GENERAL REQUIREMENTS FOR APBI-ICMA MEMBERSHIP APPLICATION WHO CAN BE MEMBER OF APBI-ICMA? • COAL MINING COMPANY OR ITS RELATED SUPPORTING BUSINESS (I.E. MINING CONTRACTOR, SURVEY / LABORATORY SERVICES) WHAT ARE REQUIREMENTS TO BE A MEMBER? • FOR COAL MINING COMPANY, POSSESS A VALID MINING LICENSES (I.E. KP EKSPLORASI, EKSPLOITASI, PENGANGKUTAN, PENJUALAN) • HAVING A RECOMMENDATION LETTER FROM 2(TWO) APBI-ICMA COAL MINING COMPANY MEMBERS, RECOMMENDATION LETTER FROM RELATED REGIONAL MINING OFFICE (DINAS PERTAMBANGAN) • FOR NEW NON COAL MINING COMPANY, SHOULD HAVE RECOMMENDATION LETTER FROM 2(TWO) APBI-ICMA COMPANY MEMBER • COMPLY TO THE INTERNAL APBI-ICMA REGULATIONS AND PAY THE YEARLY MEMBERSHIP FEE, ETC.
Lampiran 1/ Attachment 1
FORMULIR PENDAFTARAN KEANGGOTAAN APBI-ICMA
APBI-ICMA MEMBERSHIP REGISTRATION FORM
1.
2.
Nama Perusahaan Name of the Company Alamat Lengkap Complete Address
…………………………………………………. Provinsi / Province : ……………………… Kode Pos/ Postal Code : ……………………… Telepon/Phone : ………………………………. Faximile/Fax : ………………………………. E-mail/ mail : ………………………………. Situs/Website : ………………………………. Site Address : ………………………….. Kecamatan/District : …………………………… Kabupaten/Regency : ………………………….. Provinsi/Province : …………………………. Telepon/Phone : ………………………….. Faximile/Fax : ………………………………. E-mail/ mail : ……………………………….
3.
Mohon didaftar sebagai Please be registered as Catatan/note : Anggota Utama Full member
Anggota Utama Full Member
Anggota Pendamping Associate Member
: Perusahaan Pertambangan Batubara yang memiliki IUP Eksplorasi, dan/atau Produksi/ Coal mining company having exploration permit and/or Production permit
Anggota Pendamping/ : Perusahaan Jasa Pertambangan Batubara/ Coal Mining Services Company Associate member A. Kontraktor Tambang/Mining Contractors B. Jasa Komersial (Trader, Supplier, Pengangkutan, Surveyor dll ) Commercial services ( Trader, Supplier, Transportation , Surveyor etc ) C. Konsultan ( Legal,Keuangan,Engineering, Manajemen dll ) Consultant ( Law, Finance, Engineering, Management etc ) D. Jasa Informasi ( IT, Price Indexing dll ) Information Services ( IT, Price Indexing etc )
4.
Nama Penghubung Kami Our Contact Person (L.O.)
……………………………………………….
Jakarta, ……………………, …. Pimpinan Perusahaan Company’s Leader
( …………………………. )
Lampiran 2/ Attachment 2
DATA KELENGKAPAN PENDAFTARAN ANGGOTA UTAMA COMPLEMENTARY REGISTRATION DATA FOR FULL MEMBER I.
DATA LEGALITAS PERUSAHAAN/ Legality of Data Company : 1. Izin Pendirian Perusahaan/Company Establishment Permit : A. Akta Notaris/Notary : ........................................... B. Surat Pengesahan Kementerian Hukum dan HAM RI / Approval letter from Ministry Law and Human Rights of Indonesia : ............................ C. SIUP (Surat Izin Usaha Perdagangan ) / Trading License : ................................. 2. Susunan Pengurus /Management Structure A. Komisaris Utama/President Commissioner B. Komisaris/ Commissioner C. Direktur Utama/ President Director D. Direktur/Director E. Direktur/Director F. Direktur/Director
: : : : : :
..................................... ..................................... ..................................... ..................................... ..................................... .....................................
3. Pemegang Saham Utama / Main Share holders : A. .......................................................... ( .........% ) B. .......................................................... ( .........% ) C. .......................................................... ( ........ % ) D. .......................................................... ( ........ % ) 4. Khusus untuk Penanaman Modal Asing/ Foreign Investment A. Surat Izin BKPM ( Badan Koordinasi Penanaman Modal ) No : ……………………… License Permit from Investment Coordinating Boards Number : …………………… B. Principal/ Principals : 1. ............................ 2. ............................ 5. Mempunyai 2 ( dua) surat rekomendasi dari perusahaan pertambangan batubara yang sudah menjadi anggota APBI-ICMA/ Having two (2) recommendations from existing coal mining company which are member of APBI-ICMA 6. Mempunyai surat rekomendasi dari Dinas Pertambangan setempat/ Having recommendations letter from Regional Mining Office
Lampiran 3/ Attachment 3
II. DATA TEKNIS
PERUSAHAAN/ Technical Data Company :
1. Lokasi Tambang/ Mine site : Kecamatan / District : ........................................ Kabupaten / Regency : ........................................ Provinsi/ Province : ........................................ 2. Koordinat Lokasi Tambang/ Mine location coordinates :
3. Luas Total daerah tambang/Total Area of Mining
....................................................... ....................................................... ....................................................... .......................................................
