Pre-Qualification Survey

Survai Pra-Kwalifikasi

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Halaman : 1

Pre – Qualification Questionnaire Form

Form Pertanyaan Pra-Kwalifikasi

VENDOR/SUPPLIER

PT. Truba Jaya Engineering

Graha Truba
Jl. Swadaya II No. 7, Tanjung Barat
Pasar Minggu, Jakarta Selatan

PT. Truba Jaya Engineering

Supply Chain Management @ 2010
 Pre-Qualification Survey
Survai Pra-Kwalifikasi

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Halaman : 2
Guidelines

1. All Questioners shall have to be answered, please type or print all answers, insert word N/A (Not Available )
in the case the question is not applicable. If additional spaces is required, attach additional page/sheet
referring to the specific question number.
Semua pertanyaan pada kuesioner ini harus dijawab, mohon diisi dengan huruf cetak atau ketik, bila
terdapat pertanyaan yang berlaku pada perusahaan anda mohon cantumkan kata N/A (tidak tersedia)
sebagai jawaban. Bila masih membutuhkan ruang tambahan silahkan menambahkan dengan lembar
tambahan baru dan cantumkan nomor refernsi pertanyaannya.

2. Please mail (2) two completed filled document with all attachments and address to :
Mohon mengirimkan dokumen dan lampiran-lampiran yang telah terisi dan dialamatkan ke :

PT. Truba Jaya Engineering

Graha Truba
Jl. Swadaya II No. 7, Tanjung Barat
Pasar Minggu, Jakarta Selatan
Indonesia

Attn. SCM Division Head

PT. Truba Jaya Engineering

Supply Chain Management @ 2010
 Pre-Qualification Survey
Survai Pra-Kwalifikasi

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Halaman : 3

1. General
Umum

Name of company : ........................................................................................................................................

Nama Perusahaan :

Operational Address : ....................................................................................................................................

Alamat
Operasional : .....................................................................................................................................
....................................................................................................................................
.
(Code Post – Kode Pos) ...................................................................................................................................
Other Address / Branch : ...............................................................................................................................
……………………………………………………………………………………………..

Telecommunication – Telekomunikasi :
Telephone No. : ..........................................................................................................................................
Nomor Telpon :
Facsimile No. : ..........................................................................................................................................
Nomor Faksimile :
e-mail address : ..........................................................................................................................................
Alamat e-mail
Number of years in operation as :
Waktu (tahun) perusahaan operasional/aktif :
a. Trading/Supplier : _______________ years
b. Sole Agent : _______________ years
e. Other, _____________ : _______________ years (please specify)

Legal & Financing – Badan Hukum & Keuangan :

Type of company : _____ Individual Ownership/UD-CV _______ Agency/Keagenan
Jenis perusahaan : _____ Corporation / PT _______ Joint Venture/Join
_____ Representative/Perwakilan
_____ Others (please specify) Lain lain (sebutkan) …………………………..…….

Date of Established : ……………………………………………………………………………………...

Tanggal pendirian :

Registered Address : ………………………………………………………………………………………..

Alamat Registrasi :
………..............................................................................................................................
………..............................................................................................................................
………..............................................................................................................................
(code post – kode pos) ....................................................................................................................................

Registration of notary act : ………………………………………………………………………………...

Akte Notaries (Akte Notaries & Nomor / Tahun )

Government Operation Permit for Trading & Construction ( No. & Expired year ) :
Surat Izin Usaha Perdagangan & Surat Ijin Jasa Konstruksi ( No. & Tahun berakhir ) :

a. Trading : ………………………………………………………………………………...
SIUP
b. Construction : ………………………………………………………………………………...
SIUJK
Tax Payer Registration Number : …………………………………………………………………………..
Nomor Pokok Wajib Pajak (NPWP) :

Company classification : ……………………………………………………………………………………

Klasifikasi/kelas perusahaan

PT. Truba Jaya Engineering

Supply Chain Management @ 2010
 Pre-Qualification Survey
Survai Pra-Kwalifikasi

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Halaman : 4
Banking :
1. …………………………………… Acc.No …………………………………………….
2. …………………………………… Acc.No …………………………………………….

II. Company Profile

1. Financing
Please mention the company’s Original Capital : ……………………………………………………..
Sebutkan modal setor perusahaan

Contract Range :
Range kontrak
1.3.1. How much the maximal contract have been awarded : …………………………………….
Berapa kontrak terbesar yang pernah dimenangkan

1.3.2. How much the range contract expected :

Berapa range kontrak yang diharapkan

Minimum Amount/Minimum kontrak : ................................................................................

Maximum Amount/Maximum kontrak : ..............................................................................

1.3.2. Please mentioned your past 3 years sales : 1 ...……………………… year ………….
Harap lampirkan penjualan 3 tahun terakhir 2 …………………………year ………….
3 …………………………year ………….

Please attach the past 3 Years Balance Sheet (preferably submitted to Tax Directorate)
Mohon dilampirkan Neraca Rugi Laba 3 Tahun terakhir (sesuai Neraca dikeluarkan untuk Direktorat Pajak)

2. Management
1. Do you have International Standard Certificate ? No/Yes, ISO/ASME/..................................
Apakah Anda punya Sertificate Standard International ?

2. Do you have Safety Procedure ? please attach.

Apakah Anda punya prosedur safety ? harap dilampirkan

3. Do you have scheduling control system ? please attach

Apakah Anda punya system untuk monitor schedule ? harap dilampirkan

4. Please attach your experiences.

Harap lampirkan pengalaman-pengalaman Anda.

