APPLICATION FOR CREDIT FACILITIES WITH

PT.JOTUN INDONESIA

COMPANY NAME (Nama Perusahaan) : ...............................................................

LEGAL ASPECT
Company Registration (TDP) : ...............................................................
Company License (SIUP) : ...............................................................
Company/Tax Registration (NPWP) : ...............................................................
Website : ...............................................................
NPWP Address : ...............................................................
...............................................................
Invoice Address : ...............................................................
...............................................................

PERSON IN CHARGE
Procurement/ Purchasing : ...............................................................
Designation (jabatan) :...........................
Email Address : ...............................................................
Finance : ...............................................................
Designation (jabatan) :...........................
Email Address : ...............................................................
Phone No. : ...............................................................
Fax No. : ...............................................................

COMPANY INFORMATION
Type of Company (Jenis Perusahaan)
:
: Sole Proprietor (perusahaan perorangan)
Partnership (Persekutuan komanditer/ Firma)
Private Ltd (Perseroan Terbatas)
Public Listed (Perusahaan Terbuka)
Lainnya...............

Type of Business (Jenis Usaha) : Manufacturer/Fabrikasi (Manufaktur/Fabrikasi)

Supplier/Stockist (penyedia)
Supplier/Agent (Agen)
Paint Applicator (Aplikator)
Lainnya.............

Establishment (Tanggal Pendirian) : ...................................

Number of Employees (Jumlah Karyawan) : ...................................
Capitalization (Modal Usaha) : Authorized Capital .................................
Paid Up Capital......................................
Issued Capital........................................

Shareholder : 1)..........................................................
2)..........................................................
3)..........................................................
 APPLICATION FOR CREDIT FACILITIES WITH
PT.JOTUN INDONESIA

4)..........................................................

FINANCIAL STATEMENT
DATE ( In thousand IDR) 2016 2017
Receivables ( Piutang)
Total Current Asset (Total Aktiva Lancar)
Total Fixed Asset (Total Aktiva Tetap)
Total Current Liabillities (Total Hutang Lancar)
Total Liabillities (Total Hutang)
Retained Earnings ( Laba Ditahan)

Capital Stock (Modal Saham)

Total Shareholder's equity (Total Modal usaha)
Sales (Penjualan)
Operating expense (biaya operational)
Net Profit (Laba bersih)

Certification (sertifikasi): ..........................................................

Three Biggest Supplier with Limit & Term : 1) ......................................................

(3 Suplier terbesar dengan Limit & Term) 2) ......................................................
3) ......................................................

Banking & other Financial (Bank) : 1) ......................................................

2) ......................................................

Details of completed projects (Project yang sudah dikerjakan)

Name Year Value Address

Details of Project on Hand (Project yang sedang dikerjakan)

Name Year Value Address
 APPLICATION FOR CREDIT FACILITIES WITH
PT.JOTUN INDONESIA

Details of Project Under Negotiation (Project dalam proses negoisasi)

Name Year Value Address

ATTACHMENTS
(lampiran)
Please provide the following documents in your submission:
a) Company Profile (profil perusahaan) *
b) Company Registration (SIUP,TDP,NPWP)*
c) 3 months Bank Statement (rekening Koran tiga bulan terakhir)*
d) Latest Audited Account - additional (Laporan Audit Keuangan terakhir-tambahan)
e) Personal & Director Guarantee – additional (Surat Jaminan Direksi-tambahan)
f ) Corporate Guarantee – additional (Surat Jaminan Perusahaan-tambahan)
g) Agreement - project (kontrak kerjasama)
* Necessary Requirement ( Syarat Utama)

We confirm that all the information given by me/us is true and correct and I/We have not wilfully with
Kami menyatakan bahwa semua informasi yang diberikan adalah benar adanya dan tepat dan saya/kami tidak dengan sengaja
held any material fact. I/We authorize PT Jotun Indonesia Paints to obtain any information it may require,
menambah fakta yang ada. Saya/kami memberi kebebasan bagi PT.Jotun Indonesia untuk mendapatkan
in order to process this application from any person or relevant source.
informasi tamabahan dari pihak yang relevan.

I / We agree:
Saya/kami menyetujui
1)         to settle our account promptly at approved terms
pembayaran dilakukan tepat waktu
2)      to bear interest at 1.5% per month on all overdue from date of invoice
membayar bunga 1,5% per bulan atas keterlambatan pembayaran utang yang jatuh tempo
3)        that the credit facilities granted are subjected to review at the supplier’s discretion
Fasilitas kredit yang diberikan dapat berubah sesuai pertimbangan PT.Jotun Indonesia

Materai Rp.6000,-

Aplicant Signature (Tanda Tangan Pemohon)

Name : Designation/ Jabatan :

 APPLICATION FOR CREDIT FACILITIES WITH
PT.JOTUN INDONESIA

OFFICE USE
Credit Limit : .........................
Credit Term : .........................
Curr : .........................
Salesman : .........................
Dept : .........................
Salesman Recommendation :
Credit Wortiness : Good
Average
Bad

Capacity to repay : Good

Average
Bad
Comments :
......................................................................................................................................................

Sales Manager Recommendation :

Credit Wortiness : Good
Average
Bad

Capacity to repay : Good

Average
Bad
Comments :
......................................................................................................................................................

Approved : Yes
No

Credit Manager / Finance Manager Recommendation :

Credit Wortiness : Good
Average
Bad

Capacity to repay : Good

Average
Bad
Comments :
......................................................................................................................................................

Approved : Yes
No

Managing Director Recommendation :

Credit Wortiness : Good
Average
Bad

Capacity to repay : Good

Average
Bad
Comments :
......................................................................................................................................................

Approved : Yes
No