DATA PELANGGAN

CUSTOMER DATA
INDIVIDU
INDIVIDUAL
No. FORM : ERAA/20……./……./03-……………………

Data Pelanggan yang akan dicantumkan pada invoice

Customer Data to be written on the invoice

Nama Pelanggan : ..................................................................................................................................................................................................................................

Customer Name
Alamat Pelanggan : ..................................................................................................................................................................................................................................
(sesuai NPWP jika ada)
Customer Address
(in accordance with NPWP if any)
No. NPWP / SPPKP : ............................................................................. Tgl. Registrasi NPWP / SPPKP : ......................................................................................
NPWP / SPPKP Number Registration Date of NPWP / SPPKP

Data Toko
Store Data
Nama Toko : ...............................................................................................................................................................................................................
Store Name
Alamat Toko : ................................................................................................................................................................................................................
Store Address
Kota : ............................................................................. Provinsi : ......................................................... Kode Pos : ........................
City Province Postal / Zip Code
No. Telp : ............................................................................. No. Fax : .........................................................
Phone Number Fax Number
Email : .............................................................................
Email
Status Gedung Toko : Milik Sendiri Sewa Lainnya : ........................................... Lama Menempati : .............. tahun
Store Building Status Owned Lease Other Occupying for : .............. years
Alamat Korespondensi : ...................................................................................................................................................................................................
(Apabila alamat berbeda)
Correspondence Address
(if the address is different)
Kota : ............................................................................. Kode Pos : ..................................................................................................
City Postal/Zip Code
Provinsi : ............................................................................. Negara : ..................................................................................................
Province Country

Data Pemilik Dokumen untuk dilampirkan – KTP – NPWP

Owner Data Documents to be attached - ID Card - NPWP

Nama Lengkap : .........................................................................................................................................................................................................

Full Name
Domisili Hukum : Lokal Asing ......................................
Legal Domicile Domestic Foreigner
Alamat KTP : .........................................................................................................................................................................................................
Address as stated in ID Card
Alamat Tempat Tinggal : .........................................................................................................................................................................................................
(Apabila alamat berbeda)
Home Address
(If the address is different)
No. KTP : .........................................................................................................................................................................................................
ID Card Number
No. Telp / Handphone : .........................................................................................................................................................................................................
Phone / Hand phone Number
Email : .........................................................................................................................................................................................................

Pihak yang dapat mewakili Pelanggan (Jika ada selain Pemilik)

Authorized representative of the Customer (if any, aside from the Owner)
Nama : .........................................................................................................................................................................................................
Name
Alamat Tempat Tinggal : .........................................................................................................................................................................................................
Home Address
No. KTP : .........................................................................................................................................................................................................
ID Card Number
No. Telp / Handphone : .........................................................................................................................................................................................................
Phone / Hand phone Number
Email : .........................................................................................................................................................................................................
Email
Bank Settlement
Nama Bank ................................................................................................................................ BIC/SWIFT Code ..........................................................................................
Bank Name BIC/SWIFT Code
Nama Pemegang Rekening Bank*..................................................................................................................................................................................................................
Name of the Holder of Bank Account*
No. Rekening ............................................................................................................................. Jenis Mata Uang .........................................................................................
Account Number Currency Type

* Berdasarkan Keputusan Direktur Jenderal Pajak No. KEP-136/PJ/2014 Tentang Penetapan Pengusaha Kena Pajak Yang Diwajibkan
Membuat Faktur Pajak Berbentuk Elektronik, maka terhitung sejak tangal 1 Juli 2015 akan diberlakukan ketentuan E-Faktur Pajak. Sesuai
Peraturan Menteri Keuangan No. 197/PMK.03/2013 bagi Pengusaha yang memiliki omzet/peredaran bruto lebih dari Rp.4,800,000,000,-
(empat milyar delapan ratus juta Rupiah) per tahun buku harus melaporkan kegiatan usahanya untuk dikukuhkan sebagai Pengusaha
Kena Pajak *

* Pursuant to the Decision of Director General of Taxes No. KEP-136/PJ/2014 Regarding Determination of Taxable Entrepreneurs which Required
to Make Electronic Tax Invoices, commencing from 1 July 2015 E-Tax Invoice provision will be enforced. In accordance with the Regulation of
Minister of Finance No. 197/PMK.03/2013, any entrepreneurs who has revenue/gross turnover of more than Rp 4,800,000,000.- (four billion eight
hundred million Rupiah) per accounting year must report its business activities to be declared as Taxable Entrepreneur*

DEKLARASI
DECLARATION
Dengan menandatangani formulir ini, saya
By signing this form, I
1. Menyatakan bahwa semua informasi yang dicantumkan dalam formulir ini adalah jujur, benar dan sah dan tidak terdapat
penyembunyian terhadap fakta yang material serta menjamin bahwa seluruh fotokopi dokumen-dokumen yang dilampirkan/
diserahkan adalah sesuai dengan aslinya. Saya bertanggungjawab penuh atas keterangan yang saya sampaikan, dan atas segala transaksi
yang menggunakan nama Pelanggan tersebut anak-anak perusahaan PT Erajaya Swasembada Tbk (“Erajaya Group”).
Declare that all information contained herein is truthful, true and valid and there is no concealment of material facts and warrants that all
copies of the documents attached/ submitted are in accordance with the original. I am fully responsible for the information I conveyed, and for
any transactions which conducted under the name of such Customer with the subsidiaries of PT Erajaya Swasembada Tbk (“Erajaya Group”).

