ASEAN Business Award 2007

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					          INDONESIA                  Nomination Form                                                Nomination Deadline
                                     ASEAN BUSINESS AWARDS                                              31 August 2008

                                                  ASEAN Most Admired Enterprises

CHECK-LIST
Before you send in your nomination form, please ensure these items are followed and completed:
 Complete this nomination form and return to your ABA National Gateway by 31 August 2008:
     MR. ANANGGA W. ROOSDIONO
     ASEAN-BAC Indonesia
     c/o Roosdiono & Partners
         Jakarta Stock Exchange Building
         Tower 1, 12th Floor
         Jl. Jendral Sudirman Kav. 52-53
         Jakarta 12190, Indonesia
         Tel: +6221 528 951 25 | Fax: +6221 5289 5112 | E-mail: anangga.w.roosdiono@roosdionolawfirm.co.id
Companies may also submit nomination form directly to:
      ASEAN-BAC SECRETARIAT                               KENAN INSTITUTE ASIA (Competition Strategic Partner)
      70 A, Jl. Sisingamangaraja                          2nd Floor, Zone D, Room 201/2
      Jakarta 12110, Indonesia                            Queen Sirikit National Convention Center
      Tel: + 6221 726 2991 ext 491 | 722 0705 (DL)        60 New Rachadapisak Road
      Email: aseanbac@aseansec.org                        Klongtoey, Bangkok 10110, Thailand
                                                          Tel: 662.229.3131 | Fax: 662.229.3130 | E-mail: aba@kiasia.org
Online nomination form may be obtained directly from above organizations, or downloaded from www.asean-bac.org
    Nomination form must be signed by the Chief Executive Officer, or equivalent
    Enclose copy of the Registration Certificate of the Company
    If financial statements are audited, please enclose a set of the Audited Statements
    Enclose copy of the Residence, Passport or Identification Card of the Nominee (CEO of the Company, or equivalent)
    Enclose copy of latest Annual Reports if available and sustainability/CSR reports as relevant

The nomination form can be completed by anyone, including the nominated organization. Entry submission, with supporting
documents and materials, should be in English.

Any information provided in this form will be confidentially treated and will only be used by the Strategic Partner and Judges
during the review and selection process. The award entry submission will not be returned.

SECTION 1: ELIGIBILITY CRITERIA

 LARGER SIZE COMPANY
To be considered for the ASEAN Business Awards, the category for a larger company must:
1.   Be an ASEAN-incorporated enterprise with at least 40% ASEAN-owned equity and have operational presence in two or
     more ASEAN countries
2.   Be in operations for a minimum of five years and must have three years of financial statements
3.   Fulfill one of the following conditions:
     - Annual revenue of a minimum of US$20 million
     - Fixed assets of more than US$10 million
     - Minimum of 300 employees
 SMALL AND MEDIUM ENTERPRISE (SMEs)
To be considered for the ASEAN Business Awards, the category for an SME must:

1.   Be an ASEAN-incorporated enterprise with at least 40% ASEAN-owned equity preferably with operational presence in
     two or more ASEAN countries
2.   Be in operations for a minimum of three years and preferably two years of financial statements
3.   Fulfill one of the following conditions:
     - Annual revenue of less than US$20 million
     - Fixed assets equal to or less than US$ 10 million
     - Less than 300 employees

If the nominated company meets with all the eligibility conditions, please return the completed nomination form, typed or
handwritten. All nominations shall be acknowledged by the National Gateway.
SECTION 2: GENERAL INFORMATION

A.       Organization Information
Organization Name (English): _____________________________________________________________________
(Chinese / Malay / Tamil / Others):
Organisation Address: ___________________________________________________________________________


Telephone:______________________ Fax : _______________________ Email: : ___________________________
Website (if any): ________________________________________________________________________________

B.       Key Personnel (Nominee)
Chief Executive Officer or equivalent:
_____________________________________________________________________________________________

Chief Operating Officer or equivalent:
_____________________________________________________________________________________________

Chief Financial Officer or equivalent:
_____________________________________________________________________________________________

C.       Capital Structure
(i) Individual Shareholders

Please provide the names of all main individual shareholders and their nationalities (please attach a separate sheet if
the space provided is insufficient):

      Name of Shareholder                    Nationality                Designation in Organisation   Percentage of Shareholding




(ii) Company Shareholders

Please provide the names of all main company shareholders, if relevant
(please attach a separate sheet if the space provided is insufficient):

                                                         Company                                      Number        Percentage of
     Name of Company        Country of Registration                             Business Activity
                                                       Registration No.                               of Staff      Shareholding




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SECTION 3: BUSINESS INFORMATION

A.       Main Business Activities (Please tick where appropriate)
        Agriculture / Agribusiness/Fisheries
        Business / Engineering Services
        Food & Beverage
        Healthcare Services
        Hospitality / Travel / Tourism
        Information and communications Technology / High Tech
        Transportation/Logistics
        Mining/energy
        Real Estate / Construction
        Wholesale / Distribution / Retail
        Manufacturing (electronic, automotive, textiles, apparel, etc.)
        Others (please specify) ____________________________________________________________________

Please provide a brief description of the organization and its business in no more than 150 words.

