ECONOMIC REFORMinvesttimor-leste.com/files/Questionnaire_EN_BI.pdf · REFORM MECAE ECONOMIC 1.4...

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MECAE ECONOMIC REFORM Investor Certificate Sertifikat Investor Questionnaire Kuesioner Please fill out each of the following questions- Should you face any problems to answer any of the questions, please feel free to contact TradeInvest for clarifications. Bila anda mendapat kesulitan dalam menjawab salah satu pertanyaan berikut, tolong jangan ragu menghubungi TradeInvest untuk memperoleh penjelasan. 1. Information on investor Informasi mengenai investor 1.1 Investor’s name/ company Nama Investor/perusahaan 1.2 Business type (please tick the correct answer) Jenis perusahaan (tolong pilih jawaban yang tepat) Sole Trader | Pedagang perorangan Single Shareholder with Limited Liability I Pemegang Saham-tunggal dengan Perseroan Terbatas Limited Liability Company I Perseroan Terbatas Joint Stock Company I Perusahaan Saham Gabungan State-Owned Enterprise I Badan Usaha Milik Negara (BUMN) Other (please specify): Lain (tolong disebutkan) 1.3 Investor’s postal address Alamat pos Investor

Transcript of ECONOMIC REFORMinvesttimor-leste.com/files/Questionnaire_EN_BI.pdf · REFORM MECAE ECONOMIC 1.4...

Page 1: ECONOMIC REFORMinvesttimor-leste.com/files/Questionnaire_EN_BI.pdf · REFORM MECAE ECONOMIC 1.4 Nationality of investor certificate holder/parent company’s country of origin Kewarganegaraan

MECAEECONOMIC REFORM

Investor Certificate Sertifikat Investor

Questionnaire Kuesioner

Please fill out each of the following questions- Should you face any problems to answer any of the questions, please feel free

to contact TradeInvest for clarifications. Bila anda mendapat kesulitan dalam menjawab salah satu pertanyaan berikut, tolong jangan ragu menghubungi TradeInvest untuk memperoleh penjelasan.

1. Information on investor

Informasi mengenai investor

1.1 Investor’s name/ company Nama Investor/perusahaan

1.2 Business type (please tick the correct answer) Jenis perusahaan (tolong pilih jawaban yang tepat) □ Sole Trader | Pedagang perorangan □ Single Shareholder with Limited Liability I Pemegang Saham-tunggal dengan Perseroan Terbatas □ Limited Liability Company I Perseroan Terbatas □ Joint Stock Company I Perusahaan Saham Gabungan □ State-Owned Enterprise I Badan Usaha Milik Negara (BUMN) □ Other (please specify): Lain (tolong disebutkan)

1.3 Investor’s postal address Alamat pos Investor

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1.4 Nationality of investor certificate holder/parent company’s country of origin Kewarganegaraan dari pemilik sertifikat investor / Asal dari perusahaan induk □ Timor-Leste □ China I Cina □ Japan I Jepang □ South Korea I Korea Selatan □ USA I Amerika Serikat □ Australia | Australia □ CPLP (Please specify):

tolong sebutkan:

□ ASEAN (Please specify): tolong sebutkan:

□ Other (please specify: Lain (tolong sebutkan):

1.5 Investor Certificate Number Nomor dari Sertifikat Investor

1.6 Tax Identification Number Nomor Pokok Wajib Pajak

1.7 Type of investment (please tick appropriate answer) Jenis investasi (pilih jawaban yang tepat)

□ National I Nasional □ Foreign I Negara Asing

1.8 Permanent establishment in Timor-Leste

(for foreign commercial companies) Memiliki perusahaan tetap di Timor-Leste

(untuk perusahaan komersial luar negeri)

1.9 General Industry Classification (UN Statistics ISIC Rev. 4) Klasifikasi Industri Umum (Statistik PBB, ISIC Rev. 4) □ A Agriculture, forestry and fishing Pertanian, Kehutanan dan Perikanan □ B Mining and quarrying Pertambangan dan pengalian □ C Manufacturing | Pabrik □ D Electricity, Gas, Steam and Air Conditioning Supply Pengadaan Listrik, Gas, Uap dan Air Condition □ E Water Supply, Sewage, Waste Management and Remediation Activities Aktivitas pengadaan air, Pembuangan Limbah, Pengelolaan Limbah dan Remediasi □ F Construction I Konstruksi □ G Wholesale and Retail Trade, Repair of Motor Vehicles and Motorcycles