2. Telah menerima, menelaah dan memahami semua peraturan yang ditetapkan oleh Erajaya Group dalam Syarat dan Ketentuan
Pelanggan dan setuju untuk mematuhi seluruh peraturan yang ditetapkan termasuk pada perubahan-perubahan yang mungkin timbul
di kemudian hari.
Have received, reviewed and understood all the rules set forth by Erajaya Group stipulated under the Terms and Condition of Customer and
agreed to comply with all stipulated rules including any amendments that may arise in the future.

3. Mengerti bahwa persetujuan pemberian fasilitas dapat dipertimbangkan untuk diberikan berdasarkan informasi dalam formulir ini
dan syarat-syarat perjanjian lainnya, Erajaya Group mempunyai hak untuk menolak aplikasi ini tanpa adanya keharusan untuk
memberikan alasan.
Understand that approval for facilities granting may be considered to be granted pursuant to the information contained herein and the terms
of any other agreements, Erajaya Group reserves the right to refuse this application without the necessity of giving any reason.

4. Menyatakan bahwa bersedia melakukan pengkinian data dan wajib menyampaikan pemberitahuan dan data/ dokumen pendukung
dalam waktu selambat-lambatnya 3 (tiga) hari setelah adanya perubahan terhadap data-data Pelanggan dan/ atau dokumen pendukung
yang tercatat di data base Erajaya Group. Untuk itu Erajaya Group tidak bertanggungjawab atas segala resiko akibat keterlambatan
pemberitahuan tersebut.
Declare that I am willing to update the data and shall submit any notification and supporting data/ documents within no later than 3 (three)
days after any changes to Customer Data and / or supporting documents recorded in data base Erajaya Group. For that matter, Erajaya Group
is not responsible for any risks which might be occurred due to any delay of such notice.

Pelanggan/Customer, Erajaya Group,

Materai Rp 6.000,-
Stamp duty Rp 6.000,-

Nama & Tanda Tangan / Name & Signature Nama & Tanda Tangan / Name & Signature
Tanggal / Date : Tanggal / Date :
 DATA PELANGGAN
CUSTOMER DATA
BADAN USAHA / BADAN HUKUM
BUSINESS ENTITY / LEGAL ENTITY
No. FORM : ERAA/20……./……./03-……………………

Nama Toko : .............................................................................................................................................................................................

Store Name

Alamat Toko : .............................................................................................................................................................................................

Store Address
Dokumen untuk dilampirkan (Fotocopy) :
Data Pelanggan yang akan dicantumkan pada Invoice & Faktur Pajak Documents to be attached (Photocopy):
Customer Data to be written on the Invoice & Tax Invoice - Akta Pendirian & SK - Akta Perubahan Terakhir & SK
Deed of Establishment & its Legalization Decree
Badan Usaha / Badan Hukum Deed of Latest Amendment & its Approval Decree
Business Entity / Legal Entity - NPWP - SPPKP - SIUP - TDP - SK Domisili
NPWP - SPPKP - SIUP - TDP - Certificate of Domicile

Nama Lengkap Pelanggan : .............................................................................................................................................................................................

Customer Full Name

NPWP : ................................................................. No SPPKP : .....................................................................................

NPWP Number SPPKP Number

Alamat NPWP : .............................................................................................................................................................................................

NPWP Address

No. Akta Pendirian : ......................................................................... No. SK Akta Pendirian : ...................................................................

Number of the Deed of Establishment Number of the Legalization Decree of the Deed of Establishment

No. Akta Perubahan Direksi : ......................................................................... No. SK Perubahan Direksi : ...................................................................

Number of Deed on Change of Directors Composition Number of the Decree of the Deed on Change of Directors Composition

Alamat Domisili Pelanggan : ......................................................................... No. SK Domisili : ...................................................................

Customer Domicile Address Number of Certificate of Domicile

No. Telp. Kantor : ......................................................................... No. Fax : ...................................................................

Office Phone Number Fax Number

Email : ......................................................................... Izin Usaha (SIUP) : ...................................................................

Email Business License (SIUP)

Domisili Hukum : Lokal Asing ...........................................................................

Legal Domicile Domestic Foreigner

Status Gedung/Toko : Milik sendiri Sewa Lainnya ............................................. Lama Menempati : ........... tahun
Building/Store Status Owned Lease Others Occupying for : ........... years

Alamat Korespondensi (jika berbeda) : .....................................................................................................................................................................................................

Correspondence Address (if different)

Kota : .......................................................................................................... Kode Pos : ..........................................................................................................

City Postal/ Zip Code

Propinsi : .......................................................................................................... Negara : ..........................................................................................................

