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Citra Graha, 7th Floor, Suite 703 , Jl. Jend. Gatot Subroto 35 – 36 , Jakarta 12950, Indonesia Phone: 021 – 5201023 Fax.: 021 – 5201029 E-mail: [email protected] http://www.fcgi.or.id Corporate Governance Self Assessment Checklist SERI TATA KELOLA PERUSAHAAN (CORPORATE GOVERNANCE) Jilid Ill FCGI Bekerjasama dengan Asian Development Bank (ADB) Corporate Governance Self Assessment Checklist Penilaian Mandiri (Self Assessment) Praktek Good Corporate Governance suatu Perusahaan (Edisi ke-2)

Transcript of Fcgi Self Assessment Checklist KUESIONER

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Citra Graha, 7th Floor, Suite 703 , Jl. Jend. Gatot Subroto 35 – 36 , Jakarta 12950, IndonesiaPhone: 021 – 5201023 Fax.: 021 – 5201029E-mail: [email protected] http://www.fcgi.or.id

Corporate Governance Self Assessment Checklist

SERI TATA KELOLA PERUSAHAAN (CORPORATE GOVERNANCE)Jilid Ill

FCGI Bekerjasama dengan Asian Development Bank (ADB)

Corporate Governance Self Assessment Checklist

Penilaian Mandiri (Self Assessment) Praktek Good Corporate Governance suatu Perusahaan

(Edisi ke-2)

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SERI TATA KELOLA PERUSAHAAN (CORPORATE GOVERNANCE)Jilid IIl

(Edisi ke-2)

FCGI Bekerjasama dengan Asian Development Bank (ADB)

Corporate GovernanceSelf Assessment Checklist

Penilaian Mandiri (Self Assessment) Praktek Good Corporate Governance suatu Perusahaan

Citra Graha, 7th Floor, Suite 703 , Jl. Jend. Gatot Subroto 35 – 36 , Jakarta 12950, IndonesiaPhone: 021 – 5201023 Fax.: 021 – 5201029E-mail: [email protected] http://www.fcgi.or.id

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Kata Pengantar

Saudara-saudara yang kami hormati,

Dalam kesempatan yang berbahagia ini kami ingin menyampaikan bahwaForum for Corporate Governance in Indonesia (FCGI) didirikan pada 8Februari satu tahun yang lalu oleh lima asosiasi bisnis dan profesi, yaitu:Asosiasi Emiten Indonesia (AEI), Ikatan Akuntan Indonesia-KompartemenAkuntan Manajemen (IAI-KAM), Indonesian Financial Executives Association(IFEA), Masyarakat Transparansi Indonesia (MTI), dan IndonesianNetherlands Association (INA). Sebagai forum yang terbuka, FCGI bersifatinklusif dimana asosiasi-asosiasi bisnis dan profesi yang tertarik dapatbergabung dalam keanggotaan FCGI. Hingga kini asosiasi bisnis danprofesi yang tergabung dalam FCGI berjumlah 10 (sepuluh) asosiasi denganbergabungnya lima asosiasi lainnya. Kelima asosiasi yang bergabungkemudian ini yaitu: Asosiasi Perusahaan Efek Indonesia (APEI), Institute ofInternal Auditors (IIA) - Indonesian Chapter, Forum Komunikasi SatuanPengawas Intern BUMN/BUMD, Yayasan Pendidikan Internal Audit (YPIA),dan Masyarakat Profesi Penilai Indonesia (MAPPI).

Tujuan utama didirikannya FCGI adalah untuk mensosialisasikanprinsip-prinsip dan aturan Good Corporate Governance kepada dunia bisnisIndonesia. Dalam rangka melaksanakan tujuan utama kami tersebut, FCGIbekerjasama dengan Asian Development Bank (ADB) telahmengembangkan suatu penilaian mandiri (self assessment) sebagai alatuntuk menilai pelaksanaan Corporate Governance perusahaan-perusahaandi Indonesia. Penilaian mandiri berbentuk kuisioner tersebut kami namakan"Corporate Governance Self Assessment Checklist".

