MATERIAL SUPPLIER QUESTIONNAIRE

Category OTHER File Name MSQ-SUP-OTH (DP-Frey-S-3.4-02C).xlsx Document DP-Frey-S-3.4-02C Revision 06 / 1 Agustus 2010

1.
1.1.

GENERAL INFORMATION
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 website)

Contact Person: Techincal Contact No. bag. Teknis Phone tlp Facsimile fax

Commercial Contact No. bag. Sales

Phone tlp

Facsimile fax

Delivery/Shipping Contact

Phone

Facsimile

No. bag. Pengiriman

tlp

fax

Emergency Contact* No. Darurat

Phone tlp

Facsimile 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: Group Name #1 1.2. Activities #1 (Aktifitas) Activities #2 (Jika Iya, berikan informasi berikut:) (Nama Grup)

Group Name #2

Manpower (susunan perusahaan) Please provide your companys organisation chart. How many people are working in your Company? (Berapa banyak orang yang bekerja di perusahaan anda?) The distribution of manpower: (Distribusi Jabatan) Executives (bag. Exekutif) Permanent Staff (bag. Staff tetap) Sales/Marketing Staff (bag. Staff marketing)

(Tolong berikan informasi struktur organisasi perusah

1.3.

Managers (bag. manager)

Outsourcing Staff (bag. Staff tidak tetap)

Sales Support (bag. Pembantu marketing)

Supervisors (bag. supervesor)

Skilled (bag. teknis)

Warehouse Staff (bag. Staff gudang)

Operators (bag. operator)

Semi-skilled (bag. Semi teknis)

Delivery Staff (bag. Staff pengiriman)

Main Customer (Data Kostomer) Customer Name #1 1.4. Customer Name #2 (Nama kostomer 2) Main Sector #2 (Nama kostomer 1) Main Sector #1

Customer Name #3 1.5. Customer Name #4

(Nama kostomer 3)

Main Sector #3

(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 where it come from. (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 relationship type. (tolong berikan info tentang list produk, detail produk, dan tipe kerjasama Product Type #1 Principal Name #1

Address #1

City #1

Zip #1

Country #1

Contact Person #1

Relationship with Principal #1

Product Type #2

Principal Name #2

Address #2

City #2

Zip #2

Country #2

Contact Person #2

Relationship with Principal #2

1.7. Product Type #3 Principal Name #3

Address #3

City #3

Zip #3

Country #3

Contact Person #3

Relationship with Principal #3

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

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 1.8.C.

Activities #2

Facilities #1

Facilities #2

Laboratory (for chemical industry, Pest Control, Independence Laboratory services) Location #1 Location #2

Ownership #1

Ownership #2

Testing Types #1

Testing Types #2

Warehouse (for all suppliers) Location #1 1.8.D. Address #1 Address #2 Location #2

Product to be stored #1

Product to be stored #2

Areal Size (meter squares) #1

Areal Size (meter squares) #2

Ownership #1

Ownership #2

Facilities #1

Facilities #2

Transportation (for all suppliers) 1.8.E. Ownership Outsourcing Company Name

Open topped Trucks (capacity):

Open topped Trucks (no of trucks):

Enclosed Trucks / Truck with Box (capacity):

Enclosed Trucks / Truck with Box (no of tr

1.8.F.

Flat Truck with Container (capacity):

Flat Truck with Container (no of trucks):

Others:

Capacity:

No of Trucks:

Working Equipments & Tools (for all suppliers) Working Equipments #1 Working Equipments #2

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)?

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.
3.1.

If YES, please describe it.

Please describe the order-taking flow process in your company.

Does your company have a Customer Satisfaction Measurement Procedure?

If YES, please describe it.

3.2.

QUALITY MANAGEMENT AND PROCESS

Please list official certification held by your company/principal/Subcontractor for quality, environment and/or safety such as ISO9000, ISO14001, ISO22000, HACCP, OHSAS18001, SNI, Laboratory testing. (Add a copy of the 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:

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 Requirements?

Please inform what kind of employee training that already delivered to your team: A. Product Technical Knowledge training

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

Others

Bank Details:

ACKNOWLEDGE
Signed by Date

Position

AIRE

3.4-02C

tus 2010

lamat website)

Email

Email

Email

Email

(Nama Grup)

(Aktifitas)

masi struktur organisasi perusahaan anda)

Technicians (bag. Teknisi/enginerr)

bantu marketing)

Project Manager (bag. Manajer proyek)

Technical Support (bag. Asisten teknisi/enginerr)

pengiriman)

R & D Staff (bag. HRD)

(Bidang pekerjaan) #1

(Bidang pekerjaan) #2

(Bidang pekerjaan) #3

(Bidang pekerjaan) #4

(Bidang pekerjaan) #5

EY and where it come from. ana asalnya) Origin Country #1 (asal negara)

Origin Country #2

(asal negara)

Origin Country #3

(asal negara)

s and the relationship type.

p with Principal #1

p with Principal #2

p with Principal #3

be stored #2

meter squares) #2

g Company Name

ed Trucks (no of trucks):

rucks / Truck with Box (no of trucks):

with Container (no of trucks):

quipments #2

uality, environment and/or y testing. (Add a copy of the

stomer Requirements?

YES NO

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