COMPANY PREVIEW

No.
QUESTIONNAIRE
1 Name of the company
2 Addres
Phone
Fax
Email
3 Contact Person
4 Main Business of the Company
5 Type of the company (public
company? Foreign investment
company?)
6 Composition of Shareholders

7 Composition of Directors and Board

of Commissioners
8 How many subsidiaries of the
company? Please specify (the name
and the shareholding)
9 How many branches and where the
branches is

10 How many employees (local and

expatriate)
11 There is any labor union? Please
specify
12 There is any Fixed Assets? Please
specify

13 There is any Loan Agreement with

any third party? Or with any related
party?
14 There is any investment in the other
areas?
15 There is any litigation issues?

COMPANY PREVIEW
ANSWER
PT. CITO PUTRA UTAMA
81st Indraprasta street Semarang
(024) 3566749
(024) 3557770
cito.marketing@labcito.co.id
Badru Rochmat
Laboratory
Private Company

1. Director
2. Chief Commissioner
3. Commissioner
1. Director

: dr. Dyah Anggraeni, M.Kes, Sp.PK

2. Chief Commissioner : H. Achmad Djoeahir
3. Commissioner
: Sinta Saraswati,

ST.MM
-

16 branches
branch address:
1. Indraprasta street 81st Semarang
2. dr. Cipto street 14 Semarang
3. Setiabudi street 120A Semarang
4. Atmosukarto street 4 Yogyakarta
5. K.H Mas Mansyur street 33
Pekalongan
6. Gajahmada street 79
Tegal
7. RS. Fatmawati
street 27A Jakarta
8. Tanjung
Duren Barat street I/12A Jakarta
9. Veteran
street 34 Bekasi
10.
Dr. Rajiman street 349 Solo
11. Agil Kusumadya street 07 Kudus
12. Raya Mandala Muli street 293 Merauke
13. Tentara Pelajar street 126 Magelang
14. Pajajaran Bogor
15. Bantul
16. Wates
530 Person
Not Available
land, buildings, equipment, vehicles

Permata Bank, BCA Finance and BRI

Not Available
Not Available

Document
I.

Available ("A")/Not
Available ("N/A")

CORPORATE ORGANIZATION & GENERAL

INFORMATION
(a). The Company's Deed of Establishment
- Approvals of the Minister of Law and Human Rights
("MOLHR") (previously known as Department of
Justice and Human Rights, or Department of Laws
and Legislation) ("DOLHR");

- Evidence of publication in the state Gazette

N/A

(b). Compliance with the Company Law (Law No.40

of 2007
- Evidence of reporting to the DOLHR/MOLHR and
obtaining approvals from the DOLHR/MOLHR

( c ). All amandements to the Company's Articles of

Association
- Evidence of reporting to the DOLHR/MOLHR and
obtaining approvals from theDOLHR/MOLHR
(d). The Company's
- Share certificates;

A
- Register of

Shareholders;
- List of
share transfer during the life of company
- Approval
from shareholders related to transfer of share (if
any)
(e). Minutes of General Meetings of Shareholders
including resolutions of the Shareholders of the
Shareholders adopted outside a meeting, if any,
since the date of establishment of the Company,
electing the Board of Directors and Board of
Commissioners

Remarks

- 2002 Number: C-20178

HT.01.01.TH.2002
- 2006 Number : W9-00038
HT.01.04-TH.2006
- 2008 Number: AHU42292.AH.01.02. TAHUN 2008

di pak dayat

di pak dayat
di pak dayat

Included in the deed of amendment

of 2008

In 2007

Document
II

LICENSES/ PERMITS/REGULATORY COMPLIANCE

A. Permits
All Permits and license related to business area from
central government
B. General
Others permits and licenses held or to be held by
the company in compliance with the regulatory
requirements of technical Department, including,
without limitation:
(i) The Company's tranding license (SIUP)
(ii) Company registrasion certificate (TDP) issued by
the appropriate DOT regional office and any other
licenses by DOT
(iii) Tax payer Registration Number (NPWP) and
related notice
(iv) Taxable Entrepreneur Number (PKP)
(v) The Company's Letter of Domicile
(vi) Environment License (UUG/HO)
(vii) Other business license and compliance with the
relevant technical agencies or regional service office

Available ("A")/Not
Available ("N/A")

Remarks

N/A

Number: 517/262/11.01/PM/V/2010, Exp.

Date : 19 May 2015

Number: 11.01.51.04481, Exp.date: 6

September 2017

NPWP number.02.204.377.2-509.000

Number: PEM-76/WPJ.10/KP.0603/2003

A
A
A

Document
III.

ASSETS
The following documents and information with respect to
the Company's assets should be provided
A. Land
(i) Copies of any asset or property valuations since the
date establishment of the company
(ii) Search of local land office records
(iii) Evidence of any shared utilities of facilities
(iv) Registered encumbrances of land, if any
B. Others Asset
(i) Details of all assets (tangible and intangible) of the
Company, including:
- List of accounts receivables, prepares on an aging
receivable basis
- List of inventory. Including machinery and operating
supplies and inspection of machinery
- List of vehicles
- List of all material contracts
(ii) Details of all share or other securities (including shares
in subsidiaries) currently held by the Company since the
date of establisthment og the Company in other companies
as evidence by share certificates or registration of the
Company or shareholder register with such other
companies
(iii) Insurance policies (casualty and liability, also keyman):
insurance type,the insured party, the object of insurance,
insurance amount, term of insurance. At closing, policies
are to be assigned or purchaser should be named an
additional insured
(iv) Any other information which should be known in
substantiating the Company's assets or liabilities

Available ("A")/Not Available ("N/A")

A
A
A
N/A

A
A
A
A
N/A

N/A

Remarks

Document

IV.

