New Client Registration Form

This form will help us to provide the best service according to your needs and preferences.

  1. Input Nominal Token

Input the number of tokens*

  1. Company Information Details

Customer Name*

(Company Legal Entity)

Company Phone Number*

Office Address*

(As per Legal Document and NPWP)

Mailing Address*

(Only if applicable)

NIB/SIUP Number*

NPWP Number*

Company Website*

  1. PIC Information Details

(Who will sign the agreement)

Name*

Job Title*

Email Address*

Phone Number*

  1. Finance Contact Details

(for any finance purpose such as invoicing)

Name*

Job Title*

Email Address*

Phone Number*

Submit