REPUBLIK I DO ESIA BADA PUSAT STATISTIK
1. Propinsi : ..
Province
2. Kabupaten/Kota*) : ..
Regency/City
3. Kecamatan : ..
Sub district
4. ama Perusahaan : ..
ame of Company
5. Alamat Kantor Pusat Perusahaan /Addressof Head Office
Kode Pos/
E mail
Phone : ( ....) .
6. Unit Pertambangan/Unit Eksplorasi / Mining Unit / Exploration Unit
Address of Mining/Exploration Unit
7. ama Orang yang Dapat Dihubungi / Contact Person: ame
E mail
Phone .
*) Coret yang tidak sesuai/
: Pelaksanaan survei ini berdasarkan Undang undang nomor 16 tahun 1997 tentang statistik !"# $ "%%&
: Survei ini tidak memungut biaya apapun
: Selambat lambatnya sudah diterima BPS pada tanggal 1 Agustus 2007
' ( ' ) "$ *++&
, '
BPS Propinsi terdekat (lihat cover belakang) ( - .
Kepala Sub Dit Stat. Pertambangan, Energi dan Konstruksi , / $ 0 ' Badan Pusat Statistik, Jl. Dr. Sutomo No. 6 8, Jakarta 10710 1 2 $ 3 ! ' ! 4 ! #25$ 3 6 "+&"+ Telp. (021) 3841195, 3842508, 3810291 4, Pesawat 5231, -+*". 758""%9$ 758*9+5$ 75"+*%"28$ 0 9*7"
Fax (021) 3863816 -+*". 75#75"#
Diisi Oleh / 1
Province
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SE SUS EKO OMI2006
PE CACAHA KA TOR PUSAT PERUSAHAA PERTAMBA GA
: Untuk memperoleh data statistik yang terpercaya dan tepat waktu untuk perencanaan pembangunan nasional
! "
ISIA BERIKUT I I HA YA YA G BE AR3BE AR U TUK KA TOR PUSAT SAJA
I. BE TUK BADA HUKUM/Legal status of the company
" # Ltd (Government) $%
# ! & ! Regional Government ' Cooperation (
" % Ltd. ) * Others +
II. PERMODALA
1. Persentase permodalan / Percentage of capital sharing
! # Central Government ,
! & ! Local Government ,
- ./ / ational Private ,
0 # !/ ForeignTotal ,
# ! Total 1 1-10 1 0 0,
2. Apakah ada pemilikan saham/modal asing secara individual > 10%?
Does the capital of the company owned by foreigners individually more than 10%
2 Yes 3 " 0 o 3
3. Apakah perusahaan memiliki aset di luar negeri Does the company have any assets abroad
2 Yes 3 " 0 o 3 # 4 - 5 go to guest for 10
4. Apakah perusahaan memiliki penyertaan modal pada perusahaan di luar negeri >10%? Does the company invest its capital in other company abroad more than 10%?
2 Yes 3 " 0 o 3
5. Apakah perusahaan menjual hasil tambang ke luar negeri/orang asing? Does the company export or self its product to foreigners?
2 Yes 3 " 0 o 3
6. Apakah perusahaan membeli jasa dari perusahaan luar negeri/orang asing?
Does the company purchase any services from any company abroad or from foreigners?
2 Yes 3 " 0 o 3
III. TE AGA KERJA / Employment
(
- . 6 Post Graduate
. 7 & 8% Graduate
- . 6 9#0 7 &888 Diploma Bachelor Degree
0 .)" Senior High School
.)" Junior High School
: .& Elementary School JUMLAH / TOTAL
; 8 Indonesian ; Foreigners
) 3) / Male
PERHATIA / Attention :
For Head Office Only
IV. PE GELUARA U TUK TE AGA KERJA (Rupiah) W A
Employment Expenses Foreigners
(2) (3)
Benefits consists of pension funds, social security, accident allowance and other benefits
V.
# #! ! * 0 0 # !# 55+
Value of fuel and lubricants used in the main office during 2006 VI. TE AGA LISTRIK / Electricity
< * 0 # # !
Generator used unit
" ) * 0 0
Electricity generated by the establishment
" ) * 0
Electricity purchased
" ) * 0 6#
Electricity sold to other parties
VII. PE GELUARA LAI / Other Expenses
8 # # 0 # ! # 0 ! !# 55+
Fill in other expenses exclude the expenses for raw materials during 2006
. / 0 7 9 0 4ent of vehicles, machinery and equipment
. / ! 0 0# Expenses for rent of land and building
! ! Cleaned Water
0 " # Post and Telecommunication
6 #0 0 " Warehousing and Transportation Cost
* 4 0 Cost of Research and Development
* .# & * 9 # Human Research Development
6 # Indirect Tax
) * Others
PEMAKAIA BAHA BAKAR DA PELUMAS / Fuel and Lubricants (Rupiah)
* * ># *
';=
* * ># *
4# !
Value
VIII. ERACA PERUSAHAA / Company's BalanceSheet
! 7 7 6# 0 *# # 0 !# 55+
Addition, major repair, sale and depreciation of fixed capital in 2006
A. HARTA / ASSETS
1. Harta / Aset Lancar ……….. ………. 2. Harta / Aset Tetap / Fixed Assets
a. " ! Land b. < 0# Building c. 9 ? 1. Kewajiban / Hutang
0 @ A !# B ……….. ……….
Gross income from leasing and other services in Head Office
6# 0 # * 0 / # # 0
Income from goods sold in the same form as its bought Purchase value
6# Sales value
- ' # # ' # Profit / Loss 3
JUMLAH / TOTAL ( 1 + 2c ) Uraian / Description
4# ! 4# !
(1) (2)
Value
4# !
Keadaan akhir tahun 2006
@ 3 3 55+ B
(3) Keadaan akhir tahun 2005
(
& 0 0 : 0 0 * 0 # # 0 * # #! * !
& 0 ! : ! : 0 # # !:# * 0 --# * *
ame Occupation
" Telephone C D 3
" 0 " 0 - # !
. # 0 - *
Kerahasiaan Data / Data Confidentiality
' ! 0 * 0 6 ! + " !# EEF7 * * !/
G * / 6 6 ! * 0 ! 0 0 G
Data confidentiality is guarranteed under Article 21 of Law o. 16, 1997;
"The conductor of statistical activities must ensure the confidentiality of the information obtained from respondents".
' / 6 0 0 * 0 F + " !# EEF7 * * !/
G. 0 / 6 * 0 # 0 * 0 !
0 # . G
Respondent obligation is guarranteed under Article 27 of Law o. 16, 1997;
"Every respondent must provide the required information when the BPS Statistics Indonesia is collecting basic statistic".
ame
Occupation '.' 3 . : . # 3
. : . ' # ' 3 ) * 3(
. : . 3
" * ! & # 55F
" & # 55F
( " 0 "
CATATA PETUGAS / Enumerator's 2otes For BPS Enumerator's Use Only SERTIFIKASI PE GISIA KUESIO ER
Questionnaire Certification
KERAHASIAA Confidentiality