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MEMBERSHIP APPTICATION FORM

IMPORTANT:
1. Read the following instructiorl carefully before filling in the membership application. All requested information must be
furnished. The information lyou give will be used to determine your application for membership, it is important that you
answer all questions accurately and completely. Please Tick [V] the appropriate column where necessary
LEuenl ap4licatioofor mpmherrihi+shallhemadp ongrescrihedformsandhe grogacad arulcpJrnnderl hy
two existing APMA members axrd shall be forwarded to the Honorary Secretary ard the Executive
Committee for approval, 3. The: APMA Executive Committee may at its discretion reject any application
without r€OSOh threr€Of.

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ASSOCIATION DATA

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Contact SriWaluyo Email: Maluyo.unipest@gmail.com
person:

Designation: President Disector Office{Tel.} +62-2L 8497 4553, 84901494

Assoe.HkrAee*s: l##fr&e: www.uni pesti ndonesia.co. id

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Date of Establishment of Company:
Pondok Melati, Kota Bekasi - ilawa
Barat,lndonesia L74L4 2 Februari 2009

National Association Registration Certificate No:

o2ol DPDI ASPPHAMyJABAB/2023

Principal Executive Commit'&Eee Officers:

(alName SriWaluyo Position President Director

(bj Name Revfani Posrtion Ffnance & Admfn Manager

{c)Name Dias Sukmaw;rti Position Corporate Secretary

{d) Name Yuly Ananto Position QAHSE Manager