COMPANY & ADDRESS
Company*
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Company Registration Number*
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Company Address*
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City*
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Postcode*
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State*
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Telephone Number*
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Fax Number
:
Website ( http:// )
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Business Details
Number of Employees*
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Core Business*
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Other services provided*
:
What other brand(s) do you sell now?*
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Do you currently supply any antivirus solutions?*
:
If Yes, Kindly specify brand
:
Note: Maximum file size for upload is 4MB/file.  
1. Copy of 'Tanda Daftar Perusahaan' (TDP)*
:
(*accept png, jpeg, jpg, pdf, microsoft word, microsoft excel, microsoft powerpoint, zip, rar)
2. Copy of 'Surat Izin Usaha Perdagangan' (SIUP)*
:
(*accept png, jpeg, jpg, pdf, microsoft word, microsoft excel, microsoft powerpoint, zip, rar)
3. Copy of Director's Passport/'Kartu Tanda Penduduk' (KTP)*
:
(*accept png, jpeg, jpg, pdf, microsoft word, microsoft excel, microsoft powerpoint, zip, rar)
4. Copy of Company's NPWP*
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(*accept png, jpeg, jpg, pdf, microsoft word, microsoft excel, microsoft powerpoint, zip, rar)
5. Copy of Director's NPWP*
:
(*accept png, jpeg, jpg, pdf, microsoft word, microsoft excel, microsoft powerpoint, zip, rar)
6. Latest Financial Report/'Laporan Keuangan' & Tax Report with 'Bukti Penerimaan Surat' from Kementerian Keuangan Republik Indonesia*
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(*accept png, jpeg, jpg, pdf, microsoft word, microsoft excel, microsoft powerpoint, zip, rar)
7. Latest 3 month bank statement*
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(*accept png, jpeg, jpg, pdf, microsoft word, microsoft excel, microsoft powerpoint, zip, rar)
8. Company Profile*
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(*accept png, jpeg, jpg, pdf, microsoft word, microsoft excel, microsoft powerpoint, zip, rar)
***    Please fill the form in English
***    Documents no. 1 - 5 have to be certified by Ministry of Law
PRIMARY CONTACT PERSON
 
Name*
:
Email*
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Designation*
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Mobile Number*
:
SECONDARY CONTACT PERSON
 
Name*
:
Email*
:
Designation*
:
Mobile Number*
:
ACCOUNT CONTACT PERSON (Finance)
 
Same as*
:
Name
:
Email
:
Designation
:
Mobile Number
:
Form Submitted by
 
Same as*
:
NOTE: The below email address will be receiving a copy of the submission info.
Email Address*
:
Declarations*
:
Should you require further assistance, please email to sales-ID@tech-titan.com and do not hesitate to contact us at  (+62.21)57958231-34.

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Address:   The East Tower Lt. 25 Unit 01 & 02, Jl. Dr. Ide Anak Agung Gde Agung Kav E 3.2 No. 1, Mega Kuningan, Jakarta Selatan 12950 – Indonesia.

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