Professional Documents
Culture Documents
2-15r2 Application Form
2-15r2 Application Form
System Certification
SUCOFINDO
SUCOFINDO ICS
SUCOFINDO INTERNATIONAL
CERTIFICATION
SERVICES
a
Strategic
Business
Unit
of
PT.
SUCOFINDO
(PERSERO)
FRM 2.15
Issue 04 Rev. 2
1 of 4
Part One
Name of Organization:
......................................................................................................................
Address:
......................................................................................................................
(See Note 1)
......................................................................................................................
......................................................................................................................
Telephone:
..................................
.
Facsimile:
......................................
NPWP No.:
......................................................................................................................
I on behalf of the organization detailed above hereby apply for certification and declare that we agree to
comply with SUCOFINDO INTERNATIONAL CERTIFICATION SERVICE (SUCOFINDO ICS) Terms and
Conditions Governing System Certification and that the information given in this application and the attached
questionnaire (see Note 2.) is correct.
..........................................
..(Signature)
..........................................
. (Name)
..........................................
.. (Position)
............................
. (Date)
I nominate the following person as our Authorized Representative (see Note 3):
Authorized Representative:
......................................................................................................................
Position:
......................................................................................................................
Postal Address:
......................................................................................................................
......................................................................................................................
......................................................................................................................
Telephone:
......................................
..........................................
..(Signature)
..........................................
.. (Name)
Facsimile:
......................................
..........................................
.. (Position)
............................
. (Date)
I.
............................................................................................, hereby accept nomination as my
organizations authorized representative for SUCOFINDO ICS Certification. I declare that I will observe the
Terms and Conditions Governing System Certification and authorize you, on certification of the organization,
to enter my name in the Directory of Certified Organizations.
.............................................................................
..
..........................................
(Date)
(Signature)
SUCOFINDO ICS
FRM 2.15
Issue 04 Rev. 2
2 of 4
Part Two
Notes
Note 1
If the scope of your application covers more than one location, please enter details on page
four (4) of this application. Photo copies of page 4 can be made and attached to the
application form if required.
Note 2
In additional to this application can you please complete the applicable section of
SUCOFINDO ICS System Certification Questionnaire and attach it to this application.
Note 3
......................................................................................................................
Address:
......................................................................................................................
......................................................................................................................
......................................................................................................................
SUCOFINDO ICS
FRM 2.15
Issue 04 Rev. 2
3 of 4
Telephone:
......................................
Facsimile:
......................................
Local contact:
......................................................................................................................
Name of Location:
......................................................................................................................
Address:
......................................................................................................................
......................................................................................................................
......................................................................................................................
Telephone:
......................................
Facsimile:
......................................
Local contact:
......................................................................................................................
Name of Location:
......................................................................................................................
Address:
......................................................................................................................
......................................................................................................................
......................................................................................................................
Telephone:
......................................
Facsimile:
......................................
Local contact:
......................................................................................................................
Name of Location:
......................................................................................................................
Address:
......................................................................................................................
......................................................................................................................
......................................................................................................................
Telephone:
......................................
Local contact:
......................................................................................................................
SUCOFINDO ICS
Facsimile:
......................................
FRM 2.15
Issue 04 Rev. 2
4 of 4