         _______________________________________________________________

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B.       Please rank your strength of the categories conferred under ABA 2008
         (1 being strongest and 4 being weakest)

     ___ Growth            ___ Employment            ___ Innovation          ___ Corporate Social Responsibility
Please provide an elaboration on why you should be considered for the category you have chosen in no more than
250 words (please refer to Attachment A).

         _______________________________________________________________

         _______________________________________________________________

         _______________________________________________________________

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C.      Financial Information
(i)     In which year was the organisation incorporated? ____________________________
(ii)    In which country was the organisation incorporated? __________________________
(iii)   Please indicate if the organisation is listed on any stock exchange(s):
                ◘Yes                               ◘ No
        If organisation is listed, please indicate year of listing and the stock exchange(s) it is listed on

        ___________________________________________________________________




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(iv)    Please indicate the following organization’s details:
                                                      FY 2004-2005          FY 2005-2006            FY 2006-2007
                                                          (US$)                 (US$)                   (US$)
         a   Revenue
             - Local Revenues
             - Overseas Revenues
             - Intra-ASEAN Revenue (as a
             percentage of Overseas Revenue)

         b   Shareholders' Equity
             - ASEAN
             - Non-ASEAN

         c   Profit before tax

         d   Total fixed assets

         e   Number of employees

         f   Operating costs
             - Salaries and benefits
             - Cost of sales
             - Financial costs
        Note: Data must be converted to United States Dollar Equivalent applying the exchange rate at the end of
        each particular fiscal year.
(v)     Please indicate if the financial statements are audited:
                ◘Yes                              ◘ No
        If financial statements are audited, please enclose a set of the audited statements
(vi)    State the geographical presence of the organization (manufacturing and project sites, sales offices, wholly-
        owned subsidiaries, etc.) of the organization (country & city)

        ___________________________________________________________________

(vii)   Please indicate if the nominated organisation has been subjected to any investigation or litigation:

                ◘Yes                              ◘ No
        If the nominated organisation has been subjected to investigation or litigation, please provide brief details
        (You may enclose the details as a separate sheet)

        ____________________________________________________________________




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SECTION 4: REFERENCES

Please provide below the professional advisors who have assisted the nominated organisation in its enterprise efforts.

(a) Bank

Banker

Bank

Tel:                                              Email:


(b) Audit Firm

Auditor

Audit Firm

Tel:                                              Email:


(c) Other Advisor

Name

Firm

Tel:                                              Email:


(d) Other Advisor

Name

Firm

Tel:                                              Email:


SECTION 5: DECLARATION

To be completed only by the Chief Executive Officer / Managing Director / Chief Financial Officer or equivalent) of
the organisation nominated for this Awards:

I hereby declare that the facts stated in this application together with the accompanying information are true and
correct, to the best of my knowledge, and satisfy the eligibility criteria. I understand that the financial information
provided will be used strictly by the panel of judges in the judging process and not for public release unless I agree
to its release. I further authorize the use and public release, in connection with the ASEAN Business Awards, of
organisation’s name, non-financial information, photographs, video and audio recordings from any source. I agree
that no compensation shall be due to me or my organisation for such usage.


Name: ________________________________                 Designation: ________________________________

Signature: ______________________________               Date:       : ________________________________




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                                                     ATTACHMENT A

Information important to the judges will include, but is not limited to:

Categories        Most Admired               Most Admired             Most Admired       Most Admired Enterprise in the
                 Enterprise in the          Enterprise in the        Enterprise in the        “Corporate Social
                “Growth” category           “Employment”               “Innovation”       Responsibility” Category
                                                Category                 Category
Judging         % Profit Growth          Number of new jobs        Number of           Environmental excellence in
Criteria        Long term vision          created                     patents filed       production and business
                 for sustainable          Staff retention rate      R&D budget (as       process
                 growth                   Training expense per       a percentage of     Environmentally sustainable
                Return on                 employee                   revenues)            business strategy
                 investment               Creation of a positive    Innovative          Link of business to social or
                Return on assets          work environment           products             community development
                % annual                 Availability of good      Innovative          Employee volunteering
                 revenue growth            health care                business             programs
                                          Proper appraisal           processes
                                           system




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