This questionnaire will help us understand your business.

Please send us your completed application form

with your company profile, business registration or other document proof via fax or e-mail to BSI. If you
have any questions, you can contact us on: T: +852 3149 3300, E: hk@bsigroup.com, F: +852 2743 8727

BSI Service Request Form

Type of Service: Certification Audit Capacity Building Program Action Manager
(tick as many as Pre-assessment Gap Audit BSI VerifEye Profile
TM
Annual Management Fee (AMF)
needed)
Transfer SCREEN Essential AMF
Extension of Scope SCM Success AMF
Extension of Location BSOL Excellence AMF
1. Organization Details

Organization name:
PT ZIEGLER INDONESIA

Website:
www.ziegler.co.id Tel:
(021) 8972835 Fax:
Jalan Muhammad Haji Thamrin Blok A10 No.2, Jalan Muhammad Haji Thamrin Blok A10 No.2
Main site address: Invoice address:
Sukaresmi, Cikarang Sel., Bekasi, Jawa Barat Sukaresmi, Cikarang Sel., Bekasi, Jawa Barat

Post code:
17550 Post code:
17550

Business Registration No. (ABN/BR etc.)

8120101851656

Contact for Service Coordination:

Ammar Farras Contact for Finance/Accounts:
Murin

Job title:
HRGA Job title:
Finance Staff

Email address:
mfarras@ziegler.co.id Email address:
murin@ziegler.co.id
(021) 8972835 ext 203 08118008568 (021) 8972835 ext 202
Tel: Mobile: Tel: Mobile:

2. Please provide a brief description of the critical activities/processes relating to products/services and any relevant
regulatory obligation

Design, Fabrication, Assembly, Sales and Service of Fire Fighting Vehicle and Rescue Vehicle

3. Do you outsource any critical processes? If yes please give details below: Yes ■ No

4. Details of main site and other relavent sites address (If more than five, please outline on a seperate spreadsheet)
Site Name Site Address Total Shifts Site-specific activities

Office & Factory Sukaresmi, Cikarang Sel., Bekasi, Jawa Barat 1 Office & Factory
5. Employee Number Details - For more than five roles, please list those in a separate document
Location Role/activity Full Time Part Time Contract Temporary
Sukaresmi, Cikarang Sel., Bekasi, Jawa Barat Office & Factory 62 9

Are there significant numbers of employees conducting the same work process?
(If yes, please give details of the work processes and the number of employees involved)
Yes No

6. Which Standards/Products/Services do you require quotation for from BSI? (please tick appropriate)
BSI’s Standards Portfolio for Organizational Resilience
Operational Resilience
ISO 9001 Quality Management
ISO 14001 Environmental Management
OHSAS 18001 Occupational Health & Safety
ISO 13485 Medical Devices
ISO 20252 Market and Social Research
ISO 55001 Asset Management
ISO/TS 29001 Oil and Gas Quality
AS 9100 Aerospace Quality
ISO 50001 Energy Management
SA 8000 Social Responsibility
ISO 20121 Sustainable Events
ISO 31000 Risk Management
BS 10500 Anti-Bribery Management
ISO 39001 Road Traffic Safety
PAS 2050 Product Carbon Footprinting
IATF 16949 Automotive Quality Information Resilience
TISSE 2012 Standard for Excellence ISO/IEC 27001 Information Security
Sustainability Report Assurance - GRI G4 ISO 22301 Business Continuity
PAS 2060 Carbon Neutrality CSA STAR Certification
DIS/ISO 14046 Water Footprinting ISO/IEC 20000 IT Service Management
ISO 14064 GHG Emissions Verification Building Information Modelling (BIM)
ISO 14051 Material Flow Cost Accounting Food Schemes
FSC (Forest Stewardship Council) Forestry BSI HACCP & GMP Criteria
Management
Supply Chain Resilience FSSC 22000 Standards
BSI VerifEye Profile
TM ISO 22000 Food Safety Management
Security - CTPAT Audits SQF - Safe Quality Food
Client-Specific Supplier Audits (2nd Party) BRC Global Standards
FSC (Forest Stewardship Council) Chain of GlobalGAP Agricultural Practices
Custody [COC]
PAS 7000 Supplier Pre-qualification PAS 96 (TACCP) Protect & Defend Food
Social Compliance Audits (SA 8000, BSCI, RSPO Sustainable Palm Oil
Sedex, EICC and Client Specific)
Other Standards Gluten-Free Certification Program

7. Choose surveillance frequency - Increased audit frequency improves performance (please tick appropriate)

BSI recommended best practice:

Benefits of regular audit
Every 4 months - Recommended for new
startups, higher risk businesses, businesses new to
management systems, frequent changes in system,
Performance Systems

process and people, or franchise/multi-site

businesses wishing to embed good behaviour quickly.

Every 6 months - Recommended as general good

practice for stable companies with minimal change to
systems, processes and people. Facilitates continuous
improvement, embeds good behaviour and provides a Before After

good insurance policy for effective implementation.

Certification

Every 9 months - Recommended for mature 0 12 24 36 48

Time (Months)
organizations with established systems wishing to
adopt best practice in compliance and performance. by quarter No certification

by half year

by annual
Every 12 months - Meeting minimum accreditation requirements.

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 8a. For Food Schemes Details of main site and other sites address (If more than five, please use a seperate spread sheet)

Site-1 Site-2 Site-3 Site-4

Production/manufacturing/wholesale/transport 41
Number of personnel
Full-time equivalent Quality assurance/research and development 2
on main shift
Office-based (e.g. sales, marketing, finance, etc.) 34
Type of facility# (refer to the list of numbers below)
Size of facility (sqm/sqf/ha) 2976 sqm
Size of entire site (sqm/sqf/ha) 3553 sqm

Total number HACCP studies/families*

Centrally managed system? (Y/N) y
#
Please place number into table above under Type of facility
*A HACCP study/family corresponds to a group of products [HACCP Plans] with similar hazards and similar production technology

Type of Facility: Boning Room Broker Catering Facility Distribution Center

(please select)
Factory Farm Freight Forwarder / Cross Docking Grading Floor
Hatchery Head Office Packhouse Retail Outlet
Slaughterhouse Warehouse If other, please specify

8b. Which Standards/Products/Schemes does your enquiry relate to? (please tick all applicable)
BSI HACCP & GMP Certification Criteria
HACCP and GMP (must apply to manufacturers warehouse/distributors where storing and handling food)
HACCP only (Head Office, Broker)
GMP only
BRC (select sub-category)
BRC Global Standard for Food Safety
BRC Global Standard for Storage and Distribution
BRC Global Standard for packaging and packaging material
ISO 22000 Conversion to BRC Food Safety
BRC Food safety excellence module
BRC FSMA module
BRC Global Markets programs
FSSC 22000 - Food Safety System Certification (select sub-categories)
FSSC 22000 Food Manufacturing (ISO 22000 + ISO/TS 22003-2013)
CI. Perishable animal products i.e. Production of animal products including fish and seafood, meat, eggs, dairy and fish products
CII. Perishable plant products i.e. Production of plant products including fruits and fresh juices, vegetables, grains, nuts, and pulses
CIII. Perishable animal and plant products (mixed products) i.e. Production of mixed animal and plant products including pizza,
lasagne, sandwich, dumpling, ready- to-eat meals
CIV. Ambient stable products i.e. Production of food products from any source that are stored and sold at ambient temperature,
including canned foods, biscuits, snacks, oil, drinking water, beverages, pasta, flour, sugar, food-grade salt
I. Auxiliary Services: Production of Food Packaging and Packaging Material i.e. Production of food packaging material
K. Biochemical: Production of (Bio) Chemicals i.e. Production of food and feed additives, vitamins, minerals, bio-cultures,
flavourings, enzymes and processing aids, Pesticides, drugs, fertilizers, cleaning agents

GLOBALG.A.P. (BSI can conduct audits for the following Crop Base scopes - Fruit and Vegetables, combinable crops, Tea)
Option 1
Individual Farmer (grower) applies for GLOBALG.A.P. certificate
Multisite operation without implementation of a QMS
Multisite operation with implementation of a QMS
Option 2
A Producer Group applies for a GLOBALG.A.P. group certificate
Produce safety standard
Gluten Free Certification Program (GFCP) Have you already made a formal application to GFCP?
Yes No
ISO 22000 - Food Safety System Certification (select sub-categories)
AI.  Farming of Animals (for Meat/Milk/Eggs/Honey) i.e. Raising animals (other than fish and seafood) used for meat production, egg
production, milk production or honey production; Growing, keeping, trapping and hunting (slaughtering at point of hunting);
associated farm packing and storage

