EXPRESSION OF INTEREST

Guidelines:

1. If a group of individuals are planning to jointly set up the business, please photocopy SECTION I: - Personal
Fact Sheet and fill the details of respec ve members.
2. Please enter all relevant details. Do not keep any details vacant/unfilled.
3. In case of ques ons with mul ple op ons, please ck the appropriate answer.
4. In case you wish to provide addi onal informa on, please a ach a separate sheet.
5. This intellect property belongs to NIBAV, so pls dont share any data without our concern
6. All details will be kept completely confidential and will not be shared without your conern

Jakarta & Solo

In which City do you plan to setup the showroom? _____________________________________________

All future correspondence should be addressed to:

Wawan Setiawan Rustandi

Name (Dr/Mr/Mrs/Miss/Ms): ____________________________________________________________

Address:
Babakan Kalicondong RT/RW.003/016 Ds.Cilampeni Kec. Katapang Kab. Bandung
____________________________________________________________________________________________
__________

____________________________________________________________________________________________
___________________

State Jawa Barat

_______________________
Indonesia
Country ______________________________________

Phone +628115218801
_______________________ What’s App No: +6281314355836
___________________________

Email rustandisetia@gmail.com
______________________________________
rustandisetia@gmail.com
Postal Code: _______________________
 Sec on 1: Personal Fact Sheet

Photograph
Wawan Setiawan Rustandi
1. Name : __________________________________________________
(First Name) (Middle Name) (Surname)

2. DOB* : ___________________
rustandisetia@gmail.com
3. Email : _______________________________

4. Contact No.s : _______________________________________________

Babakan Kalicondong RT/RW.003/016 Ds.Cilampeni Kec. Katapang Kab. Bandung
5. Address : ___________________________________________________________________

6. Educa onal Qualifica on beginning with the most recent

Qualifica on Year of Passing Name of Ins tu on

Degree 2000 Bandung College

7. Current Occupa on: Service Business Others

(To be filled in by those in service )

Name of current employer:

______________________________________________________________________________________

Designa on: __________________________________________________

Previous Work Experience

Period Organisa on Name Designa on Responsibili es

(To be filled in by those in business )

 Company Proprietary Nature of Products / Years in People Turnover (USD in Millions) Last 3
Name(s) /Partnershi Business Services Business Employed years
p/ Private
Ltd/ Public
Ltd.
1st 2nd 3rd
0 0.6 mios 2.5
PT. Blitzcom Cakrawala
Partnership Telco contractor Service installaation
3 38 Mios
2 mio 2.7 Mios 4.2Mios
PT. Numedia Mitra Sejahtera
Partneship IT & ISP Internet service
1 80
0
PT.RJGF Indonesia Partnership Online shop Electronic & Other Goods
1 20

Others:

8. Financial Informa on:

Par culars Annual Income (USD)

Salary 24.000
Bonus/Commission/Incen ve
Property Income 17.000
Dividend/Interest 15.000
Business Profit 65.000
Other Income (please specify)
Total 121.000

Assets USD Liabili es USD

Cash on hand 176.000 Loans 0
Shares/ Mutual Fund/ FDs 150.000 Mortgages 23.000
Property (current market value) 400.000 Accounts/Bills Due 0
Motor Vehicles 95.000 Other Debts/obliga ons (specify) 0
Others (please specify)

Total 820.000 Total 23.000

9. How soon can you free yourselves from present commitments to start this possible associa on with NIBAV
Li s?

Immediately Within 3 months Within 6 months Undecided

References (excluding rela ves)

Name Address Contact No. Occupa on

Bayu Semarang Central java +62811279945 Business Owner

10. Your social status

a) Any past criminal record?

b) Are any criminal proceedings pending against you in any courts in India?
c) Have you ever been charged for any unlawful acts?

