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Vendor Information Form

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46 views1 page

Vendor Information Form

Uploaded by

yesigusman gusman
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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PT Indonesia Pos Chemtech Chosun Ref

Vendor Detail Confirmation Form


Company Information:
Name*: PT Ukas Nadhiva Saudara
Type of Business: Manufacturer/ Distributer/ Trade/ SVC/ Other: Retail/Perdangangan Eceran
Address*:
JL KH Syam'un Link Sambimanis Kel Citangkil, Kec Citangkil Kota Cilegon

Postal Code: 42441 City: Cilegon


Country: Indonesia Region: Banten
Telephone No.*: 0878-7802-0124 Phone Extn No.: -
Fax No.: - Website: -
Business Information:
Incorporation Date: 2024 Paid-up Capital: 100.000.000
NPWP/ Tax ID* : 20.808.420.2-417.000 Total Assets:
No. of Employees: 1 Total Liabilities:

Shareholding Structure:
S.No. Name of Sharehlders % of Shareholding Country of Residence
1 Dedy Sumardi 100% Indonesia
2
3

Documents to be attached:
a. Copy of Business License c. Bank Reference letter*
b. Copy of Tax ID* d. Company Profile (if any)

Representative Details:
E-mail Address*: [email protected]
E-mail - 2:
Name Contact Person*: Dedy Sumardi Mobile No.: 0878-7802-0124
Contact 2: Mobile No.:
Payment Term*: Optional Order Currency: Idr

Name of Finance Counterpart:


E-mail Address*: ptukasnadhivasaudara@gma
Mobile No.: 0812-8769-3387

Payment Conditions:
a. TT/ Advance Payment Other :
b. Credit Days
b. Inco terms

Bank Details*:
Account Holder Name*: PT Ukas Nadhiva Saudara
Bank Account #*: 1855696642 Bank Name*: BNI

Branch Name*: KCP. Pasar Anyer Jl. SA Tirtayasa No 25


Branch Address*: Kantor Cabang BNI Cilegon
Branch Code:
A)Swift*: BNINIJDA B)IBAN: _______ C)IFSC Code*: _______________________
Notes/ Remarks:

* Compulsory fields

I hereby declare that the particulars given above are correct and complete. If the transaction is delayed or not
effected at all for reasons of incomplete or incorrect information I would not hold the user institution responsible.

Dedy Sumardi
Direktur/Pemilik
Date: 15 Juli 2024

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