FR-PCS-002-03

JL. Raya Bogor Km 28, RT 004 RW 07

Pekayon, Pasar Rebo Jakarta Timur 13710
Tel. (6221) 87704988

FORM REGISTRASI VENDOR NEW VENDOR REGISTRATION FORM - (MOHON DI ISI DENGAN KETIKAN Please to fill with typing)
No Pertanyaan / Question Ya / Yes Tidak / No
1. Apakah anda memiliki sertifikasi dari pihak ke-3?
Do you have any third party certification?
No. Standar standard no. : ________________________ No. Lisensi licence no.: _______________________
(Jika ya, lampirkan salinan dari jangkauan sertifikasi dan struktur organisasi anda, langsung ke pertanyaan terakhir)
If yes, please attach a copy of the certification and your organization structure, go to question no. 5
2. Apakah anda memiliki Kebijakan Perusahaan? (Do you have company policy ?)
Kebijakan Mutu (Quality)
Kebijakan Lingkungan (Environment)
Kebijakan Keselamatan (Safety)
Kebijakan Halal
Jika Anda tidak Memiliki Kebijakan,Berikan Alasannya………
If you don’t have any policy, please give the reason……..

5. Apakah anda mempunyai wakil manajemen untuk mutu ?

Do you have a Management representative for quality in your Company?
(Nama dan Nomor kontak)/Name and contact number : ____________________________________

6 Apakah material anda sudah memiliki seritikat halal?

is it your material has been Halal certified?
Jika ya, lampirkan salinan sertifikat halal material tersebut
If yes, please attach a copy of it material halal ceritificate
Jika tidak, apakah sumber material anda mengandung unsur Binatang?
If not, is it your source material containing the animal?
Jika ya, tolong sebutkan, nama binatang yang dimaksud ……………………………………………
If yes, please discrabe what kind of animal do you use?

NAMA PERUSAHAAN Company’s Name: __________________________________________________________

ALAMAT PERUSAHAAN Company’s address: _______________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
TELP/FAX Phone/fax: ________________________________________________________________________
KONTAK Person In Charges: ___________________________________________________________________
ALAMAT EMAIL Email Address: __________________________________________________________________
JABATAN Tittle: _____________________________________________________________________________

NPWP Company’s Registration no: ______________________________________________________________

MATA UANG Currency: _______________________________________________________________________

NAMA BANK Bank’s name : ____________________________________________________________________
KODE BANK Bank’s Code : ____________________________________________________________________
CABANG BANK Bank Branch: __________________________________________________________________
ALAMAT BANK Bank Address: __________________________________________________________________
_________________________________________________________________________________________
NOMOR REKENING Account no: ________________________________________________________________
NAMA BENEFICIARY Beneficiary Name: ___________________________________________________________
KODE SWIFT Swift Code: _____________________________________________________________________
IBAN IBAN (If Any): __________________________________________________________________________

KONTAK FINANCE Finance Contact: _____________________________________________________________

ALAMAT EMAIL Email Address: _________________________________________________________________

METODE PEMBAYARAN Tunai Cash Cek / giro checque

Payment method Transfer transfer Lainnya others

TERMIN PEMBAYARAN Credit Terms : ____________________________________________________________

BATAS KREDIT Credit limit : ____________________________________________________________________

Kami bersedia menyediakan barang dan jasa sesuai persyaratan yang ditentukan dalam Purchase Order
We are willing to supply goods/service as per Terms and Condition stated in Purchase Order(s)

TANDA TANGAN Signature & CAP Stamped

NAMA Name: ____________________________________

JABATAN Tittle: __________________________________

Lampirkan NPWP, Tanda Daftar Perusahaan (TDP), Perusahaan Kena Pajak (PKP), Surat Ijin Usaha (SIUP)