Perdagangan Grosir dan Eceran, Perbaikan Kendaraan mobil dan Sepeda Motor □ H Transportation and Storage Transportasi dan penyimpanan

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□ I Accommodation and Food Service Activities Kegiatan layanan Akomodasi dan Makanan □ J Information and Communication Informasi dan Komunikasi □ K Financial and Insurance Activities Kegiatan keuangan dan Asuransi □ L Real Estate Activities Aktivitas real state □ M Professional, Scientific and Technical Activities Aktivitas Profesional, Ilmiah dan Teknis □ N Administrative and Support Service Activities Kegiatan administratif dan Pelayanan □ O Public Administration and Defense, Compulsory Social Security Administrasi dan Pertahanan publik, Wajib Jamsostek □ P Education I Pendidikan □ Q Human Health and Social Work Activities Kegiatan Kesehatan Masyarakat dan Pekerjaan Sosial □ R Arts, Entertainment and Recreation Kesenian, Hiburan dan Rekreasi □ S Other Service Activities Kegiatan Pelayanan lainnya □ T Activities of Households as Employers, Undifferentiated Goods and Services

Producing Activities of Households for Own Use Kegiatan Rumah Tangga sebagai Pengusaha, Kegiatan Rumah Tangga Memproduksi Barang

dan Jasa tak terdiferensiasi untuk pengunaan sendiri □ U Activities of Extraterritorial Organisations and Bodies Kegiatan Organisasi dan Badan Ekstrateritorial

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2. Monitoring questions on Investor Certificate Pertanyaan Pemantauan tentang Sertifikat Investor

2.1 Number of investor certificate Nomor sertifikat investor

2.2 Date of investor certificate emission Tanggal pengeluaran sertifikat investor

2.3 Investment location Lokasi investasi

2.4 Start and end of the investment project Awal dan akhir dari proyek investasi

2.5 Investment rating according to the classification table of economic activities (DL 45/2011) Peringkat investasi berdasarkan pada tabel klasifikasi kegiatan ekonomi (DL 45/2011)

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3. Monitoring questions on employment Pertanyaan pemantauan tentang lapangan kerja

3.1 Numbers of employees (as of 2015) I Jumlah karyawan (pada 2015) 3.1.1 Number of current employees Jumlah karyawan saat ini

3.1.2 Number of Timorese employees Jumlah karyawan kewarganegaraan Timor-Leste

3.1.3 Number of foreign employees Jumlah karyawan kewarganegaraan asing

3.1.4 Number of female employees Jumlah karyawan perempuan

3.1.5 Number of male employees Jumlah karyawan laki-laki

3.2 Salary data: Range of employees’ salaries

Data tentang gaji: Tingkatan gaji karyawan 3.2.1 Lowest monthly salary Gaji bulanan terendah

3.2.2 Highest monthly salary Gaji bulanan tertinggi

3.3 Job creation since implementation of the investment (up to end of 2015)

Lapangan kerja yang diberikan semenjak pelaksanaan investasi (hingga akhir 2015) 3.3.1 Total number of created jobs Total jumlah pekerjaan yang diberikan

3.3.2 Please list the number of created jobs since the investor certificate was issued Tolong sebutkan jumlah pekerjaan yang diberikan sejak dikeluarkannya sertifikat investor

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

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3.3.3 Please estimate the total number of indirect jobs that were created as a result of the investment since the investor certificate was issued. Tolong berikan perkiraan tentang jumlah total pekerjaan tidak langsung yang diciptakan sebagai hasil dari investasi sejak dikeluarkannya sertifikat investor

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

3.3.4 Please list the industries and businesses where indirect employment was created as a result of the investment. Tolong sebutkan industri dan usaha yang mana pekerjaan tidak langsung diciptakan sebagai hasil dari investasi.

3.4 Information on current employees I Informasi tentang karyawan 3.4.1 Domestic Staff Positions: Please list below your company’s different staff

positions, the number of staff in this category and the average monthly salary in each category Posisi karyawan lokal: Tolong daftar di bawah posisi karyawan perusahaan anda yang berbeda, jumlah karyawan dalam kategori ini dan gaji bulanan rata-rata di setiap kategori

Job Title (e.g. director, driver)

Nama pekerjaan (misalnya direktur, kondektur)

Number of Staff Jumlah karyawan

Average monthly salary per employee

Rata-rata gaji bulanan dari setiap karyawan

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3.4.2 International Staff Positions: Please list below your company’s different staff positions, the number of staff in this category and the average monthly salary in each category Posisi karyawan internasional: Tolong isi di bawah ini posisi karyawan perusahaan anda yang berbeda, jumlah karyawan dalam kategori ini dan gaji bulanan rata-rata di setiap kategori Job Title (e.g. CEO, lawyer)

Kategori Profisional Nama pekerjaan (mis CEO,

pengacara)

Number of Staff Jumlah karyawan

Average monthly salary per employee

Rata-rata gaji bulanan per karyawan

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3.5 Information on training

Informasi tentang pelatihan Please list below in detail the internal and external training courses that your employees benefited from. (Please specify type of training, length and outcome) Tolong isi di bawah ini secara rinci program pelatihan internal dan eksternal yang dimanfaatkan oleh karyawan anda. (Silakan tentukan jenis pelatihan, jangka waktu dan hasil)

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4. Monitoring questions on investment Pertanyaan pemantauan tentang investasi

4.1 Investment value | Nilai investasi 4.1.1 Total value of invested capital since

the investor certificate was issued Total nilai modal yang diinvestasikan sejak sertifikat investor dikeluarkan

4.1.2 Please specify the total value of invested capital since the investor certificate was issued Tolong tentukan nilai total modal yang diinvestasikan sejak sertifikat investor dikeluarkan

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

4.2 Value of paid taxes | Nilai pajak yang dibayar 4.2.1 Total value of paid income taxes

since the investor certificate was issued Total nilai pajak penghasilan yang dibayar sejak sertifikat investor dikeluarkan

4.2.2 Please state the annually paid income tax since the investor certificate was issued Tolong sebutkan pajak penghasilan yang dibayarkan setiap tahun sejak sertifikat investor dikeluarkan

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

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4.3 Gross income | Pendapatan kotor 4.3.1 Please state the total gross income

since the investor certificate was issued Tolong sebutkan pendapatan kotor secara keseluruhan sejak sertifikat investor dikeluarkan

4.3.2 Please state the annual gross income since the investor certificate was issued Tolong sebutkan pendapatan kotor tahunan sejak sertifikat investor dikeluarkan

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

4.4 Revenue | Pendapatan 4.4.1 Please state the total revenue since

the investor certificate was issued Tolong sebutkan total pendapatan sejak sertifikat investor dikeluarkan

4.4.2 Please state the annual revenue since the investor certificate was issued Tolong sebutkan pendapatan tahunan sejak sertifikat investor dikeluarkan

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

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4.5 Tangible Assets | Aset nyata 4.5.1 Description of tangible assets created

in Timor-Leste (e.g. buildings) Deskripsi aset nyata yang dibuat di Timor-Leste (mis. bangunan)

4.5.2 Value of tangible assets in balance sheets Nilai aset nyata dalam neraca

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

4.6 Intangible Assets | Aset tidak berwujud 4.6.1 Description of intangible assets

created in Timor-Leste Deskripsi dari aset tidak berwujud dibuat di Timor-Leste

4.6.2 Value of these intangible assets in balance sheets

Nilai aset tidak berwujud dalam neraca

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

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5 Issues & problems Isu dan masalah

5.1 Environment (MCIA) Lingkungan-hidup (MCIA)

□ Yes | Ya □ No | Tidak □ N/A | N/A

Comments Komentar

5.2 Lease of Land and Property Sewa Tanah dan Properti

□ Yes | Ya □ No | Tidak □ N/A | N/A

Comments Komentar

5.3 Business Registration (SERVE) Pendaftaran Perusahaan (SERVE)

□ Yes| Ya □ No | Tidak □ N/A | N/A

Comments Komentar

5.4 Working Visas Visa Kerja

□ Yes | Ya □ No | Tidak □ N/A | N/A

Comments Komentar

5.5 Funding Issues Masalah pendanaan

□ Yes | Ya □ No | Tidak □ N/A | N/A

Comments Komentar

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5.6 Security Keamanan

□ Yes | Ya □ No | Tidak □ N/A | N/A

Comments Komentar

5.7 General comments relating to the business Komentar secara umum yang berkaitan dengan perusahaan

Name and signature of the staff in charge ______________________________

Nama dan tanda tangan dari karyawan yang bertanggung jawab

Date | Tanggal _____ / ________ / ________

Name and signature of investor representative ____________________________

Nama dan tanda tangan dari perwakilan investor Date | Tanggal _____ / ________ / ________