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)
: