VENDOR REQUEST/UPDATE FORM

(International)

VENDOR NAME DENYY FERYDIANSAH

44.631.305.8-628.000 (NPWP)
ABN/GST/VAT REGISTRATION #

If the Australian supplier does not provide its ABN, AECOM may need to
withhold an amount from their invoices when making payment. Certain
suppliers are not required to quote an ABN. In these cases, the suppliers
Important note regarding Australian
can use the form, “Statement by a supplier:
ABN (www.ato.gov.au/Forms/Statement-by-a-supplier-not-quoting-an-ABN/) to
justify the payer not withholding from the payment.. Refer to the ATO
website for further details or speak to your accountant.

CONTACT DETAILS

Address Jl. Mustari 17 RT.03 RW.13 Kel. Ngaglik Kec. Batu

Kota Batu

Phone Number 081216420078 / 08123455868

Email Address Deny81.kantor@gmail.com

BANKING DETAILS Full Details Must Be Provided.

Account Name DENY FERDIANSYAH

Bank Name Bank Jatim
Bank Sub Branch (BSB) Kantor Cabang Kota Malang
Bank Account Number 47144477
SWIFT

Please provide a copy of one item of evidence to confirm your bank account details:
Yes No

Bank Statement X

Deposit Slip X

Cheque X

Other bank account evidence. Describe;

Unable to provide evidence. Please

explain;

I SAKTYANU P.S DERMOREDJO

certify that the above information is correct and that I have the
authority to provide these details on behalf of the vendor
(Print name above)
named above.

Date: DENYY FERDIANSYAH Signature: ………………………………………………………

Note well: Details above must be completed and signed by the Vendor or Vendor’s
representative.