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Category Document
File Name Revision
1. GENERAL INFORMATION
1.1. Name of your Company (nama perusahaan)
NPWP
Head Office Address (alamat kantor)
City (kota) Zip (kode pos)
Country (Negara)
Phone (tlp) Email
Facsimile (Fax) Website (Alamat websi
Contact Person:
Techincal Contact Phone FacsimileNo. bag. Teknis tlp fax
Commercial Contact Phone Facsimile
No. bag. Sales tlp fax
Delivery/Shipping Contact Phone Facsimile
MSQ-SUP-OTH (DP-Frey-S-3.4-02C).xlsx
MATERIAL SUPPLIER QUESTIONNAIRE
OTHER DP-Frey-S-3.4-02C
06 / 1 Agustus 2010
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No. bag. Pengiriman tlp fax
Emergency Contact* Phone Facsimile
No. Darurat tlp fax
* Person who can be contacted outside working hours*(nomor yang bisa dihubungi di luar jam kerja)
Does your company belong to a group?
(Apakah perusahaan anda masuk grup?)
If YES, please give: (Jika Iya, berikan informasi berikut:)
Group Name #1 (Nama Grup) Group Name #2
1.2.
Activities #1 (Aktifitas) Activities #2
Manpower
(susunan perusahaan)
Please provide your companys organisation chart. (Tolong berikan informasi struktur
How many people are working in your Company?
(Berapa banyak orang yang bekerja di perusahaan anda?)
The distribution of manpower:
(Distribusi Jabatan)
Executives Permanent Staff Sales/Marketing Staff
(bag. Exekutif) (bag. Staff tetap) (bag. Staff marketing)
1.3. Managers Outsourcing Staff Sales Support
(bag. manager) (bag. Staff tidak tetap) (bag. Pembantu marke
Supervisors Skilled Warehouse Staff
(bag. supervesor) (bag. teknis) (bag. Staff gudang)
Operators Semi-skilled Delivery Staff
(bag. operator) (bag. Semi teknis) (bag. Staff pengiriman)
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Main Customer
(Data Kostomer)
Customer Name #1 (Nama kostomer 1) Main Sector #1
1.4.Customer Name #2 (Nama kostomer 2) Main Sector #2
Customer Name #3 (Nama kostomer 3) Main Sector #3
1.5.
Customer Name #4 (Nama kostomer 4) Main Sector #4
Customer Name #5 (Nama kostomer 5) Main Sector #5
Products or services range that you can provide:
(Produk/jasa yang bisa anda berikan)
1.6.
Please list the main Material that you used in the Products (will be) supplied to FREY and wher(tolong berikan daftar material yang anda gunakan dalam produk anda dan dari mana asalnya)
Main Material #1 (Nama Material) Source #1 (Sumber)
Main Material #2 (Nama Material) Source #2 (Sumber)
Main Material #3 (Nama Material) Source #3 (Sumber)
Please list down the type of products (will be) supplied to FREY, the Principal details and the re
(tolong berikan info tentang list produk, detail produk, dan tipe kerjasama
Product Type #1 Principal Name #1
Address #1
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City #1 Zip #1
Country #1
Contact Person #1 Relationship with Princ
Product Type #2 Principal Name #2
Address #2
City #2 Zip #2
Country #2
Contact Person #2 Relationship with Princ
1.7.
Product Type #3 Principal Name #3
Address #3
City #3 Zip #3
Country #3
Contact Person #3 Relationship with Princ
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Do you use any sub-contractors for certain service at any time?
If YES, please state the companys name and address and the product(s) sub-contracted.
Product/Service Type #1
Sub-contractor Name #1
Address #1
City #1 Zip #1
Country #1
Phone #1 Email #1
Facsimile #1
Product/Service Type #2
Sub-contractor Name #2
Address #2
City #2 Zip #2
Country #2
Phone #2 Email #2
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Facsimile #2
Product/Service Type #3
Sub-contractor Name #3
1.8.
1.8.A. Address #3
City #3 Zip #3
Country #3
Phone #3 Email #3
1.8.B. Facsimile #3
Please inform the facilities that owned by your company/principal/sub-contractor.
Production (for fabrication or producer company)
Location #1 Location #2
Activities #1 Activities #2
1.8.C.
Facilities #1 Facilities #2
Laboratory (for chemical industry, Pest Control, Independence Laboratory services)
Location #1 Location #2
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Ownership #1 Ownership #2
Testing Types #1 Testing Types #2
Warehouse (for all suppliers)
Location #1 Location #2
1.8.D.
Address #1 Address #2
Product to be stored #1 Product to be stored #
Areal Size (meter squares) #1 Areal Size (meter squa
Ownership #1 Ownership #2
Facilities #1 Facilities #2
Transportation (for all suppliers)
1.8.E.
