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  • Data Vendor Form

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    Panji Arya Mambal
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    This document is a supplier data requirements form from PT Pamayu Balimula Asri, a general contractor, supplier and engineering company located in Bogor, Indonesia. The form collects information about the supplier such as business type, name, tax ID, address, bank details, and authorized representatives. The supplier must sign to confirm the accuracy of the provided information.

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    List untuk Pengajuan Vendor

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    This document is a supplier data requirements form from PT Pamayu Balimula Asri, a general contractor, supplier and engineering company located in Bogor, Indonesia. The form collects information about the supplier such as business type, name, tax ID, address, bank details, and authorized representatives. The supplier must sign to confirm the accuracy of the provided information.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    30 views2 pages

    Data Vendor Form

    Uploaded by

    Panji Arya Mambal
    This document is a supplier data requirements form from PT Pamayu Balimula Asri, a general contractor, supplier and engineering company located in Bogor, Indonesia. The form collects information about the supplier such as business type, name, tax ID, address, bank details, and authorized representatives. The supplier must sign to confirm the accuracy of the provided information.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 2

    PT.

    PAMAYU BALIMULA ASRI


    General Contractor, Supplier & Engineering
    Jln. Golf No. 39A RT.002/RW.005 Ciriung – Cibinong
    Bogor - Jawa Barat - Indonesia, Kode Pos 16810
    Telp/ Faxcimile : +62 879 05384/ +62 879 05384
    E-mail : Pamayu,balimulaasri@gmail.com

    SUPPLIER DATA REQUIREMENTS FORM


    No. Form : SHE – PMY – 01 – IV – 2019

    KODE REKANAN :……………………………………………………………………………………….…………………….. (*Di isi oleh PT Pamayu )

    DATA BADAN USAHA *Chek list/Coret yang tidak perlu

    Jenis Badan Usaha : PT CV UD LAIN NYA


    Jenis Bidang Usaha : Supplier Kontraktor Panel Maker End User Lain nya

    Sub Bidang Usaha :……………………………………………………………………………………………………………………………………………..

    Nama Badan Usaha :……………………………………………………………………………………………………………………………………………..

    NPWP :…………………………………………………………………………………………………………………………………………….

    Dokumen Lain : SBU SIUJK Lainnya

    Alamat :……………………………………………… Website :………………………………………………………………………….

    Telp/Hp :………………………………………………. Email :………………………………………………………………………..

    PENANGGUNG JAWAB USAHA :

    Nama :………………………………………………..Jabatan :…………………………………………………………………………

    Telp/Hp :………………………………………………..Email :…………………………………………………………………………


    INFORMASI BANK PENANGGUNG JAWAB KEUANGAN
    Nama Bank :………………………………………………… Nama :…………………………………………………………………………….
    Nama Akun Bank :………………………………………………… Jabatan :……………………………………………………………………………
    No. Akun Bank :………………………………………………… Telp/Hp :………………………….………………………………………………..
    Cabang :………………………………………………… Email :……………………………………………………………………………
    _______________________________________________________________________________________________

    Saya yang bertanda tangan dibawah ini, menyatakan semua formulir ini adalah lengkap dan benar. Formulir yang di
    isi atau pun yang dilampirkan pada form Data Pelanggan ini.

    REKANAN DIPERIKSA OLEH

    Nama : Nama :
    Tgl : Tgl :
    PT. PAMAYU BALIMULA ASRI
    General Contractor, Supplier & Engineering
    Jln. Golf No. 39A RT.002/RW.005 Ciriung – Cibinong
    Bogor - Jawa Barat - Indonesia, Kode Pos 16810
    Telp/ Faxcimile : +62 879 05384/ +62 879 05384
    E-mail : Pamayu,balimulaasri@gmail.com

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