasing Dept
Apply Type： New Create（Please fill in all mandatory fields）
Change（Please fill in fields need changing）
What to change:
VENDOR NO: Business Type:

Full Company Name：

Company Address: Country of Company:

City/Region:

VAT Reg. No. / NPWP NO:

INFORMATION BANK

Beneficiary name：

Bank Name：

Country of Bank: Bank of Region:

Bank Address：

Bank Account Number： Swift Code:

(Please remark account type, such as USD /IDR account)

Bank Code: Branch Code：

ADDITIONAL INFORMATION
Name of CEO： Name of CFO： Name of Sr. Sales/Mktg. Executive：

Business Contact Name： Finance Contact Name：

Telephone Number： Telephone Number：
Fax Number： Fax Number：
E-mail Address： E-mail Address：

Vendor Stamp/Signature： Date:： YY MM DD

Note:
1. Please ensure all information and documents are correct and legal. Any incorrect information will affect PO place and
payment.
2. If bank information change, vendor should offer vendor bank information change notification with stamp/signature.
3. If there’s more than 1 bank information, please mark clearly in related field. (Like account number 1**, account number 2
**)
4. Required valid documents below are attached (circled) :
a. NPWP Copy or Original Statement Letter of Non NPWP with stamp duty
b. SPPKP Copy or Original Statement Letter of Non PKP with stamp duty
c. Bank Account copy and Original Statement Letter of Different Bank Account if has different name of
beneficiary and company with stamp duty.
d. Construction Service Permit copy Approved by Purchasing Manager:
e. SIUP copy
f. Vendor Visit Report
g. Other relevant docs (please specified): ____________________________
____________________________________________________________
Date: YY MM DD