Surabaya: Raya Kendangsari No.

63, Tenggilis Mejoyo, Surabaya 60292

Jakarta: Grand Aries Niaga E1/5Q Jl. Taman Aries Utama Jakarta 11620
Yogyakarta: Seturan No. 3, Caturtunggal, Depok, Sleman, DI Yogyakarta 55281

Website: about.superapp.id

STRICTLY CONFIDENTIAL
Employee Joining Form

Please complete below form and return to HR along with the followings:
1. Copy of ID Card (KTP/SIM)
2. Copy of NPWP
3. Copy of Kartu Keluarga
4. Copy of Marriage Certificate (if any)
5. Copy of BPJS Kesehatan (if any)
6. Copy of BPJS Ketenagakerjaan (if any)
7. Copy of Latest Academic Certificate
8. Copy of Bank Account Passbook

Personal Detail

Full Name
Job Title
Joining Date
Birth
Place Date (dd/mm/yyyy)

Gender
Marriage Status Single
Married with child(ren)
Divorce with child(ren)
KTP No.
NPWP No.
BPJS Kesehatan No. (if any)
BPJS Ketenagakerjaan No. (if any)
Home Address (as stated in KTP)
Full Street Address (Please include RT/RW, Kelurahan, and Kecamatan)

City Province Zip Code

Correspondency Address
 Surabaya: Raya Kendangsari No. 63, Tenggilis Mejoyo, Surabaya 60292
Jakarta: Grand Aries Niaga E1/5Q Jl. Taman Aries Utama Jakarta 11620
Yogyakarta: Seturan No. 3, Caturtunggal, Depok, Sleman, DI Yogyakarta 55281

Website: about.superapp.id

(If different with above) Full Street Address (Please include RT/RW, Kelurahan, and Kecamatan)

City Province Zip Code

Mobile Number
E-mail Account
Bank Account
Bank Account No. Account Holder Bank Name & Branch

Emergency Contact

In case of emergency, please put the right information about your emergency contacts.

1. Full Name Relationship

Address
Mobile Number
2. Full Name Relationship
Address
Mobile Number

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my

application or interview may result in my release.

Signature Date