INTELLECTUAL PROPERTY
(a) Details of all intelectual property rights of the
company and copies of related registration
documents with the Directorate General of
Copyrights, Patents & Trademarks
(b) Agreements relating to the company's use and
intended use and intended use of any patent,
know-how, confidential information, trademark,
trade name, copyright, or the Intellectual property
belonging to any other person, and of any
agreement relating to the use by any other person
of any of the same belonging to or licensed to the
company

Available ("A")/Not
Available ("N/A")

LOANS, FOREIGN CURRENCY TRANSACTIONS

GUARANTEES
(a). Any loans made by or to the company and any
related security granted (including facility and loan
agreements, debentures, mortgages, charges or
other document relevant to security
arrangements);

(b). Any guarantees or indemnities given by the

company or by any shareholder or third party in
respect of any liability of the company (FTA, AOI,
Mortgage, Assignment of Receivables, Pledge,
etc.);

N/A

( c ) Consents of any lender to a change in

shareholding of the company

N/A

(d) Estoppel certificates from lenders stating that

company is not in default

N/A

(e) Evidence of use of proceeds of loans received

N/A

(f) List of loan transaction with shareholders and

affiliates

N/A

(g) Evidence of foreign currency transactions

entered into by the company or no its behalf

N/A

(h) Monthly reports to Bank Indonesia on the

realization of commercial offshore loan from
lenders to the Company

N/A

(i) List of encumbrances

(j) Search of encumbrances at relevant Fiduciary
Registration Offices

N/A
N/A

Remarks

Document
VI

Available ("A")/Not
Available ("N/A")

MATERIAL AGREEMENTS, INCLUDING THIRD

PARTY CONTRACTS COMMITMENTS AND
MISCELLANEOUS AGREEMENTS
The following information and copies of the
relevant documents should be asked for,
provided and reviewed:
(a) All management and operations, technical
assistance or similar agreements, including
without limitation, all agreements entered into
between the company and third party;

N/A

(b) All approval required for company to enter

into an agreement with any third party;

N/A

( c ) All capital commitments;

(d) All equipment leases, hire purchases, credit
sales or leasing contracts;

N/A
A

(e) All contract or sub-contracts for the

purchases or sale by the company of goods or
services;

(f) All agency, distributor, joint venture,

shareholder, partnership or similar agreements
entered into by the company, whether written
or on a sole agency basis;

N/A

(g) All agreements relating to acquisition or

disposal or shares, businesses, or material
assets;

N/A

(h) All consulting, agency technical services or

similar contracts;

N/A

(i) All material contracts with shareolders (and

their owners), directors, commissioners and
key employees;

N/A

(j) All contract with any government or

govermental agency;

N/A

(k) All contract with provisions purporting to

limit the company's business activities or
ability to compete in any market or providing
for exclusive rights;

N/A

(l) Any agreement, restricting the company's

ability to pay or declare dividends;

N/A

(m) Any agreement, restricing or

understanding which may materially effect the
financial conditional, position, result or
prospects of the company

N/A

(n) Any profit sharing or royalty agreement;

N/A

(o) All agreement which will cease on the

purchase of controlling interest in the
company or which are capable of being
terminated or varied on sale of such; and

N/A

(p) All notices of default/force majeure given

or received by the company; and

N/A

(q) All marketing agreements entered into by

the company with other third party to market
its coal;

N/A

Remarks

Document
VII

Available ("A")/Not
Available ("N/A")

LITIGATION & CLAIMS

N/A
(a). Any litigation or arbitration proceeding in which
the company or any of its employees is or may
become engage or has been threatened with
including actual or potential claims
(b) Confirmation from the relevant District Courts
(including courts in for the areas in which its
laboratory clinic domiciled) to the evidence that
there is no pening litigation involving the company
in the jurisdiction of the company's main business
activity

N/A

( c ) Any existing evidence of non-compliance with

any laws, regulations or rules (including internal
rules/guideslines)

N/A

(d) Confirmation from BANI that the company is not

involved in arbitration

N/A
N/A

(e) Confirmation from Ministry of Manpower or the

relevant Industrial Relation court (Labor Court), as
relevant, that company is not in a labor dispute
N/A

VIII

(f) Copies of any notices received regarding, or

information regarding the company's
management's knowledge of, non-compliance with
any laws, unless or regulations (including internal
rules and regulations)
MANPOWER
A
(a) List of all employess of the company setting
forth their names, age, sex, functions,
compensation (including perquisites) and any other
relationships to the company or any of its officers
and directions; copies of employment agreements
with such employess
(b) List of all expatriate (if any) and all the work
permits

N/A

Remarks