ELN Vendor Master Data Form

In order to be registered as Vendor of Danone*, please complete the required field below in full :
(*: PT Sarihusada Generasi Mahardhika, PT Nutricia Indonesia Sejahtera and/or and/or other affiliated companies within

Request Type* : Create Change Flag Delete Unflag Delete Exte

Valid From : (dd/mm/yy) to : (dd/mm/yy)

Maintained in company code* : 5600 - NIS SHDA - SGM (Choose 1 or both)

GENERAL DATA

Vendor Code : (Filled after created into system) Account Group

Purch. Org. : ID81 ID82 ID91 ID92

Title* : Mr. Mrs. Mr.&Mrs. Ms. Company: (PT/CV/UD/Ko

Legal Name* :

Search Term 1 : Search Term 2 :

Street* :

Street 2 :

City* : Region / Province* :

Telephone 1* : Ext. :

Fax Number 1* :

Email Address Company* :

Email Address Marketing :

Email Address Finance* :

Communication Mode : INT

CONTROL

VAT Reg. No/NPWP* : *For local vendor only

*No NPWP, please submit "Surat P
PAYMENT TRANSACTION

Term of Payment* : Refer to ToP Form signed

Check double inv. : YES

Order Currency* : Incoterm : Payment Method*

Salesperson : Contact Number

BANK INFORMATION
1)
Bank Country* : Account Holder* :
 Bank Name* : Bank Account* :

Bank Key : IBAN Code :

2)
Bank Country : Account Holder :

Bank Name : Bank Account :

Bank Key : IBAN Code :

ACCOUNTING INFORMATION

Recon. Account : Sort Key : 003

I/We hereby warrant that the information provided in this form is accurate and valid, in the event of changes, details will be provid
I will further indemnify and hold harmless of Danone against any losses and claims which may arise from any misleading or inco
this Form and will take all legal consequences, include but not limited to be terminated immediately without notice and no compe
I also grant : (i) consent to Danone to use my personal or company information and/or documents ("Data") in regard to the trans
(“Transaction”) and (ii) authorize Danone to transmit the Data to Danone's appointed third party or affiliations in connection with

- to be filled by vendor valid name & name of authorized person & to be signed by vendor with its company stamp.

Requested by Approved by Mas

VENDOR / REQUESTER SSD FINANCE Data proceed by:

Name : Name : Name : Name :

Date : Date : Date : Date :
 No. : F/SC-MD/ELN/001
Revision : 00
Form Effective Date : 1-Dec-16
Refer to : ELN-SCM/16/02/00-001G

nd/or other affiliated companies within Danone Group in Indonesia)

Extend (Choose 1)

Company: (PT/CV/UD/Koperasi/Yayasan) (Choose 1)

Postal code* :

Country* :

*No NPWP, please submit "Surat Peryataan Tidak Memiliki NPWP"

NO

NIS Domestic Transfer Foreign Transfer

SGM Transfer (Choose 1)

Currency* :
 Swift Code :

Currency :

Swift Code :

he event of changes, details will be provided immediately.

ch may arise from any misleading or incorrect material information of
immediately without notice and no compensation by Danone.
documents ("Data") in regard to the transaction with Danone
hird party or affiliations in connection with the Transaction.

Master Data
Data proceed by: Data reviewed by

Name :
Date :