Submitted to BKPM in 2 _two_ copies

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					Submitted to BKPM in 2 (two) copies.                                   Lampiran 2
                                                                       SK Kepala BKPM
                                                                       No. 57 / SK / 2004


                                                                       MODEL I / PMA


                                   INVESTMENT APPLICATION
                                INTERM OF FOREIGN INVESTMENT

This invesment application under the Foreign Invesment Law no. 1 of/year 967 and No. 11 of/year
1970 is herewith submittedto BKPM on behalf of the Government of The Republic of Indonesia
and implementation of Presidential Decree Number 29 of 2004 concerning.

I.    DESCRIPTION OF THE PARTICIPANTS

      A. Foreign Participant(s)
         1. Name                                      :
            Address                                   :
            Phone                                     :

           2. Name                                    :
              Address                                 :
             Phone                                    :

      B. Indonesian Participant(s)
         1. Name (company, cooperative or             :
            Individuals
         2. Tax. Registration Code Number (NPWP)      :
         3 - Main line of business                    :
            - Invesment status                        :
         4. Address (incl. Phone, E-mail              :
                address and fax number)

      *) Stripe which are not used

II.   DESCRIPTION OF THE PROPOSED PMA COMPANY
      1.    Name of company                           :
      2.    Main line of business                     :
      3.    Location of the project                   :
            - Regency                                 :
            - Province                                :
4.   Annual Production
                                                      Design Capacity
 Name of Product(s)/ Service                                                                Remark
                                                     Value      Amount


5.   Annual Production.

                                                                  Export            Domestic Market
     Name of Product(s)/ Service                    Value         Market
                                                                                                Internal Use
                                                                  Amount     Sales Amount
                                                                                                  Amount




     Estimated total export value                            : US$                    ,-

6.   Land area required                                      :                        Sqm

7.   Employment                                              : Expatriate            Indonesian
     a. Commissioner (s)                                     :
     b. Director (s)                                         :
     c. Professional(s) : - Manager(s)                       :
                            - Expert(s)                      :     -                       -
     d. Workers                                              :     -                       -
        Total                                                :     -                       -

     Note : Expatriate professionals position must be specified


8.   Allocation of Invesment fund :
     a. Fixed capital                                                  :
        - Cost of Land & land development                              :
        - Cost of Building                                             : US$               ,-
        - Cost of Machinery, Equipment and spare parts                 : US$           ,-
        - Others Miscelenous                                           : US$           ,-
                                  Sub total                            : US$    540.000,-
     b. Working Capital (one turn over operation)                      : US$           ,-
        Total                                                          : US$    800.000,-
     Note : if more than one locations/line of business, invesment should be devided for each location and/or
            field of business
       9. Source of Invesment Funds
           a. Equity                                                     : US$   540.000,-
           b. Loan                                                       : US$          ,-
                Total                                                    : US$   800.000,-

       10. Equity Capital
            a. Authorized Capital                                        : US$   800.000,-
            b. Issued Capital                                            : US$   540.000,-
            c. Paid-up Capital                                           : US$   540.000,-
             Note : Issued capital at lease is equal to equity.


       11. Shareholding (s)

       a. Foreign Share holding (s)                               US $                   %


       Sub Total
       b. Indonesian Shareholding (s)                             US $                   %


       c. Total ( a + b )

       12 Imlementation will be within 24 month from the date of the issuance of the Government‘s
          Approvals.


III.      DECRELATION
          1. We acknowledge that the company(ie) shall be obliged to take preventive measures
             agains any pollution resulting from the operation of our invesment project, at our joint
             venture company’s own expense(s) and in comformity with the applicable laws and
             regulations.
          2. This application has been properly and duly executed and we (the participants) are
             responsible for its accuracy, correctness and completeness, including all data and
             document attached here to.




              Jakarta,
              Foreign Applicant(s)

				
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