New Credit Application (CAF)

Fields match _ref/CAF_Form_2.html §1–§6 incl. declaration/e-signature. §7 Verification and §8 remainder are filled internally during confirmation (see the request detail page).

Section 1 — Company's Particulars

Customer's Business Name *

Requester Email

Registered Address *

Business Address (if different from registered)

Office Phone Number 1 *

Office Phone Number 2

Fax Number

Director's Name *

Contact Person *

Position

Working Hours

Warehouse Address

Warehouse Phone Number

Warehouse Contact Number

Warehouse Working Hours

Section 2 — Business Information

Registration Number *

NPWP Number *

Place of Incorporation

Date of Incorporation

Authorised Capital

Paid Up Capital

Are you PKP Company?

Company Status

Main Line of Business

Number of Years in Business

Number of Employees

Name of Proprietor / Partner / Director & ID Number (KTP) / Passport Number

Name of Proprietor / Partner / Director	ID Number (KTP) / Passport Number

ID numbers are treated as personal data — never logged, never shown outside this form and the request detail view.

Related / Affiliate Companies (if any)

Section 3 — Bank References

At least one bank reference (Bank 1, 2, or 3) is required.

Bank 1

Bank Name

Branch

Account Number

Currency

Years Dealing

Name of Bank Officer

Contact Number

Bank 2

Bank Name

Branch

Account Number

Currency

Years Dealing

Name of Bank Officer

Contact Number

Bank 3

Bank Name

Branch

Account Number

Currency

Years Dealing

Name of Bank Officer

Contact Number

Which is your main bank? (most transactions)

Which bank account will you use to pay PT Lam Seng Hang Indonesia?

May we contact your bank officer for a reference?

Bank reference letter attached?

Upload capability is Track B7 — for now this records intent only.

Section 4 — Credit Standing with Other Suppliers

Other Supplier Name	Period of Dealing (years)	Credit Terms (Days)	Credit Limit	Monthly Purchase Order

Section 5 — Customer's Requirements

Preferred Delivery Time (Days)

Do you want purchase confirmed by Purchase Order?

Reflect PO Number on Delivery Order?

Reflect PO Number on Certificate of Analysis?

Section 6 — Application

NET Payment Terms (Days) *

Requested Credit Limit (USD) *

Category is set by the Sales & Marketing Executive during confirmation (Section 8), not by the requester.

We, [Customer's Business Name], wish to apply for an open account of NET 0 Days, with a credit limit of USD ___, and do certify that the above information given is true and correct.

I confirm that the information provided in this form is true, complete and accurate, and I am duly authorized to submit it on behalf of the company. *

Name *

Position

Date

Authorized Signatory (E-Signature) *

Upload image instead

Draw your signature above with your mouse or finger, or upload a photo of your signature.

Official Stamp

Upload stamp image

Upload a photo or scan of your company's official stamp (optional).