Province Country

Pihak Yang Dapat Mewakili Badan Usaha / Badan Hukum Dokumen untuk dilampirkan (Fotocopy) : KTP - NPWP (Direktur)
Authorized Representation of Business Entity / Legal Entity Documents to be attached (Photocopy): ID Card – NPWP (Director)

Nama Lengkap Direktur : ...............................................................................................................................................................................................................

Full Name of the Director

No. KTP : ............................................................................................ NPWP : ............................................................................................

ID Card Number NPWP

Alamat KTP : ...............................................................................................................................................................................................................

Address as stated in ID Card

Alamat Tempat Tinggal (saat ini) : ................................................................................................................................................................................................................

Home Address (current)
Kota : ............................................................................... Kode Pos : ...............................................................................
City Postal /Zip Code

Propinsi : ............................................................................... Negara : ...............................................................................

Province Country

No. Telp. / Handphone : ............................................................................... Email : ...............................................................................

Phone / Hand phone Number Email

Bank Settlement
Nama Bank : ............................................................................... BIC/SWIFT Code : ...............................................................................
Name of Bank BIC/SWIFT Code

Nama Pemegang Rekening Bank* : ...........................................................................................................................................

Name of the Holder of Bank Account*

No. Rekening : ............................................................................................................... Jenis Mata Uang : ...............................................................................

Account Number Currency Type

* Berdasarkan Keputusan Direktur Jenderal Pajak No.KEP-136/PJ/2014 Tentang Penetapan Pengusaha Kena Pajak Yang Diwajibkan
Membuat Faktur Pajak Berbentuk Elektronik, maka terhitung sejak tangal 1 Juli 2015 akan diberlakukan ketentuan E-Faktur Pajak. Sesuai
Peraturan Menteri Keuangan No. 197/PMK.03/2013 bagi Pengusaha yang memiliki omzet/peredaran bruto lebih dari Rp.4,800,000,000,-
(empat milyar delapan ratus juta Rupiah) per tahun buku harus melaporkan kegiatan usahanya untuk dikukuhkan sebagai Pengusaha
Kena Pajak *

* Pursuant to the Decision of Director General of Taxes No. KEP-136/PJ/2014 Regarding Determination of Taxable Entrepreneurs which Required
to Make Electronic Tax Invoices, commencing from 1 July 2015 E-Tax Invoice provision will be enforced. In accordance with the Regulation of
Minister of Finance No. 197/PMK.03/2013, any entrepreneurs who has revenue/gross turnover of more than Rp 4,800,000,000.- (four billion eight
hundred million Rupiah) per accounting year must report its business activities to be declared as Taxable Entrepreneur*

DEKLARASI
DECLARATION

Dengan menandatangani formulir ini, kami

By signing this form, We

1. Menyatakan bahwa semua informasi yang dicantumkan dalam formulir ini adalah jujur, benar dan sah dan tidak terdapat
penyembunyian terhadap fakta yang material serta menjamin bahwa seluruh fotokopi dokumen-dokumen yang dilampirkan/
diserahkan adalah sesuai dengan aslinya. Kami bertanggungjawab penuh atas keterangan yang kami sampaikan, dan atas segala
transaksi yang menggunakan nama Pelanggan tersebut dengan anak-anak perusahaan PT Erajaya Swasembada Tbk (“Erajaya Group”).
Declare that all information contained herein is truthful, true and valid and there is no concealment of material facts and warrants that all
copies of the documents attached/ submitted are in accordance with the original. We are fully responsible for the information We conveyed, and
for any transactions which conducted under the name of such Customer with the subsidiaries of PT Erajaya Swasembada Tbk (“Erajaya Group”).

2. Telah menerima, menelaah dan memahami semua peraturan yang ditetapkan oleh Erajaya Group dalam Syarat dan Ketentuan
Pelanggan dan setuju untuk mematuhi seluruh peraturan yang ditetapkan termasuk pada perubahan-perubahan yang mungkin timbul
di kemudian hari.
Have received, reviewed and understood all the rules set forth by Erajaya Group stipulated under the Terms and Condition of Customer and
agreed to comply with all stipulated rules including any amendments that may arise in the future.

3. Mengerti bahwa persetujuan pemberian fasilitas dapat dipertimbangkan untuk diberikan berdasarkan informasi dalam formulir ini
dan syarat-syarat perjanjian lainnya, Erajaya Group mempunyai hak untuk menolak aplikasi ini tanpa adanya keharusan untuk
memberikan alasan.
Understand that approval for facilities granting may be considered to be granted pursuant to the information contained herein and the terms
of any other agreements, Erajaya Group reserves the right to refuse this application without the necessity of giving any reason.