FCGI akan dengan senang hati bekerjasama dengan semua pihak untukmenyebarkan penilaian mandiri ini kepada dunia bisnis di Indonesia danmasyarakat umum. Meskipun penilaian mandiri ini telah rampung, FCGImengakui terhadap penilaian mandiri ini dapat terus dilakukan

FCGI

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penyempurnaan-penyempurnaan dan FCGI sangat terbuka untuk menerimasaran dan masukan dari semua pihak berkenaan dengan isi dan penggunaanpenilaian mandiri ini.

Jakarta, 16 Juli 2001Hormat kami,Forum for Corporate Governance in Indonesia (FCGI)

Eddie M. GunadiActing Chairman

FCGI

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Preface

Dear Colleagues,

We are very pleased to inform you that the Forum for Corporate Governancein Indonesia (FCGI) was established on 8 February last year by 5 (five)private sector of business and professional associations namely: the AsosiasiEmiten Indonesia (AEI), the Ikatan Akuntan Indonesia-KompartemenAkuntan Manajemen (IAI-KAM), the Indonesian Financial ExecutivesAssociation (IFEA) and the Masyarakat Transparansi Indonesia (MTI),supported by the Indonesian Netherlands Association (INA). Since the FCGIis inclusive in nature and other business and professional associations arewelcome to join, currently the FCGI has 10 (ten) members of business andprofessional associations. The joining members of the FCGI are the AsosiasiPerusahaan Efek Indonesia (APEI), the Institute of Internal Auditors (IIA) -Indonesian Chapter, the Forum Komunikasi Satuan Pengawas InternBUMN/BUMD, the Yayasan Pendidikan Internal Audit (YPIA), and theMasyarakat Profesi Penilai Indonesia (MAPPI).

The main objective of this open Forum is to promote and to foster theimplementation of principles and rules of Good Corporate Governanceamongst companies in Indonesia. In line with our main objectives and withcooperation with the Asian Development Bank (ADB), we have developed aSelf-Assessment on Corporate Governance, namely "Corporate GovernanceSelf Assessment Checklist".

The FCGI appreciates to cooperate with all of you in distributing theSelf-Assessment to the business communities and public at large. Althoughthe Self-Assessment has already been final in its form, the FCGI admitsmodestly that improvements on the assessment still could be done. Thereforethe FCGI would appreciate if you could read through the final draft and wewelcome your comments on the ease of use and the relevance of this form.

FCGI

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Jakarta, 16 July 2001With my best regards,Forum for Corporate Governance in Indonesia (FCGI)

Eddie M. GunadiActing Chairman

FCGI

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FCGI

Daftar Isi

Kata Pengantar ............................................................................................................................................. i

Daftar Isi ................................................................................................................................................................ v

Forum for Corporate Governance in Indonesia .............................................................. v i i

Corporate Governance Self Assessment Checklist. Penilaian Mandiri(Self Assessment) Praktek Good Corporate Governance suatu Perusahaan................................................................................................................. 1

Kuisioner: Forum for Corporate Governance in Indonesia (FCGI) Corporate

Governance Self Assessment Checklist. (versi Bahasa Indonesia) ....... 7

Contents

Preface …………………………………………………............................... iii

Contents …………………………………………………............................. v

Forum for Corporate Governance in Indonesia ……………………......... ix

Corporate Governance Self Assessment Checklist. A Self Assessment forCompany’s Corporate Governance Practices.…..………………………… 19

Questionnaire: Forum for Corporate Governance in Indonesia (FCGI)Corporate Governance Self Assessment Checklist. (English version) ... 25

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FORUM FOR CORPORATE GOVERNANCE IN INDONESIA( FCGI )

