Registration Form - SampaiDepanPintu

EN ID

The Sampai Depan Pintu team will conduct a verification process for each registrant.
Not everyone who fills out the form will automatically join.
The decision of acceptance or rejection will be conveyed within less than 24 hours through the contact you provide.
For applicants who are approved and start using our services, you will automatically become a member of the cooperative and be entitled to receive SHU (Remaining Business Proceeds) which will be distributed after the Annual Member Meeting (RAT).

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Full Name^*

National ID Number (NIK)^*

0/16

Email^*

Phone^*

WhatsApp^*

Place of Birth^*

Date of Birth^*

Gender^*

Marital Status^*

Residential Address

Fill in the address details below to automatically populate the address

Select Province, City, District, or Subdistrict^*

Province^*

City / Regency^*

District^*

Subdistrict^*

Postal Code^*

Full Address^*

Password^*

Confirm Password^*

Business Type^*

NPWP / NIK^*

Business Website^*

Business Address

Fill in the address details below to automatically populate the business address

Select Province, City, District, or Subdistrict^*

Province^*

City / Regency^*

District^*

Subdistrict^*

Postal Code^*

Full Business Address^*

Google My Business Link

Maps Screenshot

Property Status^*

Estimated Monthly Shipping Volume^*

Product Brand

Sales Page URL^*

Instagram URL

Shopee URL

Tokopedia URL

TikTok URL

Has Product License?^*

Yes

Pickup Address

Pickup Google Maps Link

Pickup Maps Screenshot

Pickup Phone^*

Pickup Email^*

Contact Person^*

Name^*

WhatsApp Number^*

Bank Name^*

Bank Branch^*

Account Holder Name^*

Account Number^*

Bank Account Proof (Screenshot/Photo)

References^*

Reference Name^*

Reference Phone^*

Reference WhatsApp^*

Reference Relationship^*

Videocall Verification

Schedule a videocall for verification of your provided data.

Preferred Videocall Date

Preferred Videocall Time

: :

By submitting this form, I declare that the data I have uploaded is true and accountable. I understand that any misuse of data or violation of platform policies will result in sanctions or termination of access from SampaiDepanPintu.

I agree to the Terms and Conditions^*

I agree to the Privacy Policy^*

Verification^*