Company Name:

Sub-contractor of:

Filled by registration number of Filled by the Filled by document

document document issuance expiration/validity
date date
Documents
No Priority Documents No. Date Expiration Date Remarks
(in English) (in Bahasa)
1 Mandatory documents: Dokumen Wajib:

a. Deed of Establishment of Limited Liability Company (PT) a. Akta Pendirian Perusahaan High
b. Legal Entity Legalization Decree b. Pengesahan Akta Pendirian High
c. Business license/ permit c. Izin Usaha High
d. Company domicile certificate. d. Surat Keterangan Domisili (SKDP) High
e. Certificate of Company Registration e. Surat Tanda Daftar Perusahaan (TDP) High
f. Tax ID number and Tax Registered Certificate e. NPWP dan Tanda Daftar High
2 Mandatory Employment Report Dokumen Wajib Lapor Ketenagakerjaan (WLTK) [Please attach]
a Company Identity a. Nama Perusahaan

b Employment Relations b. Hubungan kerja High

c Labor Protection c. Perlindungan Perusahaan BPJS

d Employment Opportunities d. Lowongan kerja

3 Organization Structure Struktur Organisasi Medium [Please attach]

Status Banten Non-Banten Expatriate
Permanent/Permanen
4 List of all Permanent and Contract Employees. Jumlah pekerja permanen dan kontrak High
Contract/Kontrak
Daily Worker/Pekerja harian
5 Employment Agreement documents of all Employees (Summary). Daftar Status Ketenagakerjaan seluruh karyawan (Rangkuman). High
6 Company Regulation/Collective Labor Agreement. Peraturan Perusahaan (PP) atau Perjanjian Kerja Bersama (PKB) Medium PP
7 Report of Industrial Relation activities Laporan Kegiatan Industrial Relation (Jika ada Serikat Pekerja)
a. Report on Company Activities with Worker Unions (Bipartite a. Laporan kegiatan perusahaan dengan Serikat Pekerja Low
Cooperation Institution). No Have
b. Report on Company Employment Activities, Workers' Unions with b. Laporan Kegiatan perusahaan dengan Tripartite
the Government (Tripartite Cooperation Institution). No Have
8 List of Outsourcing (Labor Supply) Company with its type of job scope, Daftar Perusahaan Outsourcing dengan penjelasan jenis pekerjaan, Low
name/company address, operational permit (if any) nama/alamat perusahaan, izin operasi (jika ada).

Company Name Scope of Work This is sample of sub-

contractor list.

Jumlah sub-kontraktor perusahaan dan perusahaan penyedia

List of sub-contractor companies and supplier companies with its type
9 barang/material dengan lingkup kerjanya, nama/alamat High 1
of job scope, name/company address, operational permit (if any).
perusahaan, dan izin operasi (jika ada).
2
3
4

10 List of security companies and cleaning service companies with its Jumlah perusahaan keamanan dan petugas jasa kebersihan dengan Medium
operational permit (if any) . izin operasinya (jika ada).

11 Structure of salary scale . Struktur dan skala upah. Low Minister Regulation No. 1 of 2017
Daftar peserta BPJS Ketenagakerjaan dan BPJS Kesehatan.
List of Government Employment Insurance participant and Government Bukti iuran terakhir
12 health Insurance participant with evidence of premium payment (Last 3 Low
months).
Laporan pelaksanaan cuti tahunan dan cuti melahirkan.
13 Report of annual leave and maternity leave implementation. Very low

14 K3 Object Inspection and Testing Documents owned (Program and or Dokumen pemeriksaan dan pengujian (program dan Very low
Implementation). pelaksanaannya) objek K3 yang dimiliki.