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. Nama Perusahaan Name of the Company. 2. Alamat Lengkap Provinsi / Province : Complete Address 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 Anggota Utama Full Member Anggota Pendamping Associate Member Catatan/note : Anggota Utama Full 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 3. Dokumen Perencanaan Reklamasi / Reclamation planning document 4. Dokumen Penutupan Tambang / Mine Closure document
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. 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 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. Daftar rekanan Perusahaan Tambang Batubara/ List of Client on Coal Companies 1.... 2.... 3.... 4.... 5....