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 AII.  Farming of Animals (of Fish and Seafood) i.e. Raising fish and seafood used for meat production; Growing, trapping and fishing
(slaughtering at point of capture); Associated farm packing and storage
BI.  Farming (of Plants) i.e. Growing or harvesting of plants (other than grains and pulses): horticultural products (fruits, vegetables,
spices, mushrooms, etc.) and hydrophytes for food Associated farm packing and storage
BII.  Farming (of Grains and Pulses) i.e. Growing or harvesting of grains and pulses for food; Associated farm packing and storage
CI.  Food Manufacturing (Perishable animal products) i.e. Production of animal products including fish and seafood, meat, eggs, dairy
and fish products
CII.  Food Manufacturing (Perishable plant products) i.e. Production of plant products including fruits and fresh juices, vegetables,
grains, nuts, and pulses
CIII.Food Manufacturing (Perishable animal and plant products (mixed products) i.e. Production of mixed animal and plant products
including pizza, lasagne, sandwich, dumpling, ready- to-eat meals
CIV. Food Manufacturing (Ambient stable products) i.e. Production of food products from any source that are stored and sold at
ambient temperature, including canned foods, biscuits, snacks, oil, drinking water, beverages, pasta, flour, sugar, food-grade salt
DI.  Animal Feed Production (Production of Feed) i.e. Production of feed from a single or mixed food source, intended for food-
producing animals
DII.  Animal Feed Production (Production of Pet Food) i.e. Production of feed from a single or mixed food source, intended for
non-food producing animals
E.  Catering i.e. Preparation, storage and, where appropriate, delivery of food for consumption, at the place of preparation or at a
satellite unit
FI. Distribution (Retail/Wholesale) i.e. Provision of finished food products to a customer (retail outlets, shops, wholesalers)
FII.  Distribution (Food Broking/Trading) i.e. Buying and selling food products on its own account or as an agent for others
GI.  Transport and Storage (for Perishable Food and Feed) i.e. Storage facilities and distribution vehicles for the storage and
transport of perishable food and feed
GII.  Transport and Storage (for Ambient Food and Feed) i.e. Storage facilities and distribution vehicles for the storage and transport
of ambient food and feed
H.  Services i.e. Provision of services related to the safe production of food, including water supply, pest control, cleaning services,
waste disposal
I. Production of Food Packaging and Packaging Material i.e. food packaging material
J. Equipment manufacturing i.e. food processing equipment and vending machines
K.  Production of (Bio) Chemicals i.e. Production of food and feed additives, vitamins, minerals, bio-cultures, flavourings, enzymes
and processing aids; Pesticides, drugs, fertilizers, cleaning agents

PAS 96 Audit - Protecting food and drink from deliberate attack

RSPO Principles and Criteria (Plantation) Certification (if this is selected another form requesting specific information will be issued)
RSPO Supply Chain Certification RSPO Membership Number:
How many products are produced using palm oil?
How many processing lines are using palm oil?
Which traceability methodology are you seeking certification to? (Select all applicable) (Please indicate Parent Company or Applicant
Segregation Mass Balance Identity Preserved Book and Claim membership number)

SQF
SQF CODE Edition 7.2
Level 1 - Food Safety Fundamentals
Select which Food Sector Category(ies) apply to your organization:
1. Production, Capture and Harvesting of
Livestock and Game Animals
4. Fresh Produce Pack House Operations
7. Slaughterhouse, Boning and Butchery
Operations
Level 2 - Food Safety Plan Level 3 - Food Quality Plan
2. Growing and Harvesting of Animal Feeds 3. Growing and Production of Fresh Produce
5. Extensive Broad Acre Agriculture
6. Harvest and Intensive Farming of Fish
Operations and Seed Production
8. Processing of Manufactured Meats and
9. Seafood Processing
Poultry

10. Dairy Food Processing 11. Honey Processing 12. Egg Processing

15. Canning (except dairy), Pasteurizing,

13. Bakery and Snack Food Processing 14. Fruit and Vegetable Processing
UHT and Aseptic Operations

16. Ice, Drink and Beverage Processing 17. Confectionary Manufacturing 18. Preserved Foods Manufacture

21. Oils, Fats and the Manufacture of oil or

19. Food Ingredient Manufacture
22. Processing of Cereal Grains and Nuts
25. Fresh Produce, Wholesaling and
Distribution
28. Provision of Crop Spray Services
31. Manufacture of Dietary Supplements
20. Recipe Meals Manufacture
fat-based spreads
23. Food Catering and Food Service
24. Food Retailing
Operations
27. Manufacture of Food Sector Packaging
26. Food Wholesaling and Distribution
Materials
30. Provision of Sanitation and Hygiene
29. Provision of Field Harvest Services
Services
33. Manufacture of Agricultural
32. Manufacture of Pet Food
Chemicals and Food Processing Aids

34. Manufacture of Animal Feed 35. Broker or Agent

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9. BSI Accreditations (Please tick appropriate box)
BSI adopts GLOBAL accreditation unless stated otherwise (i.e. ANAB, UKAS, ANSI)
If any special local accreditation requirements needed, please specify

10. Audit Preparation - BSI Best Practice Recommendation (please tick if you want to receive more information)
Pre-assessment Gap Analysis
- An audit done prior to and outside of the scope of the formal certification audit
- An independent gap analysis of the systems preparedness to identify areas that need more work
before a formal assessment
- Useful experience in preparing key management and employees for the eventual audit
- Opportunity to rehearse, align and debug your system and processes
BSI Capacity Building Program
- BSI Training Academy offers a comprehensive range of courses to help qualify and prepare your
employees for the system, processes and standards you adopt

