PT.

PANASONIC GOBEL ECO SOLUTIONS MANUFACTURING INDONESIA

PASURUAN FACTORY
Jl.Rembang Industi Raya No.47 PIER Rembang
Pasuruan 67152 Jawa Timur
Telp.(0343)740230 Fax.(0343)740239

To: PT Panasonic Gobel Eco Solutions Date:

Manufacturing Indonesia
Attn:

Agreement of Remittance
Receiving Company Name:

PT Sinar Bacan Khatulistiwa

Signature & Stamp:

Signer name:

Beneficary Name :

Beneficary Address :

Bank name:

Branch & Address:

Other Inf.:

Currency and Account Number(s):

Currency Account Number Remarks

Please fill in one account number which is available for all kinds of currency.
But if you have an separate account for each currency, Please enter an account number in the
above-mentioned blank for each one. Do not fill in two account numbers for one currency, please.

If you need "Payment Advice" by FAX, please fill in the person-in-charge name and FAX No.
of an Accounting Division below.

Contact person of Acc.Div.:

Fax No.of Acc.Div.: