agen pos+form
TRANSCRIPT
![Page 1: Agen Pos+Form](https://reader037.vdocuments.pub/reader037/viewer/2022100304/5571fb00497959916993b266/html5/thumbnails/1.jpg)
![Page 2: Agen Pos+Form](https://reader037.vdocuments.pub/reader037/viewer/2022100304/5571fb00497959916993b266/html5/thumbnails/2.jpg)
![Page 3: Agen Pos+Form](https://reader037.vdocuments.pub/reader037/viewer/2022100304/5571fb00497959916993b266/html5/thumbnails/3.jpg)
![Page 4: Agen Pos+Form](https://reader037.vdocuments.pub/reader037/viewer/2022100304/5571fb00497959916993b266/html5/thumbnails/4.jpg)
![Page 5: Agen Pos+Form](https://reader037.vdocuments.pub/reader037/viewer/2022100304/5571fb00497959916993b266/html5/thumbnails/5.jpg)
FORMULIR PENDAFTARAN AGENPOS DATA PRIBADI
1. 2. 3. 4. 5. 6. 7. 8.
Nama sesuai dengan KTP/SIM No KTP/SIM (Lampirkan fc) Jenis kelamin Tempat/Tanggal lahir Alamat saat ini Alamat E-mail Telepon rumah/kantor Telepon genggam/Hp
: : : : : : : :
.................................................................................
.................................................................................
................................................................................
................................................................................
.................................................................................
.................................................................................
.................................................................................
.................................................................................
INFORMASI BADAN USAHA / PERORANGAN
1. 2. 3. 4. 5. 6. 7. 8. 9.
Nama Badan Usaha/Perorangan Alamat Badan Usaha/Perorangan Nomor NPWP Jenis Usaha No Telepon Fax Kantor Email Kantor Kantorpos Penghubung (Kprk) Jarak ke Kprk
: : : : : : : : :
.................................................................................
.................................................................................
.................................................................................
.................................................................................
.................................................................................
.................................................................................
.................................................................................
.................................................................................
.................................................................................
SYARAT-SYARAT KEAGENAN / LAMPIRAN
1. 2. 3. 4. 5. 6. 7.
Formulir pendaftaran Agenpos Fc Surat keterangan domisili usaha Fc NPWP Fc KTP/Tanda pengenal Pas Fhoto 3x4 Denah lokasi Agenpos Lokasi strategis/Ukuran denah
* ) Coret yang tidak sesuai
: : : : : : :
Terlampir tidak * Terlampir tidak * Terlampir tidak * Terlampir tidak * Terlampir tidak * Terlampir tidak * 1. Jalan utama 2. Pusat perbelanjaan 3. Jalan protokol 4. Gedung pemerintahan 5. Perumahan
…………….,...........................2010
Pemohon,
.................................................
Pas Foto Berwarna
3 X 4
![Page 6: Agen Pos+Form](https://reader037.vdocuments.pub/reader037/viewer/2022100304/5571fb00497959916993b266/html5/thumbnails/6.jpg)