1 Awareness 2 Requirements and 3 Auditor Courses 4 Personal Certification

Introduction courses:
Who should attend?
Ideal for new starters or those
needing to gain a “refresher”
What will I learn?
An overview of your management
system and the standard’s
requirements
Implementation
Requirements and Internal Auditor courses: Lead Auditor courses: Personal Certification Courses:
Implementation courses: Who should attend? Who should attend? Get certified by choosing your industry /
Who should attend? Those tasked with conducting Those tasked with conducting and sector Lead Implementer courses
Those responsible for implementing, internal audits or monitoring their leading management systems audits Maximize your personal certification
or have recently taken responsibility management systems performance What will I learn? in your business by ensuring deep
for a management system What will I learn? Gain the ability and confidence to implementation of systems using
What will I learn? How to be better equipped to conduct and lead effective audits, capacity building programmes
The requirements of a standard in the maintain compliance and how to and how to manage audit teams and
context of your company and how to manage and improve risks to your processes
take the lead in planning implementation management system

BSI’s Business Improvement Solutions can help you in the initial BSI’s Business Improvement Solutions will help you prepare for auditing and
and implementation stages of your journey by: ongoing maintenance of your management system by:
• Mapping out tasks, procedures allowing usability across your • Documenting internal inspections • Providing an effective tool to manage
and policies to consider when organization and audits in one centralized hub non-conformities
implementing a management • Ongoing management • Reduced administration by
system and maintenance of your automating actions and tasks
• A single sharing portal management system

11. BSI - Business Improvement Tools (please tick to receive more information)
BSI VerifEyeTM Profile - BSI VerifEye™ Profile was developed in response to industry
demand for greater visibility and traceability. A trusted BSI VerifEye™ Profile turns
your certifications, site photos, and business credentials into a positive marketing tool,
Showcase your credentials
providing trust and confidence.
• Inspires trust in your business with a verified profile
• Promote your products and services globally
• Building trust with new clients and markets
• Manage the living profile and traceability of your supplier
http://verifeyedirectory.bsigroup.com

SCREEN Intelligence - A web based intelligence platform with country risk maps for
social, environmental and security issues. Includes country risk reports, spotlight news
and country risk maps.

Supplier Compliance Manager (SCM) - Web based audit solutions platform to identify
and manage suppliers profiles, traceability and risk. Manage self assessment,
scheduling, audit reporting, CAPA, benchmarking and status reporting.

BSOL - Web based Standards database membership providing access to over 60,000
global standards including British (BS), European (EN), international (ISO/IEC) and
public standards. Receive automated updates and access to relevant standards for your
business.

Action Manager - Business Improvement Tool is suitable for managing internal and
external audits. Automate all of your CAPA findings and action plans in a fully automated
and controlled environment providing visibility and timely follow-up.

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12. Annual Management Fee (AMF) (please tick appropriate)

Mandatory Value-added Product

Essential AMF <value $> Success AMF <value $> Excellence AMF <value $>

Service includes maintenance of

registration and accreditation,
scheduling and planning, • BSOL - Web-based standard
• BSI VerifEyeTM Profile
administration and back office database membership, 10
• Hard copy certificate
support, updates on Standards standards for 30 users
and Accreditation requirements,
certificate issue and maintenance.

13. Please confirm any restricted areas/proprietary information/confidentiality requirements

Yes If yes, please give details:

No

14. Are you using a consultant to help you with implementing a management system? Yes No

Consultant name:
Suparyadi

Address:

Email: Phone: Fax:

15. Please specify if you’re already certified to other management systems

Standard Certification body Certification No. / Expiry date Accreditation body

ISO 9001: 2015 16 00 G 18088
ISO 14001: 2015 08 04 G 18027

16. For system and/or product certification transfer to BSI only

Certification body: Accreditation body:

Certificate expiry date: Last audit date by previous CB:

Reason for transfer:

17. What is your target date for first audit (e.g. month/year)?: /
18. Declaration
I confirm that I am an authorized representative of my organization and that the above information has been provided to the best of
my knowledge for the purpose of obtaining a quotation from BSI.
*For Food schemes operating under ISO 17065 Accreditation [SQF, BRC…] by submitting this form I understand and agree to the
scheme specific Terms & Condition which can be found at http://www.bsigroup.com/en-AU/About-BSI/BSI-Certification-Guidebooks/

BSI representative name: Client representative name:

Ammar Farras

Title: Title:
HRGA

Date: Date:
23 March 2021

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