5. Are you the representative or agency ? please specify

Apakah Anda merupakan perwakilan / keagenan ? sebutkan

6. Please attach Company Organization, (from level commissioner, directors, managers, supervisors)
Mohon dilampirkan Organisasi Perusahaan (dari level Komisaris, Direktur, Manajer, Supervisi)

3. Manpower

1. Please attach your Curriculum Vitae (CV) of Key Person.

Harap lampirkan Curriculum Vitae (CV) untuk personel kunci.

2. Manpower qualification data :

Data kualifikasi karyawan
1. SLTA : ................................. person
2. Diploma / D3 : ................................. person
3. Graduate / S1 : ................................. person
4. Master / S2 : ................................. person
5. Others / Specialist : ................................. person

3. Do you have training program ? if yes please attach the category of training.
PT. Truba Jaya Engineering
Supply Chain Management @ 2010
 Pre-Qualification Survey
Survai Pra-Kwalifikasi

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Halaman : 5
Apakah Anda punya program training untuk karyawan ? harap dilampirkan jenis trainingnya.

4. Please specify your total present work force (including job site) : ...........................person
Sebutkan jumlah total karyawan sekarang (termasuk di proyek)

5. Please fill information about any labour strikes for the past 12 month.
Harap diinformasikan pemogokan yang terjadidalam 12 bulan terakhir.

Month – Bulan Reason - Alasan Month – Bulan Reason - Alasan

4. Material
1. Please attach your equipment list
Harap dilampirkan daftar equipment Anda

2. Do you in position to supply material/machine ?

Apakah Anda bersedia untuk supply material/mesin ?

III. Quality Control

Kontrol Kualitas
Documentation / Record and Certification :
Dokumentasi / Pencatatan dan sertifikasi

- Do you record and maintain all activities from beginning stage up to contract completion ? Yes/No
Apakah anda mengatur pencatatan seluruh aktivitas dari tahap awal sampai proyek selesai ? Ya/Tdk

- Do you maintain the document list procedure and control of change ? Yes/No
Apakah ada dokumentasi mengenai daftar dokumen procedure dan control perubahan ? Ya/tdk

- Who is responsible for document and change control ? .............................................................................

Siapakah yang bertanggung jawab pada dokumentasi dan control perubahan ........................................

- Does you have any National or International certificate ? Yes/No, if yes specify ....................................
Apakah anda memegang sertifikat tingkat national ? Ya/Tdak

- Do you agree to be audited in your office periodically, to maintain the quality standard ? Yes/No
Apakah anda setuju di audit di kantor anda secara periodic, untuk menjaga standard mutu ? Ya/tdk

Quality Assurance / Quality Control

Kualitas jaminan mutu / control kualitas

- Who is responsible for implementation of the QA/QC program ?

Siapakah yang bertanggung jawab pada pelaksanaan kualitas jaminan mutu dan control kualitas ?
.....................................................................................................................................................................

- To whom does the responsible QA/QC person report ? Give title and designation !
Kepada siapa orang yang bertanggung jawab pada kualitas jaminan mutu dan control kualitas melapor ?
.....................................................................................................................................................................
.....................................................................................................................................................................
.....................................................................................................................................................................

- Has QA/QC Manager any responsibilities other than QA and QC function ? if yes, please specify !
Apakah pejabat penjamin kualitas mutu dan control kualitas juga memiliki tugas fungsi yang lain.
Mohon dijelaskan !
...................................................................................................................................................................
PT. Truba Jaya Engineering
Supply Chain Management @ 2010
 Pre-Qualification Survey
Survai Pra-Kwalifikasi

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...................................................................................................................................................................

- Where no QA/QC Manager or chief inspector is employed please state who carries out that function
and what their responsibilities are :
Bila ternyata tidak ada personal khusus yang ditugaskan untuk control kualitas mohon dijelaskan
pihak terkait lain yang kemungkinan menjalankan tugas tersebut dan jelaskan tanggung jawab ?
.....................................................................................................................................................................
.....................................................................................................................................................................

- Do you have a QA/QC Manual ? Please copy and attached !

Apakah anda memiliki manual/petunjuk mengenai kualitas jaminan mutu dan control kualitas ? bila
ada mohon dilampirkan salinannya ?
.....................................................................................................................................................................
.....................................................................................................................................................................

- Do you operated a formal system for control of non confirming items ? Yes/No
Apakah mempunyai suatu sustem baku yang mengendalikan item-item tidak berkesesuaian standar
baku ? Ya/Tdk
.....................................................................................................................................................................
.....................................................................................................................................................................

- How are non-confirming items identified ?

Bagaimana item-item tidak berkesesuaian standar diidentifikasi ?
.....................................................................................................................................................................
.....................................................................................................................................................................
.....................................................................................................................................................................

- Are corrective action for the non-confirming items issued ?

Apakah tindakan perbaikan terhadap item tidak sesuai dikerjakan / dilakukan ?
.....................................................................................................................................................................
.....................................................................................................................................................................

- Is the QA programe designed to meet any other specific QA standard ?

Apakah program kualitas jaminan mutu tersebut dirancang untuk memenuhi suatu standar kualitas
dari suatu badan ? Mohon dijelaskan !
.....................................................................................................................................................................
.....................................................................................................................................................................
.....................................................................................................................................................................

- If yes, please state/bila ya, mohon disebutkan :

Assesor council :
Date assessed : Assesment due :

- If yes, please state/bila ya, mohon disebutkan :

Berapa hari tanggapan terhadap complain pihak klien :

Place : .............................................................................
Date : .............................................................................
Name of Vendor : .............................................................................

( .............................................................................)
PT. Truba Jaya Engineering
Supply Chain Management @ 2010
 Pre-Qualification Survey
Survai Pra-Kwalifikasi

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PT. Truba Jaya Engineering

Supply Chain Management @ 2010