: ................................... Ha/Hectare
4. Sumber Daya dan Cadangan Batubara/Coal Resources and Reserve : A. Sumber daya ( Resources ) : ....................... juta ton/million ton B. Cadangan Tertambang ( Mineable Reserve ) : ....................... juta ton/million ton 5. Analisa Proksimat Batubara ( Typical / rata – rata ) / Proximate analysis of coal A. Nilai Kalori/calorific value : ......................................... kcal/kg ( GAR ) B. Kadar Air Total/ Moisture content : .......................................... % ( ADB ) C. Kadar Abu/ Ash content : .......................................... % ( ADB ) D. Kadar Belerang /Sulfur content : .......................................... % ( ADB ) E. Indeks Kekerasan ( HGI )/ High Grove Index : ........................... 6. Produksi Tahunan/ Annual production : ......................... juta ton/ million ton 7. Konsumen/ Consumer A. Domestik/ Domestic B. Ekspor/ Export
: .......................... % : ......................... %
8. Jarak dari tambang ke Pelabuhan/ Distance from mine to port : ............................Km/Km 9. Jenis Pelabuhan ( Coret yang tidak perlu )/ Port type ( delete as appropriate ) : A. Pelabuhan sungai / tongkang / river port/ Barge B. Pelabuhan laut/ tongkang / sea port / Barge C. Pelabuhan laut/kapal besar/sea port / Vessels
III. DATA KELENGKAPAN LAINNYA / other complementary data : 1. Nama Kepala Teknik/ name of head engineering : ........................................................... Surat Pengangkatan/letter appointment : .......................................................... 2. Dokumen AMDAL / AMDAL document Keputusan / Tanggal berlaku /Decision/date valid : .............................................. 3. Dokumen Perencanaan Reklamasi / Reclamation planning document Keputusan / Tanggal berlaku /Decision/date valid : .............................................. 4. Dokumen Penutupan Tambang / Mine Closure document Keputusan / Tanggal berlaku /Decision/date valid : ..............................................
Lampiran 4/ Attachment 4
DATA KELENGKAPAN PENDAFTARAN ANGGOTA PENDAMPING COMPLEMENTARY REGISTRATION DATA FOR ASSOSIATE MEMBER I. DATA LEGALITAS PERUSAHAAN/ Legality of Data Company : 1.
Izin Pendirian Perusahaan/Company Establishment Permit : A. Akta Notaris/Notary : ........................................... B. Surat Pengesahan Kementerian Hukum dan HAM RI / Approval letter from Ministry Law and Human Rights of Indonesia : ............................ C. SIUP (Surat Izin Usaha Perdagangan ) / Trading License : .................................
2. A. B. C. D. E. F.
Susunan Pengurus /Management Structure Komisaris Utama/President Commissioner Komisaris/ Commissioner Direktur Utama/ President Director Direktur/Director Direktur/Director Direktur/Director
A. B. C. D.
Pemegang Saham Utama/ Main Share holders : .......................................................... ( .........% ) ......................................................... ( .........% ) .......................................................... ( ........ % ) .......................................................... ( ........ % )
3.
4.
: : : : : :
..................................... ..................................... ..................................... ..................................... ..................................... .....................................
Khusus untuk Penanaman Modal Asing/ Foreign Investment Surat Izin BKPM ( Badan Koordinasi Penanaman Modal ) No : ……………………….. License Permit from Investment Coordinating Boards Number : ……………… B. Principal/ Principals : 1. ............................ 2. ............................ A.
5. Mempunyai 2 ( dua) surat rekomendasi dari perusahaan pertambangan batubara yang
sudah menjadi anggota APBI-ICMA/ Having two (2) recommendations from existing coal mining company which are member of APBI-ICMA
II. REKAM JEJAK PERUSAHAAN / Track Record Company A.
Sudah terdaftar minimum 3 Tahun/ Already registered a minimum of 3 years No. Surat ./ letter number : ...................................................................................
B. 1. 2. 3. 4. 5.
Daftar rekanan Perusahaan Tambang Batubara/ List of Client on Coal Companies ....................................... ....................................... ....................................... ....................................... .......................................