Semenjak didirikan pada tanggal 8 Februari 2000 oleh 5 (lima) asosiasibisnis dan profesi, yaitu AEI, IAI-KAM, IFEA, INA, dan MTI, Forum forCorporate Governance in Indonesia (FCGI) telah memainkan peranan danusahanya yang signifikan dalam mensosialisasikan prinsip-prinsip GoodCorporate Governance. Saat ini FCGI beranggotakan 11 (sebelas) asosiasibisnis dan profesi setelah 6 (enam) asosiasi lainnya bergabung kemudiandalam keanggotaan FCGI. Berikut ini adalah asosiasi-asosiasi bisnis danprofesi yang tergabung dalam keanggotaan FCGI, dimana 5 (lima) urutanyang pertama adalah asosiasi pendiri FCGI, yaitu:

1. AEI (Asosiasi Emiten Indonesia);2. IAI-KAM (Ikatan Akuntan Indonesia – Kompartemen Akuntan

Manajemen);3. IFEA (the Indonesian Financial Executives Association / Ikatan

Eksekutif Keuangan Indonesia);4. INA (the Indonesian Netherlands Association / Perkumpulan

Indonesia Belanda);5. MTI (Masyarakat Transparansi Indonesia);6. APEI (Asosiasi Perusahaan Efek Indonesia);7. CLDI (Corporate Leadership Development Institute);8. FKSPI BUMN/BUMD (Forum Komunikasi Satuan Pengawas Intern

BUMN/BUMD);9. IIA Indonesia Chapter (the Institute of Internal Auditors);

10. MAPPI (Masyarakat Profesi Penilai Indonesia); dan11. YPIA (Yayasan Pendidikan Internal Auditoor).

Selain kesebelas asosiasi bisnis dan profesi tersebut, terdapat 7 institusidalam kapasitasnya sebagai observer FCGI yang aktif, antara lain:

• JITF (the Jakarta Initiative Task Force);• Partnership for Governance Reform in Indonesia;• SPUR (Solidaritas Profesi Untuk Reformasi);• Universitas Bina Nusantara;• Komite GCG BPKP (Badan Pengawas Keuangan dan Pembangunan);• ISICOM (the Indonesian Society for Independent Commissioners /

Paguyuban Komisaris Independen Indonesia); dan• PERHUMAS (Perhimpunan Hubungan Masyarakat Indonesia).

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Maksud dan Tujuan FCGI

FCGI bekerjasama dan berpartisipasi dalam menciptakan danmengembangkan Corporate Governance di Indonesia. Tujuan FCGI adalah untukmeningkatkan kesadaran dan mensosialisasikan prinsip dan aturan mengenaiCorporate Governance kepada dunia bisnis di Indonesia dengan mengacukepada international best practices sehingga mereka dapat memperolehmanfaat dalam melaksanakan prinsip dan aturan yang sesuai dengan standarTata Kelola Perusahaan yang baik (Good Corporate Governance). Hal inidilaksanakan oleh FCGI melalui beberapa kegiatan, antara lain memberi masukankepada Komite Nasional mengenai Kebijakan Good Corporate Governance(KNKCG) dalam menyusun Pedoman Good Corporate Governance (Code ofConduct of Good Corporate Governance) dengan menyampaikan beberapaposition papers tentang Corporate Governance. Lebih lanjut dalam usahanyamensosialisasikan prinsip-prinsip Corporate Governance, FCGI telah menerbitkanbooklet mengenai Corporate Governance yang akan diikuti oleh booklet lainnyaserta menyusun suatu Self-Assessment Guidance, sebagai pedoman bagiperusahaan untuk menilai sejauh mana mereka telah menerapkan GoodCorporate Governance di lingkungannya masing-masing.