4. Menyatakan bahwa bersedia melakukan pengkinian data dan wajib menyampaikan pemberitahuan dan data/ dokumen pendukung
dalam waktu selambat-lambatnya 3 (tiga) hari setelah adanya perubahan terhadap data-data Pelanggan dan/ atau dokumen pendukung
yang tercatat di data base Erajaya Group. Untuk itu Erajaya Group tidak bertanggungjawab atas segala resiko akibat keterlambatan
pemberitahuan tersebut.
Declare that I am willing to update the data and shall submit any notification and supporting data/ documents within no later than 3 (three)
days after any changes to Customer Data and / or supporting documents recorded in data base Erajaya Group. For that matter, Erajaya Group
is not responsible for any risks which might be occurred due to any delay of such notice.

Pelanggan/Customer, Erajaya Group,

Materai Rp 6.000,-
Stamp duty Rp 6.000,-

Nama & Tanda Tangan / Name & Signature Nama & Tanda Tangan / Name & Signature
Tanggal / Date : Tanggal / Date :
 SURAT PENUNJUKAN PELANGGAN
CUSTOMER APPOINTMENT LETTER
Syarat dan ketentuan yang berlaku bagi Pelanggan dalam rangka bekerjasama dengan PT Erajaya Swasembada Tbk dan/atau dengan anak usahanya (“Erajaya Group”) dan
merupakan satu kesatuan dengan Form Data Pelanggan.
Terms and conditions applicable for the Customer during the cooperation with PT Erajaya Swasembada Tbk and/or its subsidiaries (“Erajaya Group”) and shall constitute as an
integral part with the Customer Data Form.
1. LINGKUP KERJASAMA DENGAN PELANGGAN
SCOPE OF COOPERATION WITH CUSTOMER
Ruang lingkup kerjasama dengan Pelanggan ini yaitu pembelian produk gadget yang dijual oleh Erajaya Group melalui anak usaha yang ditunjuk termasuk namun tidak
terbatas pada telepon genggam, tablet, komputer dan aksesories (“Produk”).
This Scope of cooperation with the Customer is the purchase of gadget products sold by Erajaya Group through its appointed subsidiaries including but not limited to hand phones,
tablets, computers and accessories (“Product”).
2. JANGKA WAKTU KERJASAMA
TERM OF COOPERATION
Kerjasama ini berlaku sejak Form Data Pelanggan ditandatangani dan tetap berlaku kecuali diakhiri sebagaimana diatur dalam Pasal 11 Syarat dan Ketentuan.
This Cooperation is effective commencing from the execution of the Customer Data Form and shall remain effective unless terminated as stipulated under Clause 11 of the Terms
and Conditions.
3. HARGA
PRICE
3.1. Harga adalah harga jual Erajaya Group kepada Pelanggan berikut diskon apabila ada dan harga jual akhir (end user price).
Price is Erajaya Group’s selling price to the Customer including discount, if any, and end user price.
3.2. Penentuan harga dan perhitungan diskon merupakan kewenangan Erajaya Group, dan Erajaya Group akan memberitahukan setiap perubahan kepada Pelanggan.
Calculation of price and discount is fall under Erajaya Group’s authority, and Erajaya Group will notify the Customer regarding any amendment thereof.
4. HAK DAN KEWAJIBAN PARA PIHAK
RIGHTS AND OBLIGATIONS OF THE PARTIES
4.1. Kewajiban Erajaya Group
Erajaya Group’s Obligations
a. Menyediakan Produk beserta aksesoris yang melekat didalam kemasan (package).
Provide the Product along with any accessories embedded in its package.
b. Mengirimkan Produk kepada Pelanggan setelah menerima Pemesanan (Purchase Order) dari Pelanggan.
Ship the Product to the Customer after accepts the Purchase Order from the Customer.
c. Melakukan evaluasi secara periodik atas kerjasama yang dilakukan dengan Pelanggan.
Conduct periodic evaluation towards the cooperation which being undertook with the Customer.
4.2. Hak Erajaya Group
Erajaya Group’s Rights
a. Menentukan dan memberikan harga Produk kepada Pelanggan.
Determine and provide the price of the Product to the Customer.
b. Menerima pembayaran dari Pelanggan.
Receive the payment made by the Customer.
4.3.Kewajiban Pelanggan
Customer’s Obligation
a. Melakukan pengecekan atas Produk yang diterima dari Erajaya Group dan menandatangani tanda terima penerimaan Produk.
Check the Product received from Erajaya Group and signs the Product acceptance receipt.
b. Memberikan bukti pembayaran Produk kepada Erajaya Group.
Provide any documents evidencing Product payment to Erajaya Group.
c. Pelanggan bertanggung jawab atas dan membebaskan Erajaya Group dari setiap akibat dan konsekuensi yang timbul sehubungan dengan rusaknya atau cacatnya
atau tidak tersegelnya Produk setelah diterima oleh Pelanggan dari Erajaya Group.
Customer is responsible for and holds harmless Erajaya Group from any results and consequences arising in relation to the damage or defects or unseal of the Product
after the same has been received by Customer from Erajaya Group.
d. Jika Pelanggan merupakan badan hukum (PT, CV dan lain-lain), maka Pelanggan harus menyerahkan foto copy anggaran dasar perusahaan,beserta surat keputusan
Kementrian Hukum dan HAM, foto copy surat keterangan domisili perusahaan, foto copy surat izin usaha perdagangan, foto copy tanda daftar perusahaan, foto copy
nomor pokok wajib pajak, foto copy surat pengukuhan pengusaha kena pajak dan foto copy identitas penanggung jawab perusahaan.
If the Customer is a legal entity (Limited Liability Company – PT, CV etc.), the Customer must submit a copy of the company’s articles of association, along with the
