1. 20 PPWG
nUSA DUA
the th
ACCSQ bali
ASEAN CONSULTATIVE COMMITTEE FOR STANDARDS AND QUALITY 13-17 may nadfc
Pharmaceutical Product Working Group 2013
Sekretariat Gabungan Perusahaan Farmasi Indonesia, Jl Angkasa No 20 A Kemayoran Jakarta 10620
Phone: +62 21 420 3040, Fax : +62 21 420 3047, 420 3048, Email : sekretariatgpfi@yahoo.com Official website : www.20thaccsq-ppwg.com
REGISTRATION FORM
To register to the Seminar, please return this form duly completed registration form before Tuesday April 30rd,
2013 by Fax. to: +62 21 420 3047 / +62 21 420 3048 or copy scan and email to: sekretariatgpfi@yahoo.com,
with Contact Person, Mr Abdul Muid or online through www.20thaccsq-ppwg.com
REGISTRATION Information (please type clearly using capital letters and use separate registration form for each person)
Full Name :
(Mr / Mrs / Ms /Dr)
Delegation Country :
Nationality :
Organization/Company
Office Address : •Postal Code :
•State : •Phone :
•Country : •Facsimile :
•Mobile :
E-mail Address :
Travel Schedule :
•Arrival Date : •Arrival Time :
•Departure Date : •Departure Time :
REGISTRATION Fees
Please tick accordingly, Registration Fee is inclusive of lunch, tea breaks, meeting materials, opening
ceremony and gala dinner. This does not include the cost of accommodation and travel expenses.
Official Designation Registration Free Attendance for Government Delegate Industry as Observer
Mr / Ms / Mdm / Dr / Prof
 Chair of ACCSQ-PPWG, Free (1) Seminar Before 30 April Before 30 April
only Rp. 1.500.000,- / Rp. 1.500.000,- /
 Co- chair of ACCSQ-PPWG, Free (1) US$ 160 US$ 160
 ASEAN Secretariat, Free (2)
 Head of Delegation, Free (1) After 30 April After 30 April
 Government Delegates, Free (3) Rp. 2.000.000.- / Rp. 2.000.000.- /
(with HOD approval) US$ 210 US$ 210
Seminar + Before 30 April Before 30 April
PPWG Rp. 5.300.000,- / Rp. 6.500.000,- /
Meeting US$ 550 US$ 680
After 30 April After 30 April
Rp. 5.800.000.- / Rp. 7.000.000.- /
US$ 600 US$ 730

2. 20 PPWG
nUSA DUA
the th
ACCSQ bali
ASEAN CONSULTATIVE COMMITTEE FOR STANDARDS AND QUALITY 13-17 may nadfc
Pharmaceutical Product Working Group 2013
Sekretariat Gabungan Perusahaan Farmasi Indonesia, Jl Angkasa No 20 A Kemayoran Jakarta 10620
Phone: +62 21 420 3040, Fax : +62 21 420 3047, 420 3048, Email : sekretariatgpfi@yahoo.com Official website : www.20thaccsq-ppwg.com
pAYMENT mETHOD
Can be made via bank transfer payable to:
Bank Name : Bank Central Asia
Swift Code : CENAIDJA
In USD
Account Name : GP Farmasi Indonesia
Account Number : 684.028.0029
Bank Address : BCA KCP. KemTower Jl. Landas Pacu Barat Blok B-10 Kav. 2 Jakarta 10610
In Rupiah
Account Name : GP Farmasi Indonesia
Account Number : 001.310.5160
Bank Address : BCA KCP. Jembatan Merah Jl. Mangga Besar No. 177C Jakarta 11180
• Note that Registration Fee is net and does not include sending bank’s transfer charges.
• Please send scanned copy of your deposit slip with your complete name through Fax: +62 21 420 3047, 420 3048
e-mail : sekretariatgpfi@yahoo.com, with cc to email : standarptpkrt@pom.go.id
Important Notes
 Please ensure your registration form has been completed and duly signed before forwarding to the Meeting Secretariat.
 The latest Registration is on May 9, 2013, at 4 pm local time.
 You are registered after payment is recieved and confirmation of registration will be issued by email or fax.
Please state your email address and fax number clearly in the form.
 For inquiries, you may get in touch with:
Mr. Abdul Muid through : email sekretariatgpfi@yahoo.com, Fax: +62 21 420 3047, +62 21 420 3048
with cc to: The National Agency of Drug and Food Control (NADFC), Email : standarptpkrt@pom.go.id.
Signature Date dd mm yy