Corporate Governance Information CenterMemasuki tahun 2002 kegiatan-kegiatan FCGI tersebut dituangkan dalamwadah Corporate Governance Information Center yang mendapat dukunganpendanaan dari Partnership for Governance Reform in Indonesia danPemerintah Kerajaan Belanda. Kegiatan Corporate Governance InformationCenter terdiri dari:

1. Held DeskHelp Desk berfungsi untuk membantu perusahaan-perusahaan diIndonesia, institusi pendidikan, mahasiswa, dan badan-badanpemerintahan serta media massa dalam memperoleh informasiyang detil dan lengkap tentang Corporate Governance. Informasiyang terdapat di Help Desk FCGI ini dapat diperoleh melalui:

Forum for Corporate Governance in Indonesia (FCGI)Citra Graha Floor 7 Suite 703Jl. Jend. Gatot Subroto Kav. 35-36Jakarta 12950, IndonesiaPh.: 021- 520 1023Fax.: 021-520 1029E-mail: [email protected]: www.fcgi.or.id

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2. In-Company Presentations and Discussion MeetingIn-company Presentations bertujuan untuk memberikanpemahaman tentang Corporate Governance besertaimplementasinya kepada jajaran direksi, komisaris, manajemendan staff perusahaan-perusahaan yang mulai dan atau dalamproses menerapkan Corporate Governance.

3. Presentation at Seminars and Workshops Tujuan utama kegiatan presentasi dalam seminar dan workshopadalah untuk menjelaskan dan mendiskusikan isu-isu CorporateGovernance baik kepada dunia bisnis di Indonesia maupunkepada masyarakat umum. FCGI menyediakan pembicara-pembicara untuk seminar dan atau workshop CorporateGovernance yang akan membawakan isu-isu yang spesifikmengenai Corporate Governance dan implementasinya.

4. PublicationsPublikasi tentang Corporate Governance dibuat oleh FCGI dalambentuk elektronik, seperti website, dan dalam bentuk tulisanseperti pembuatan booklet Corporate Governance, pemuatanartikel-artikel secara rutin di koran (seperti di Harian Republika)dan majalah, serta penerbitan bersama buku-buku CorporateGovernance bersama institusi lainnya di Indonesia. Langkahlainnya yang sedang dijajaki oleh FCGI adalah mempersiapkanserial Talkshow tentang Corporate Governance di televisi danradio (“Transparans 100%”).

Kepengurusan FCGIKetua : Eddie M. Gunadi (IAI-KAM)Sekretaris Jenderal : Irwan M. Habsjah (IFEA)Bendahara : Elmar Bouma (INA)Members of the Board : Abdurachim Husein (APEI)

Binsar Simanjuntak (BPKP)Chris Cooper (IIA Indonesia Chapter)Dewi Sri Umi (MAPPI)Dudi M. Kurniawan (IAI-KAM)Edward R. Gustely (JITF)Edy Indratjahja (BPKP)Erry Riyana Hardjapamekas (MTI)F. Antonius Alijoyo (IFEA)Felia Salim (MTI)

FCGI

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Hari Setianto (YPIA)Helmy Yahya (IAI-KAM)Herman Darmawan (AEI)Ito Warsito (IAI-KAM)Johanes Sutrisno (ISICOM)Krisnaraga Syarfuan (IFEA)Larry Berger (McKinsey&Co.)Phil Leifermann (IIA Indonesia Chapter)Reddy Nurliadie (FKSPI BUMN/BUMD)Rudyan Kopot (IFEA)Sita Supomo (SPUR)Soeroso (CLDI)Subarto Zaini (ISICOM)Sudarwan (YPIA)Tjandra Irawan (IFEA)Wierman Pamuntjak (FKSPI BUMN/BUMD)

Koordinator Program 1. Research and Development:F. Antonius Alijoyo (IFEA)

2. Socialization and Public Relations:Dewi Sri Umi (MAPPI)

3. Corporate Social Responsibility:Sita Supomo (SPUR)

Sekretaris Eksekutif : TB. M. Nazmudin Sutawinangun (INA)

FCGI

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FORUM FOR CORPORATE GOVERNANCE IN INDONESIA( FCGI )