Decree of Minister of Law and Human Rights, copy of the company’s certificate of domicile, copy of the company’s trade business license, copy of the company’s
registration certificate, copy of company’s taxpayer registration number, copy of company’s taxable entrepreneur confirmation letter and copy of identity card of
company’s person in charge.
4.4. Hak Pelanggan
Customer’s Rights
a. Mendapat harga beli dan diskon (apabila ada) dari Erajaya Group.
Obtain the purchase price and discount (if any) from Erajaya Group.
b. Mendapatkan insentif serta reward (apabila ada) dari Erajaya Group.
Obtain incentive and reward (if any) from Erajaya Group.
5. PROSEDUR PENGEMBALIAN PRODUK
PROCEDURES FOR PRODUCT RETURN
5.1. Pengajuan retur atau pengembalian Produk dapat dilakukan oleh Pelanggan yang telah memiliki Nomor Pokok Wajib Pajak (NPWP) dan terdaftar sebagai
Pengukuhan Pengusahan Kena Pajak (PKP).
Submission for return application or Product return may be conducted by the Customer who already obtain Taxpayer Registration Number (NPWP) and registered
as Taxable Entrepreneur (PKP)
5.2. Pelanggan yang tidak memiliki NPWP dan tidak terdaftar sebagai PKP akan dikenakan penalty 10% (sepuluh persen) dari Produk yang diretur sesuai dengan
jumlah tagihan Produk tersebut.
The Customers who does not have NPWP and is not registered as PKP shall subject to 10% (ten percent) penalty from the returned Product in accordance with the
amount of bills of such Product.
5.3. Pelanggan dapat mengembalikan atau meretur Produk setelah diterima dari Erajaya dengan pemberitahuan dan persetujuan terlebih dahulu dari Erajaya Group.
The Customer may return the Product after it is received from Erajaya Group with prior notification and approval from Erajaya Group.
5.4. Setiap Produk yang sudah disetujui untuk diretur harus disertai dengan retur nota yang telah diberikan stempel Pelanggan.
Every Product that has been approved to be returned must be accompanied with a return receipt which has duly stamped by the Customer.
5.5. Pelanggan hanya dapat melakukan retur atau pengembalian Produk dalam hal terdapat cacat produksi dengan jangka waktu retur atau pengembalian Produk
selambat-lambatnya 1 (satu) hari setelah Produk diterima oleh konsumen akhir.
The Customer may only return the Product in the case of production defect with return period no later than 1 (one) day after the Product is received by end consumer.
6. PEMBAYARAN
PAYMENT
6.1. Pelanggan wajib melakukan pembayaran atas pembelian Produk yang telah di beli dari Erajaya Group dengan waktu pembayaran sesuai yang ditetapkan pada
invoice yang diberikan oleh Erajaya Group.
The Customer shall make the payment for the purchased Product from Erajaya Group in accordance with the term of payment, stated on the provided invoice
from Erajaya Group.
6.2. Para Pihak sepakat apabila Pelanggan belum membayar atau melunasi pembelian yang sudah jatuh tempo, Erajaya Group berhak menghentikan secara sepihak
pengiriman Produk dan mengenakan denda keterlambatan pembayaran sebesar 0,1% (nol koma satu persen) per hari keterlambatan dari nilai tunggakan sampai
Pelanggan membayar dan melunasi kewajiban yang dimaksud diatas, demikian untuk seterusnya.
The Parties agree that if the Customer has not pay or settle the purchase payment which has already been due, Erajaya Group reserves its rights to unilaterally
discontinue the shipping of the Product and impose a late payment fine in the amount of 0.1% (zero point one percent) per day of delay from the outstanding
amount until the Customer pays and settles in full its entire obligation as mentioned above, and so on.
6.3. Cara Pembayaran:
Payment Method:
- Pembayaran atas pembelian Produk harus dilakukan oleh Pelanggan dengan di transfer ke rekening yang ditetapkan oleh Erajaya Group.
Payment over the purchase of the Product must be done by the Customer by wire transfer to the Erajaya Group designated account .
 - Apabila transfer dilakukan ke rekening selain ke atas nama yang ditunjuk oleh Erajaya Group maka Pelanggan dianggap tidak pernah melakukan pembayaran.
If the transfer is made to an account other than the account under the name appointed by Erajaya Group, the Customer shall be deemed to never make any payment.
- Pembayaran dianggap sah apabila pembayaran tersebut sudah diterima pada rekening Erajaya Group dan Pelanggan wajib menyerahkan bukti pembayaran
berupa fotocopy transfer kepada Erajaya Group pada tanggal pembayaran.
The payment shall be deemed valid if such payment has been received in Erajaya Group designated account and the Customer is required to submit any payment
receipts in the form of transfer copy to Erajaya Group on the payment date.
- Pelanggan tidak diperbolehkan melakukan pembayaran secara tunai/ cek tunai/ slip penarikan. Jika Pelanggan melakukan pembayaran secara tunai/ cek tunai/
slip penarikan, maka akan dianggap pembayaran tidak pernah dilakukan.
The Customer is not allowed to make any payment in cash/ cash cheque / withdrawal slip. If the Customer makes any payment by cash / cash cheque / withdrawal slip,
such payment shall be deemed to never been made.
6.4. Pada saat Pelanggan melakukan pembayaran kepada Erajaya Group, Pelanggan setuju dan sepakat untuk tidak melakukan pemotongan apapun secara sepihak
tanpa persetujuan tertulis terlebih dahulu dari pihak yang berwenang mewakili Erajaya Group.
