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Faximile Number *
Name of Representative *
Representative Phone Number *
Alternative Company Representative *
Alternative Representative Phone Number
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Indonesian Tax Identification Number * Your company’s NPWP is required for tax invoice issuance and regulatory compliance in Indonesia.
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HOW TO PAY
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 ICCSC Team and payment should be made by bank transfer to : Account Number : 537-5778782 Account Name : INDONESIA CARBON CAPTURE Bank : Bank Central Asia (BCA)
Membership Type : CORPORATE Membership Dues : RP. 65.000.000 * The nominal stated above does not include tax. Invoice will be sent after application form has been returned to ICCSC Team and payment should be madeby bank transfer to : Account Number : 537-5778782 Account Name : INDONESIA CARBON CAPTURE Bank : Bank Central Asia (BCA)
Salutation* Mr.Mrs.Ms.
First Name *
LastName *
Job Title*
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Postal Code*
Membership Type : INDIVIDUAL Membership Dues : RP. 800.000 * The nominal stated above does not include tax. Invoice will be sent after application form has been returned to ICCSC Team and payment should be made by bank transfer to : Account Number : 537-5778782 Account Name : INDONESIA CARBON CAPTURE Bank : Bank Central Asia (BCA)
Departement*
Faculty*
University*
Address *
Student Card Number*
Membership Type : STUDENT Membership Dues : RP. 250.000 * The nominal stated above does not include tax. Invoice will be sent after application form has been returned to ICCSC Team and payment should be made by bank transfer to : Account Number : 537-5778782 Account Name : INDONESIA CARBON CAPTURE Bank : Bank Central Asia (BCA)
