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Vendor Registration Form-Ver2

CV. Perkasa is submitting a vendor registration form to Gandacement as a new vendor. The form requests information such as company details, bank account information, CEO and contact details. It notes that scanned or faxed forms with electronic forms should be sent to [email protected] and that accurate information is required to avoid issues with purchase orders and payments.

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Anonymous YHmVCT
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2K views1 page

Vendor Registration Form-Ver2

CV. Perkasa is submitting a vendor registration form to Gandacement as a new vendor. The form requests information such as company details, bank account information, CEO and contact details. It notes that scanned or faxed forms with electronic forms should be sent to [email protected] and that accurate information is required to avoid issues with purchase orders and payments.

Uploaded by

Anonymous YHmVCT
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
  • Vendor Registration Form: This page contains the vendor registration form with fields for company details, contact information, and additional notes for registration with PT. Cemindo Gemilang.

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
[email protected]
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：CV. PERKASA

Company Address: Jl. Timor Raya Km.28 Oesao-Kab .Kupang Country of Company:
City/Region: Kab. Kupang
VAT Reg. No. / NPWP NO: 84.563.800.6-922.000
INFORMATION BANK
Beneficiary name：Perkasa

Bank Name：BNI

Country of Bank: Indonesia Bank of Region: KCP Kupang Tiumur

Bank Address：Babau –Kupang Timur

Bank Account Number： 0758322244 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：081214347658 Telephone Number：
Fax Number： Fax Number：
E-mail Address：[email protected] E-mail Address：

Vendor Stamp/Signature： Date:： YY 2018 MM 10 DD 15

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 bank account and
company with stamp duty
d. Construction Service Permit copy Approved by Purchasing Manager:
e. SIUP copy PT. Cemindo Gemilang
f. Vendor Visit Report
g. Other relevant docs (please specified): ____________________________
h. Vendors have to obey PT. Cemindo Gemilang rules and agreed to not
give gifts or gratification to all PT. Cemindo Gemilang employees.
Date: YY MM DD

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