By the time the Customer made any payment to Erajaya Group, the Customer agrees to not make any unilateral deduction without prior written consent from the
authorized representative of Erajaya Group.
7. BATAS LIMIT KREDIT
CREDIT LIMIT
Erajaya Group memberikan batas kredit/ plafon dengan jumlah yang ditentukan oleh Erajaya Group dan akan diberitahukan kepada Pelanggan.
Erajaya Group provides credit limit / plafond with a certain amount which determined by Erajaya Group and shall be notified to the Customer.
8. PAJAK
TAXES
Masing-masing Pihak akan dikenakan pajak sesuai dengan ketentuan peraturan pajak yang berlaku di Indonesia.
Each Party will be imposed with the relevant taxes in accordance with the applicable provisions regarding taxation that prevail in Indonesia.
9. LARANGAN PENGALIHAN
ASSIGNMENT PROHIBITION
Pelanggan tidak diperkenankan untuk mengalihkan baik sebagian maupun seluruh hak dan kewajiban yang timbul dari Kerjasama ini kepada pihak manapun tanpa
persetujuan tertulis dari Erajaya Group.
The Customer is not allowed to assign either in part or all of its rights and obligations arising from this Cooperation to any other party without prior written consent from
Erajaya Group.
10. PELANGGARAN ATAU KELALAIAN
VIOLATION OR NEGLIGANCE
10.1. Dalam hal terjadi kelalaian atau pelanggaran yang dilakukan oleh Pelanggan dalam hal melaksanakan kewajiban yang termaktub dalam Syarat dan Ketentuan
ini, maka Erajaya Group berhak melakukan pemutusan Kerjasama secara sepihak.
In the event of negligence or violation committed by the Customer in relation to the fulfillment of the obligations set forth in this Terms and Conditions, Erajaya
Group shall have the right to terminate the Cooperation unilaterally.
10.2. Terhadap setiap kelalaian atau pelanggaran atas Syarat dan Ketentuan ini dapat dituntut sesuai dengan hukum yang berlaku, baik secara pidana maupun
perdata, walaupun Kerjasama ini berakhir.
Any negligence or violation of this Terms and Conditions may be prosecuted in accordance with the applicable law, both criminal as well civil, even if this Cooperation is
terminated.
11. BERAKHIRNYA KERJASAMA
TERMINATION OF COOPERATION
11.1. Kerjasama dapat diakhiri oleh Erajaya Group tanpa sebab apapun atas pertimbangan Erajaya Group sendiri dengan pemberitahuan secara tertulis kepada
Pelanggan paling lambat 2 (dua) minggu sebelum tanggal efektif diakhirinya Kerjasama.
The Cooperation may be terminated by Erajaya Group without any reason by its own consideration with written notice to the Customer within at least 2 (two) weeks
before the effective date of the termination of the Cooperation.
11.2. Pengakhiran Kerjasama ini tidak dapat mempengaruhi hak dan kewajiban salah satu Pihak yang terjadi sampai dengan tanggal pengakhiran yang dapat
bertambah setiap saat sehubungan dengan kewajiban-kewajiban Para Pihak yang timbul sebelum pengakhiran atau pemutusan Kerjasama ini.
The termination of this Cooperation shall not affect the rights and obligations of any of the Parties occurring up to the termination date which might be increase at any
time with respect of the obligations of the Parties arising before the termination or discontinuation of this Cooperation.
11.3. Untuk tujuan pengakhiran Kerjasama ini, Para Pihak dengan ini sepakat untuk mengesampingkan ketentuan dalam Pasal 1266 Kitab Undang-Undang Hukum
Perdata.
For the purpose of termination of this Cooperation, the Parties hereby agree to waive the provisions stipulated under Article 1266 of the Indonesian Civil Code.
12. FORCE MAJEURE
FORCE MAJEURE
Dalam hal terjadi peristiwa-peristiwa sebagai akibat adanya hal-hal yang berada diluar batas kemampuan Para Pihak, yang menurut hukum pada umumnya
dipandang sebagai force majeure, termasuk tetapi tidak terbatas pada huru-hara, bencana alam, gempa bumi, banjir, perang dan lain-lainnya, segala akibat yang
timbul dari kejadian Force Majeure tersebut akan diselesaikan secara kekeluargaan berdasarkan musyawarah mufakat diantara Para Pihak.
In the occurrence of any events as a result of things beyond the capabilities limit of the Parties, which by law are generally deemed as force majeure, including but not limited
to riot, natural disaster, earthquake, flood, war and other consequences arising from the aforementioned Force Majeure events shall be settled amicably between the Parties.
13. PENYELESAIAN PERSELISIHAN
DISPUTE RESOLUTION
13.1. Perbedaan, kontroversi atau perselisihan yang timbul karena penafsiran dan/atau pelaksanaan Syarat dan Ketentuan ini akan diselesaikan secara musyawarah
oleh Para Pihak.
Any differences, controversies or dispute arising from interpretation and/or implementation of this Terms and Conditions shall be settled amicably by the Parties.
13.2. Apabila secara musyawarah tidak dapat diselesaikan, maka Para Pihak sepakat untuk menyelesaikan perselisihan di Pengadilan Negeri Jakarta Barat.
If the deliberation cannot be resolved amicably, the Parties agree to settle the dispute in West Jakarta District Court.
14. LAIN-LAIN
MISCELANOUS
Erajaya Group akan melakukan pengkinian data pelanggan dengan mengirimkan pemberitahuan kepada pelanggan melalui email yang tertera pada FDP ini secara
berkala setiap tahunnya.
Erajaya shall conduct Customer data renewal every year by sending reminder via customer’s stated email in FDP.

