Business & Credit Information
* Please fill the form in English

Company*
:
Invoice Details

Address*
:
Post Code*
:
E-mail*
:
Phone No.*
:
Fax No.
:
Registered Office Details (If same as invoice address leave blank)

Address
:
Post Code
:
E-mail
:
Phone No.
:
Fax No.
:

Legal Entity*
:
Phone No.*
:
E-mail*
:
Account E-mail*
:
Contact Person*
:
Tanda Daftar Perniagaan Date*
:
Tanda Daftar Perniagaan No.*
:
NPWP No.*
:
Expected Monthly Sales*
:
Partner /Director 1

Name*
:
Home Address*
:
Post Code*
:
Phone No.*
:
Partner /Director 2

Name*
:
Home Address*
:
Post Code*
:
Phone No.*
:
Bank Reference

Name*
:
Address*
:
Phone No.*
:
Contact Name*
:
Duration Of Relationship*
:
Trade Reference 1

Company Name*
:
Contact Name*
:
Address*
:
Phone No.*
:
A/C Open Since*
:
Credit Limit*
:
Trade Reference 2

Company Name*
:
Contact Name*
:
Address*
:
Phone No.*
:
A/C Open Since*
:
Credit Limit*
:

Amount Credit Requested (IDR)*
:
Credit Terms*
:
File Attachments
* Total file attachments size cannot be exceed than 20MB
 
Copy of "Tanda Daftar Perusahaan"(TDP)*
:
(*accept png, jpeg, jpg, pdf, microsoft word, microsoft excel, microsoft powerpoint, zip, rar)
Copy of "Surat Izin Perdagangan" (SIUP) / "Nomor Induk Berusaha" (NIB)*
:
(*accept png, jpeg, jpg, pdf, microsoft word, microsoft excel, microsoft powerpoint, zip, rar)
Copy of Director's Passport/"Kartu Tanda Penduduk"(KTP)*
:
(*accept png, jpeg, jpg, pdf, microsoft word, microsoft excel, microsoft powerpoint, zip, rar)
Copy of Company's NPWP*
:
(*accept png, jpeg, jpg, pdf, microsoft word, microsoft excel, microsoft powerpoint, zip, rar)
Copy of Director's NPWP*
:
(*accept png, jpeg, jpg, pdf, microsoft word, microsoft excel, microsoft powerpoint, zip, rar)
Latest Financial Report/ "Laporan Keuangan" from Kementerian Keuangan Republik Indonesia*
:
(*accept png, jpeg, jpg, pdf, microsoft word, microsoft excel, microsoft powerpoint, zip, rar)
Latest 3 Month Bank Statement*
:
(*accept png, jpeg, jpg, pdf, microsoft word, microsoft excel, microsoft powerpoint, zip, rar)
Company Profile*
:
(*accept png, jpeg, jpg, pdf, microsoft word, microsoft excel, microsoft powerpoint, zip, rar)
NOTE: The below email address will be receiving a copy of the submission info.
Email Address*
:
Download Terms & Conditions

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