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NEW SUPPLIER REGISTRATION

SUPPLIER INFORMATION :
1. SUPPLIER NAME : CV. ALVIA SUMBER JAYA
2. Authorized Person : SUNDARININGDIAH
3. Contact Person / Phone No. : 082143752746
4. ID of Authorized Person / KTP: 3516064804640003
5. Address : PERUM WISMA PUNGGING PERMAI CA 07, RT/RW03/04,
TUNGGAL PAGER, PUNGGING, JATIM
6. Type Of Service : PENGADAAN CATERING KARYAWAN
7. Tax ID / NPWP : 60.019.274.4-602.000
8. Bank Name / Rekening No. : SUNDARININGDIAH / 6410-01-010396-53-3
9. Billing Address : PERUM WISMA PUNGGING PERMAI CA 07, TUNGGAL
PAGER, PUNGGING, JATIM
10. Deed of Establishment / Akta Pendirian : AHU - 0042628-AH.01.16 TAHUN 2023
11. SIUP / Business License : 0220102810957
12. TDP / Company Register Number: 0206220042248
13. Letter of Domicile :
14. PKP / NON PKP : S – 8813KT/WPJ.24/KP.0303/2022p
15. Payment Method : PO / AP transfer / Tagihan
16. Payment Term : AP transfer / 15 days / 30 days / 60 days / …………

Note

Harap melampirkan:

1. Fotocopy KTP
2. Fotocopy NPWP
3. Fotocopy Buku Rekening
4. Fotocopy SIUP
5. Fotocopy TDP
6. Fotocopy Letter of Domicile
7. Fotocopy PKP / Non PKP ( Jika Ada )

Gempol,
ttd
Nama Terang
QUESTION ANSWER

 Apakah pemilik usaha memiliki hubungan kekerabatan dengan karyawan? Yes/No


(Does the business owner have a relatives with employees?)
Yes/No
 Apakah transaksi akan dilakukan secara rutin ? (Will the transaction be carried out continuously ?)

 Jika transaksi pembelian barang, apakah barang dijual dipasaran secara bebas ? (If the purchase
Yes/No
transaction of goods, whether the goods are sold freely in the market ?)
Yes/No
 Apakah pemilik usaha memiliki hubungan dengan politisi dan pejabat politik? (Does the business owner
have a relatives with political office?)

 Apakah pemilik usaha saat ini sedang memiliki permasalahan mengenai kinerja bisnis/performa dalam Yes/No
usahanya? (Does the business owner currently have problems regarding business
performance/performance in their business?)

ANALISIS PERSYARATAN PERJANJIAN (ANALYSIS OF AGREEMENT REQUIREMENTS)

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