Hal-hal mana yang belum diatur dalam Syarat dan Ketetuan ini akan diatur kemudian dalam suatu addendum atau amandemen yang disetujui bersama secara bersama
secara tertulis oleh Para Pihak dan merupakan bagian integral yang tidak terpisahkan dari Syarat dan Ketentuan serta mempunyai kekuatan hukum yang sama.
Erajaya Group dapat melakukan perubahan atas Syarat dan Ketentuan ini sesuai dengan kebijakan yang berlaku pada Erajaya Group.
Other matters which have not been covered in this Terms and Conditions shall be governed thereafter in an addendum or amendment which mutually agreed in writing by the
Parties and shall constitute as an integral part and inseparable part of this Terms and Conditions and shall have the same legal force.
Erajaya Group may amend this Terms and Conditions in accordance with the Erajaya Group’s prevailing policies.

Pelanggan/Customer,

Materai Rp 6.000,-
Stamp duty Rp 6.000,-
Stempel Perusahaan /
Company’s seal

Nama & Tanda Tangan / Name & Signature

Tanggal / Date :
 DATA PELANGGAN
CUSTOMER DATA

No. FORM : ERAA/20……./……./03-……………………

DATA TAMBAHAN (Pihak yang dapat mewakili)

ADDITIONAL DATA (Authorized representative)

Saya yang bertanda tangan dibawah ini : Dokumen untuk dilampirkan (Fotocopy) : KTP
I the undersigned below Documents to be attached (Copy): ID Card

Nama Lengkap Pelanggan : .............................................................................................................................................................................................

Customer Full Name
Alamat Domisili Pelanggan : .............................................................................................................................................................................................
Customer Domicile Address
Diwakili : .............................................................................................................................................................................................
Represented by
Jabatan : .............................................................................................................................................................................................
Title
No. KTP : .............................................................................................................................................................................................
ID Card Number
No. Telp / Handphone : .............................................................................................................................................................................................
Phone / Handphone Number
Email : .............................................................................................................................................................................................
Email

Selanjutnya disebut “Pelanggan”.

Hereinafter shall be referred to as the “Customer”.

Dengan ini memberikan kuasa kepada :

Hereby give authorization to:

Nama : .............................................................................................................................................................................................
Customer Full Name
No. KTP : .............................................................................................................................................................................................
ID Card Number
Alamat (Sesuai KTP) : .............................................................................................................................................................................................
Address (As Stated in the ID Card)
No. Telp / Handphone : .............................................................................................................................................................................................
Phone / Handphone Number
Email : .............................................................................................................................................................................................
Email

Nama : .............................................................................................................................................................................................
Customer Full Name
No. KTP : .............................................................................................................................................................................................
ID Card Number
Alamat (Sesuai KTP) : .............................................................................................................................................................................................
Address (As Stated in the ID Card)
No. Telp / Handphone : .............................................................................................................................................................................................
Phone / Handphone Number
Email : .............................................................................................................................................................................................
Email

Nama : .............................................................................................................................................................................................
Customer Full Name
No. KTP : .............................................................................................................................................................................................
ID Card Number
Alamat (Sesuai KTP) : .............................................................................................................................................................................................
Address (As Stated in the ID Card)
No. Telp / Handphone : .............................................................................................................................................................................................
Phone / Handphone Number
Email : .............................................................................................................................................................................................
Email

KHUSUS
SPECIFICALLY
Untuk dan atas nama serta mewakili Pelanggan untuk melakukan segala kegiatan terkait dengan Purchase Order (PO) baik secara
sendiri-sendiri atau bersama-sama.
For and on behalf of the Customer to undertake all the actions related to Purchase Order (PO) either jointly or severally.