Established on 8 February 2000 by 5 professional and businessassociations, namely AEI, IAI-KAM, IFEA, INA, and MTI, the Forum forCorporate Governance in Indonesia (FCGI) has played a significant role indisseminating Good Corporate Governance principles in Indonesia.Currently, the FCGI has 11 members since 6 others associations have nowjoined the FCGI. The members of the FCGI are:

1. AEI (the Association of Indonesian Publicly Listed Company);2. IAI-KAM (the Indonesian Accountant Association – Management

Accountant Compartment);3. IFEA (the Indonesian Financial Executives Association);4. INA (the Indonesian Netherlands Association);5. MTI (the Indonesian Society for Transparency);6. APEI (the Association of Indonesian Securities Company);7. CLDI (Corporate Leadership Development Institute);8. FKSPI BUMN/BUMD (the Association of Internal Auditor of State-

Owned Companies/Local State-Owned Companies);9. IIA Indonesia Chapter (the Institute of Internal Auditors);

10. MAPPI (the Indonesian Society of Appraisers); and11. YPIA (the Internal Auditor Education Foundation).

In addition, there are 7 institutions that are active observers of FCGI, namely:• JITF (the Jakarta Initiative Task Force);• Partnership for Governance Reform in Indonesia;• SPUR (Solidarity of Professionals for Reform);• University of Bina Nusantara;• Committee on GCG of BPKP (Financial and Development

Supervisory Board);• ISICOM (the Indonesian Society for Independent Commissioners);

and• PERHUMAS (Public Relations Association of Indonesia).

Purpose and Objectives of FCGI

The FCGI works towards improving Corporate Governance in Indonesia. TheFCGI 's aim is to enhance awareness and to socialize Good CorporateGovernance principles to the Indonesian business community based on

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international best practices, so that they can gain the benefits associated withGood Corporate Governance. The activity of the FCGI complement theactivities of the National Committee on Good Corporate Governance(NCCG), who are responsible for drafting the Code of Conduct of GoodCorporate Governance and formulating the strategies required to implementthis code. As part of the FCGI’s efforts to socialize Good CorporateGovernance principles, the FCGI has already published Good CorporateGovernance booklets and developed a self assessment questionnaire forcompanies to assess their implementation of Good Corporate Governanceprinciples.

Corporate Governance Information CenterCommencing its activities in the year 2002, the FCGI is establishingCorporate Governance Information Center supported by Partnership forGovernance Reform in Indonesia and the Netherlands Government. Theactivities of the Corporate Governance Information Center consist of:

1. Held DeskThe Help Desk will be a function where companies, educationalinstitutions and students, government agencies and the press canget detailed information on Corporate Governance in Indonesia.Available information on Corporate Governance can be obtained atthe FCGI Help Desk address at:

Forum for Corporate Governance in Indonesia (FCGI)Citra Graha Floor 7 Suite 703Jl. Jend. Gatot Subroto Kav. 35-36Jakarta 12950, IndonesiaPh.: 021- 520 1023Fax.: 021-520 1029E-mail: [email protected]: www.fcgi.or.id

2. In-Company Presentations and Discussion MeetingAn increasing number of companies and organizations that havestarted to familiarize themselves with corporate governance, arerequesting for in-company presentations and discussion meetingswith the management and staff of the company. It is a very effectiveway of getting the implementation process started.

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3. Presentation at Seminars and Workshops The main objective of presentations at seminars is to addressCorporate Governance issues to the business community andpublic at large as well. Corporate Governance is a topic at anincreasing number of seminars held. Frequently, experts of theFCGI are being invited to address specific issues in corporategovernance during seminars.

4. PublicationsPublications on Corporate Governance will provide information inelectronic format (website) as well as writing format (topicalbooklets and newspaper/magazine articles). Joint publication onCorporate Governance with other institutions was also made by theFCGI. Furthermore, the FCGI plans to broadcast a TV show onGood Corporate Governance and a radio talk show as well, namely(“Transparans 100%”).