If you have cked ‘Yes’ for any of the above op ons, please state details of the same here below:

____________________________________________________________________________________________
___________________

____________________________________________________________________________________________
___________________

____________________________________________________________________________________________
___________________
 Sec on II: The Proposed Business Plan

1. How do you propose to set up the Company? (Please ck)

Proprietorship Partnership

Is the Proprietorship/Partnership already in existence Yes No Np

If yes, what is the name of the Business _______________________________________

1(a) TAX number________________________________________________________

2. How do you propose to raise funds for this business?

Own Capital 70 % Loans from % Other sources 30 %

Financial ins tu ons

4. How will you be able to contribute in terms of personal skill and attributes to make this enterprise a success?

____________________________________________________________________________________________
___________________

____________________________________________________________________________________________
___________________

5. State reasons why we should consider you as a business partner.

We have experience in sales and know the potential market for NIBAV Product
____________________________________________________________________________________________
at Indonesia
___________________

____________________________________________________________________________________________
___________________

6. Why are you interested in a par cular city and a par cular loca on that you men oned above to open up
showroom?

• I have my owned place out there

• I know the town well and found great poten al for the services offered by NIBAV LIFTS.
• Other
____________________________________________________________________________________________
___________

NOTE: The Loca on will be approved by NIBAV Li s.

 Sec on III: BUSINESS PARTNER PROPOSITION AND DECLARATION

1. Is your organisa on accredited/affiliated to any other business similar to that of NIBAV LIFTS?

YES NO

If yes, provide details: ______________________________________________________________________________

__________________________________________________________________________________________

2. What are the products and businesses in your town/city/locality that you consider as major compe tor?

NAME OF BUSINESS KEY OFFERINGS DISTANCE

3. Market Survey

S.No Name of the Organisation Products/Services Branches Pricing

1
2
3
4
5

4. Please Fill the following Details:

List of popular daily newspaper in your region Kompas

List of popular FM/TV channel in your region RCTI

What is the approx. % of HNI popula on?

What is the plan to generate market for our

letter discuss directly between us
products?

5. Why are you interested in this business?

• Great Investment op on

• Unique Business opportunity

• I don’t know

• Other _______________________________________________________________________________
6. What do you know about business?
Business is trust, need investmet, work hard, stratetgy and get the gain
__________________________________________________________________

____________________________________________________________________________________________
___________________

____________________________________________________________________________________________
___________________

7. If you invest (x) amount how much ROI do you expect on it every year?

200% 100% 50% 25% 10%

8. Why are you interested in NIBAV LIFTS partnership?

seems this unique product and will get the great market
____________________________________________________________________________________________
___________________

____________________________________________________________________________________________
___________________

9. Have you been involved in any Par business in the past? If yes, please provide detail s.

____________________________________________________________________________________________
___________________

____________________________________________________________________________________________
___________________

____________________________________________________________________________________________
___________________

10. Tell us something about your personality - your hobbies, defini on of excitement & thrill, your people skills,
zeal to meet new people, public speaking abili es etc.

____________________________________________________________________________________________
___________________

____________________________________________________________________________________________
___________________

____________________________________________________________________________________________
___________________

DECLARATION

1. I/We, declare that I/We do not have partnership of any other business directly, indirectly or through my/our
relatives and associates similar to the one offered by NIBAV LIFTS.

2. I/We, hereby certify that I/We s hall remain the applicants and if there is any change in the composition of
applicants before signing of agreement or opening of showroom. I/We hereby agree to get the new applicants as
well as the new form of organization approved by NIBAV LIFTS. We agree to the rejection of this application if
the changes are not approved by NIBAV LIFTS.

3. I/We certify that all the information in this application form and on any attachments there to is true and
accurately represents my/our current and financial conditions. I/We understand that any misrepresentation in
this statement may result in rejection of this application.
Wawan Setiawan Rustandi
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(Name of applicant) (Signatures) (Date)

Signature – Manager, Entrepreneur Development: ………………………………..