SPECIMAN TANDA TANGAN PO

PO SIGNATURE SPECIMEN
Nama/ Name Tanda Tangan / Signature

Nama/ Name Tanda Tangan / Signature

Nama/ Name Tanda Tangan / Signature

Nama/ Name Tanda Tangan / Signature

Pelanggan/Customer,

Materai Rp 6.000,-
Stamp duty Rp 6.000,-
Stempel Perusahaan /
Company’s seal

Nama & Tanda Tangan / Name & Signature

Tanggal / Date :
 DATA PELANGGAN
CUSTOMER DATA

No. FORM : ERAA/20……./……./03-……………………

DATA TAMBAHAN (Pihak yang dapat mewakili)

ADDITIONAL DATA (Authorized representative)

Saya yang bertanda tangan dibawah ini : Dokumen untuk dilampirkan (Fotocopy) : KTP
I the undersigned below Documents to be attached (Copy): ID Card

Nama Lengkap Pelanggan : .............................................................................................................................................................................................

Customer Full Name
Alamat Domisili Pelanggan : .............................................................................................................................................................................................
Customer Domicile Address
Diwakili : .............................................................................................................................................................................................
Represented by
Jabatan : .............................................................................................................................................................................................
Title
No. KTP : .............................................................................................................................................................................................
ID Card Number
No. Telp / Handphone : .............................................................................................................................................................................................
Phone / Handphone Number
Email : .............................................................................................................................................................................................
Email

Selanjutnya disebut “Pelanggan”.

Hereinafter shall be referred to as the “Customer”.

Dengan ini memberikan kuasa kepada :

Hereby give authorization to:

Nama : .............................................................................................................................................................................................
Customer Full Name
No. KTP : .............................................................................................................................................................................................
ID Card Number
Alamat (Sesuai KTP) : .............................................................................................................................................................................................
Address (As Stated in the ID Card)
No. Telp / Handphone : .............................................................................................................................................................................................
Phone / Handphone Number
Email : .............................................................................................................................................................................................
Email

Nama : .............................................................................................................................................................................................
Customer Full Name
No. KTP : .............................................................................................................................................................................................
ID Card Number
Alamat (Sesuai KTP) : .............................................................................................................................................................................................
Address (As Stated in the ID Card)
No. Telp / Handphone : .............................................................................................................................................................................................
Phone / Handphone Number
Email : .............................................................................................................................................................................................
Email

Nama : .............................................................................................................................................................................................
Customer Full Name
No. KTP : .............................................................................................................................................................................................
ID Card Number
Alamat (Sesuai KTP) : .............................................................................................................................................................................................
Address (As Stated in the ID Card)
No. Telp / Handphone : .............................................................................................................................................................................................
Phone / Handphone Number
Email : .............................................................................................................................................................................................
Email

KHUSUS
SPECIFICALLY
Untuk dan atas nama serta mewakili Pelanggan untuk melakukan segala kegiatan terkait dengan Purchase Order (PO) baik secara
sendiri-sendiri atau bersama-sama.
For and on behalf of the Customer to undertake all the actions related to Purchase Order (PO) either jointly or severally.

SPECIMAN TANDA TANGAN PO

PO SIGNATURE SPECIMEN
Nama/ Name Tanda Tangan / Signature

Nama/ Name Tanda Tangan / Signature

Nama/ Name Tanda Tangan / Signature

Nama/ Name Tanda Tangan / Signature

Pelanggan/Customer,

Materai Rp 6.000,-
Stamp duty Rp 6.000,-
Stempel Perusahaan /
Company’s seal

Nama & Tanda Tangan / Name & Signature

Tanggal / Date :
 SURAT PERNYATAAN

Sehubungan dengan pendaftaran sebagai pelanggan Erajaya Group, saya yang bertanda tangan di bawah
ini selaku team sales :

Nama Lengkap Sesuai KTP :

Jabatan dan Lokasi Kerja :
Nama Calon Pelanggan :
Nomor Formulir Data Pelanggan :

Menyatakan telah melakukan pemeriksaan kelengkapan data yang diberikan oleh Calon Pelanggan dan
telah melakukan kunjungan verifikasi ke toko dan kediaman Calon Pelanggan sesuai dengan data yang
diberikan pada Formulir Data Pelanggan yang telah dilengkapi oleh Calon Pelanggan.

Demikian Pernyataan ini dibuat.

…………………………. . ,……………… 201...

Nama Sales:

Head Office : Operational :

Jl. Gedong Panjang No. 29 - 31, Pekojan - Tambora, Jakarta Barat - 11240 - Indonesia Erajaya Plaza, Jl.Bandengan Selatan No 19-20, Pekojan - Tambora
Ph. +62 690 5050 (hunting), Fax. +62 21 6983 1225, www.erajaya.com Jakarta Barat 11240 - Indonesia. Ph. +62 21 690 5788 (hunting), Fax. +62 21 690 5789