Ownership Outsourcing Company
Open topped Trucks (capacity): Open topped Trucks (
Enclosed Trucks / Truck with Box (capacity): Enclosed Trucks / Truc
1.8.F. Flat Truck with Container (capacity): Flat Truck with Contai
Others:
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Capacity: No of Trucks:
Working Equipments & Tools (for all suppliers)
Working Equipments #1 Working Equipments #
2.
2.1.
Working Tools #1 Working Tools #2
2.2. Safety Equipments & Tools (for all suppliers)
Safety Equipments #1 Safety Equipments #2
2.3. Safety Tools #1 Safety Tools #2
2.4. MANAGEMENT RESPONSIBILITIES
Please explain your companys mission statement.
2.5.
Does the company have an ethics policy statement?
If YES, please enclose 1 copy.
Does your company have an EHS (Environmental, Health & Safety) policy statement?
If YES, please enclose 1 copy.
Does your company have safety procedure(s)?
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If YES, please enclose 1 copy.
Customer Complaint.
A. Do you have Customer Complaint Procedures?
B. Do you keep the record of Customer Complaint?
2.6.
C. Do you decide Corrective & Preventive action?
D. Do you communicate your Corrective & Preventive action to customer?
2.7. E. How many complaint did you received within last year?
F. How many complaint did you solved within last year?
2.8.
G. What is the main problem of the complaint you received within last year?
Does your company evaluate and monitor Principal/Sub-contractor Performance?
3. If YES, please describe it.
3.1.
Please describe the order-taking flow process in your company.
Does your company have a Customer Satisfaction Measurement Procedure?
If YES, please describe it.
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3.2. QUALITY MANAGEMENT AND PROCESS
Please list official certification held by your company/principal/Subcontractor for quality, envir
safety such as ISO9000, ISO14001, ISO22000, HACCP, OHSAS18001, SNI, Laboratory testing. (A
certificate(s) that your company and/or your principal had achieved).
Certification Type and No. #1 Achieved by #1
Certification Type and No. #2 Achieved by #2
Certification Type and No. #3 Achieved by #3
Certification Type and No. #4 Achieved by #4
Please choose which documents your company capable to provide.
Product Specification / Product Data Sheet
Certificate of Analysis
Material Safety Data Sheet (MSDS)
3.3.
Food Grade certificate / Sertifikat Food Grade
Technical Drawing
Trading License
Others #1:
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Others #2:
Please send one example copy of each above document which you commit to provide.
Warranty of your Products / Services
3.4. A. Warranty Period
B. Warranty including Spare Part
C. Warranty including Service / Technician
D. Warranty service on site
3.5. E. Replacement Product/Unit or Re-work if not suitable
F. Recovery cost if your company caused the accident/damage
3.6.
Technical Support:
A. Technical Consultation
B. Providing Technical training
C. Providing Documentation we need
Does your company capable to make a Customized products/services based on Customer Req
Please inform what kind of employee training that already delivered to your team:
A. Product Technical Knowledge training
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B. Product Maintenance training
C. Product Repairing training
D. Production Training
E. Personnel Hygiene training (for Catering only)
4.
4.1. F. Customer Service Training
G. Environment, Health and Safety awareness
4.2.
H. How to use Safety equipment
I. Management System awareness
J. Others:
4.3. OTHER INFORMATION
A. Min. quantity per order:
B. Min. quantity per delivery:
Payment Method:
Cash
Credit
Days after invoice
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Others
Bank Details:
Signed by Date
Position
ACKNOWLEDGE
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(Nama Grup)
(Aktifitas)
organisasi perusahaan anda)
Technicians
(bag. Teknisi/enginerr)
Project Manager
ting) (bag. Manajer proyek)
Technical Support
(bag. Asisten teknisi/enginerr)
R & D Staff
(bag. HRD)
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(Bidang pekerjaan) #1
(Bidang pekerjaan) #2
(Bidang pekerjaan) #3
(Bidang pekerjaan) #4
(Bidang pekerjaan) #5
e it come from.
Origin Country #1 (asal negara)
Origin Country #2 (asal negara)
Origin Country #3 (asal negara)
lationship type.
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ipal #1
ipal #2
ipal #3
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2
es) #2
Name
o of trucks):
with Box (no of trucks):
er (no of trucks):
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2
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onment and/or
dd a copy of the
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irements?
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YES OWNED-B AC FORK-LIFT OWNED-B SOLE-DISTRIBUTOR
NO OUTSOUR NON-AC HAND-PAL RENT DISTRIBUTOR
CRANE AGENT
OTHERS RE-SELLER
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