PT Trakindo Utama Vendor Registration Form

Gedung TMT 1, Lt 10-17 Vendor # :

Jl. Cilandak KKO No.1 (Filled by Procurement staff)
Jakarta 12560
Indonesia
Tel.(62-21) 782 2373
Fax.(62-21) 782 2357

NPWP No. 02.025.873.7-091.000 Page 1 of 2

Supplier Data (Completed By Supplier) Contact

Title : Corporation Other Telephone : Ext :

Individual Fax : Ext :

(Company) Name : Email 1 :

Business Type : Email 2 :

Street : Sales Data

Postal Code : City Salesperson name :

Country : Province Telephone :

PO Box : Position :

Vendor Business and License Details (Completed By Supplier)

Licence Score Document No. Completed By PT.Trakindo Utama Score

Amandements Deeds No.
Akta Pendirian
(Akta Pendirian dan Akta Perubahan) Akta Perubahan

Vendor Registration No.

Expiry Date (Valid /
(Tanda Daftar Perusahaan/TDP) Invalid)
Vendor Domicile License* No.
Expiry Date (Valid /
(Surat Keterangan Domisili Usaha/Perusahaan)
Invalid)

Permit for Trading No.

Expiry Date (Valid /
(Surat Ijin Usaha Perdagangan/SIUP) Invalid)

Vendor Tax Identification* No.

Complete /
(Supplier Wajib Pajak/NPWP) Incomplete
Vendor VAT – able Letter No.
(Surat Pengukuhan Pengusaha Kena Complete /
Pajak/SPPKP) Incomplete

Speciment of Tax Form Signature

(Contoh tanda tangan Pejabat/Kuasa yang ditunjuk menandatangani Faktur Pajak)
Name: Signature:
Title:
Complete /
Incomplete

Sertifikat Badan Usaha Vendor’s Contract Signatory Complete /

(Complete with name, signature and Incomplete
company chop) Result
Total Score: _______
Others Information : Approved /
¨ Company Profile Not Approved
¨ Catalog/Brochure
¨ Experience List Note : Minimum Score 75
¨ Other Date(dd/mm/yy)

S&P.110037.R0
 PT Trakindo Utama Vendor # :

Page 2 of 2
Bank Details (Completed By Supplier)
Country Bank Account* Account Holder Name* Bank Name*
Bank Key SWIFT / IBAN
Negara No Rekening Nama Pemegang Rekening Nama Bank

Vendor # (Completed by PuRep/S&P) Payment (Completed By Finance)

Request Type Payment Terms * :
New Modifiy Delete Witholding Tax (Completed By Tax Department)
Company Code : WH Tax Country :
Purchasing Org. : WH Tax Type : Liable
Account Group : X
Business Type (Search Term2) : X
Plant Code (Search Term 1) : X
Purchasing X
Order Currency : X
Payment Terms : Control (Completed By Tax Department)
Incoterms : Tax Number :
Incoterms Desc :
Control Data
GR-Based Inv. Verification : X (Default for local Vendor) Accounting Information (Completed By Finance)
Service-Based Inv. Verification : X (Default for local Vendor) Recon Account *
Payment Transaction Accounting 6
Cash Management Group :
Check Double Invoice : X
Note : (*) Mandatory Field

For Futher Information, please contact: Sourcing & Procurement (S&P)

Prepared By: Approved By:
PT Trakindo Utama
Gedung TMT 1 – Lt.12
Jl. Cilandak KKO No.1 – Jakarta Selatan 12560
Tlp. 021-2997 6620
Email: poc@trakindo.co.id
Attn.: Triona Natali Tanor

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S&P.110037.R0