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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

 (elName Surono Position Service Manager

{f} 'vame Iriyadi Posifion Sa,bs & Marketrng Drrector

(g)ttame MeiSuget Hantanto Position HRD Manager

TOtal Membership: Please Tick [V] the appropriate column where necessary

Below 100 251-500members

members

101-250 ,{ Above 501 members

Members

Write a Short description of your Association/Society activities:

PT. Atoz Mega lndonesia {UniiiPest} is a Professional Pest Management Service Company in lndonesia
that ismanaged and operated; by professional staffs since 2009. We provide services for pest Control,
RodentControl, Termite Contr,ol, Fumigation and other special pests.
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Name: SriWaluyro Name: Triyadi
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Mobile +6285-41509-9210 Mobile +62 877-7L80-8980
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We here by declare the Sollowing:

(a) The statements and iinformation made in this application are True, Complete, and Correct. (b) Upon
approval of the membership, we shall agree to abide by the Code of Ethics, and full adherence to the
Bye-Laws & constitutionr of APMA which may be amended where appropriate.

Please submit the following documents for reference and record:

[] Association Brochure t{if any)] National Association/Society
Registration Certificatre No

Signature of designated o-fficiaI on behalf

of Association/ Socig{{App{ica nt} :

November 24,7023

ANNUALSUBSCRIfiLO!{Sr

Country membership sGD $200"00 Affiliate membership sGD $s0.00

Associate membership sGD s2s.00 AIlied membership sGD $s00.00

ENTMNCE FEES-Qne-of.f entrance, fee of SGD$5OIQ payahle.for all memhership categor:ies oJ.pptthe.
Associate Membership. Country M{embership
 FORAPMA OFFICEUSEONTY:

Date.Reca'ved' Date Submitted to Executive cornrnittee

For Approval &Remarks:
Checked & Remarks by Hon
Secretaryr

Membershfp appnoved: nYes r:Alo

Date of Approval:
Category Membership:
APMA Certificate No:
APMA Constitution sent: