FORMULIR ISIAN CALON INVESTOR
(INVESTOR INFORMATION FORM)

A. UMUM (GENERAL)

a. Nama Perusahaan (Company Name)
:
b. Nama Penanggung Jawab (Person in Charge)
:
c. Jabatan (Occupation)
:
d. Departemen (Department)
:
e. Alamat E-Mail (E-Mail Address)
f. Alamat Kantor (Office Address)
g. Telepon (Phone)
:
h. Fax (Facsimile)
:
i. Hand Phone (Mobile)
:
j. Status Perusahaan (Company Status)
j.1. PMA (Foreign Company Share)
:
j.2. PMDN (Domestic Company Share)
:
k. Nilai Investasi (Investment Value)
k.1. USD
:
k.2. IDR
:
l. Susunan Pengurus (Management Organization)
m. Produk (Product)
m.1. Nama Dagang (Trade Mark)
:
m.2. Nama Teknik (Technical Name)
:
m.3. Spesifikasi (Specification)
:
m.4. Kapasitas/tahun (Annual Capacity)
:
m.5. Jenis Kemasan (Packaging)
:
m.6. Kegunaan (Purpose)
:
n. Jumlah Karyawan (Number of Employee)
n.1. Asing (Expatriate)
: orang (person)
n.2. Lokal (Domestic)
: orang (person)
o. Pasar (Market)
o.1. Ekspor (Export)
: %
o.2. Lokal (Domestic)
: %

B. SARANA & UTILITAS (INFRASTRUCTURE & UTILITY)

1. Luas Tanah (Space)
M2
2. Tenaga Lisrik (Electricity Requirement)
KVA
3. Kebutuhan Air (Water Requirement)
M3 /jam (M3 / hour)
4. Telephone (Telephone line)
SS (Unit Connection)
a. Rencana Perluasan (Extension / Expansion Plan)
Ya (Yes)   Tidak (No Needed)
Jika ada, perkiraan kebutuhan sarana & prasarana / If any Structure & Infrastructure Additional Estimation:
a.1. Luas Tanah (Space)
M2
a.2. Tenaga Lisrik (Electricity Requirement)
KVA
a.3. Kebutuhan Air (Water Requirement)
M3 /jam (M3 / hour)
a.4. Telephone (Telephone line)
SS (Unit Connection)

C. SERVIS (SERVICE)

a. Jasa Pemeliharaan (Maintenance)
Perlu (Need)   Tidak Perlu (No Needed)
Jika diperlukan, jenis maintenance yang diperlukan (If needed, kind of maintenance):
a.1. Rutin Maintenance (Routin Maintenance)
a.2. Preventive Maintenance
a.3. Overhaul
a.4. Turn Around
a.5. Lain-lain (sebutkan) / Others (please mention)
b. Fire & Safety
Perlu (Need)   Tidak Perlu (No Needed)
Jika diperlukan, jenis pelayanan yang diperlukan (If needed, Fire & Safety services):
b.1. Pemadam Kebakaran (Fire Brigade)
b.2. Penanganan Kecelakaan Kerja
      (Work Accident Handle)
b.3. Penanggulangan Bocoran bahan kimia
      (Chemicals Leakage Handle)
b.4. Lain-lain (sebutkan) / Others (please mention)

D. FASILITAS (FACILITY)

Gedung Kantor Administrasi (Administration Office Building)
Perlu (Need)   Tidak Perlu (No Needed)
Jika diperlukan (if needed)
a. Luas yang diperlukan (Space)
M2
b. Telephone (Telephone line)
SS (Unit Connection)

E. LINGKUNGAN (ENVIRONMENT)

a. Limbah yang Dihasilkan (Waste Proceeds)
a.1. Limbah Padat (Solid Waste)
a.2. Limbah Cair (Liquid Waste)
a.3. Limbah Gas (Gas Waste/Emission)
b. Unit Pengelolaan Limbah (Waste Treatment)
Tersedia (Available)   Tidak Tersedia (Not Available)
c. Komponen yang Diolah di Unit Penglohan Limbah (Waste Component to be Processed in Waste
   Treatment Unit
c.1. Limbah Padat (Solid Waste)
c.2. Limbah Cair (Liquid Waste)
c.3. Limbah Gas (Gas Waste/Emission)

F. LAMPIRAN (ENCLOSURES)

Akan dilampirkan (to be advice)
a. Gambar Plan Lay Out (Lay Out Plan)
b. Gambar Flow Proses Produksi
    (Production Process Flow)