Corporate+ Membership

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Name of Company/Institutions

Category Company

Carbon Production

Business Address

Address Line 1

City

State / Province / Region

Postal Code

Country

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Telephone Number

Name of Representative

Alternative Company Representative

Email

Indonesian Tax Identification Number

Your company’s NPWP is required for tax invoice issuance and regulatory compliance in Indonesia.

Faximile Number

Representative Phone Number

Alternative Representative Phone Number

Alternative Company Email Address

Membership Type	: CORPORATE
Membership Dues	: RP. 100.000.000

* The nominal stated above does not include tax.

Invoice will be sent after application form has been returned to ICCS Team and payment should be made by bank transfer to:

The Secretariat will respond to your email, and the form will be valid once it is signed by the individual mentioned above.
The payment must cover the full amount, and the transmitter must bear all bank fees and money transfer costs.

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Signature