Board of Management FCGIChairman : Eddie M. Gunadi (IAI-KAM)Secretary General : Irwan M. Habsjah (IFEA)Treasurer : Elmar Bouma (INA)Members of the Board : Abdurachim Husein (APEI)

Binsar Simanjuntak (BPKP)Chris Cooper (IIA Indonesia Chapter)Dewi Sri Umi (MAPPI)Dudi M. Kurniawan (IAI-KAM)Edward R. Gustely (JITF)Edy Indratjahja (BPKP)Erry Riyana Hardjapamekas (MTI)F. Antonius Alijoyo (IFEA)Felia Salim (MTI)Hari Setianto (YPIA)Helmy Yahya (IAI-KAM)Herman Darmawan (AEI)Ito Warsito (IAI-KAM)Johanes Sutrisno (ISICOM)Krisnaraga Syarfuan (IFEA)Larry Berger (McKinsey&Co.)Phil Leifermann (IIA Indonesia Chapter)

FCGI

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Reddy Nurliadie (FKSPI BUMN/BUMD)Rudyan Kopot (IFEA)Sita Supomo (SPUR)Soeroso (CLDI)Subarto Zaini (ISICOM)Sudarwan (YPIA)Tjandra Irawan (IFEA)Wierman Pamuntjak (FKSPI BUMN/BUMD)

Program Coordinator 1. Research and Development:F. Antonius Alijoyo (IFEA)

2. Socialization and Public Relations:Dewi Sri Umi (MAPPI)

3. Corporate Social Responsibility:Sita Supomo (SPUR)

Executive Secretary : TB. M. Nazmudin Sutawinangun (INA)

FCGI

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Corporate Governance Self Assessment Checklist

Penilaian Mandiri (Self Assessment)Praktek Good Corporate Governance suatu Perusahaan

Akhir-akhir ini Corporate Governance menjadi suatu buzzword yang semakinbanyak didengungkan. Banyak pihak bertanya, bagaimana kita mengetahuiapakah suatu perusahaan sudah menerapkan prinsip-prinsip CorporateGovernance secara baik? Tampaknya tidak sulit bagi perusahaan untukmenyatakan bahwa pihaknya sudah mentaati prinsip-prinsip dasar CorporateGovernance yang mencerminkan azas transparansi, pertanggungjawaban, akuntabilitas dan keadilan. Namun, sesungguhnya perludilakukan suatu penilaian atau assessment yang sistematis untukmeyakinkan bahwa perusahaan telah sungguh-sungguh melaksanakanCorporate Governance.

Untuk itu, sebenarnya sudah ada beberapa tools (alat) yang dapat digunakansebagai penilaian mandiri (self assessment) apakah Corporate Governancepada suatu perusahaan sudah baik. Salah satu alat untuk melakukanpenilaian mandiri tersebut dikembangkan oleh FCGI (Forum for CorporateGovernance in Indonesia). Alat itu berwujud seperangkat kuisioner yangdapat diisi sendiri oleh perusahaan dan selanjutnya perusahaan memberikanpenilaian atau skor secara obyektif terhadap jawabannya itu. (Informasi lebihlanjut dapat dilihat di www.fcgi.or.id atau e-mail ke [email protected])

Melalui kuisioner tersebut, perusahaan dapat melakukan penilaian atauassessment pada beberapa bidang Corporate Governance, dimana padamasing-masing bidang tersebut dilakukan pembobotan. Dalam kuisionerFCGI tersebut, pembobotan dilakukan pada 5 bidang yaitu:

1. Hak-hak Pemegang Saham (20%); 2. Kebijakan Corporate Governance (15%); 3. Praktek-praktek Corporate Governance (30%); 4. Pengungkapan (Disclosure) (20%); dan5. Fungsi Audit (15%)

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Marilah kita lihat hal-hal yang termasuk dalam lingkup masing-masingbidang. Dalam Hak-hak Pemegang Saham, misalnya, kita dapatmemberikan penilaian apakah perusahaan telah:

- Melaksanakan RUPS tahunan dalam jangka waktu 6 bulan sesudah akhirtahun buku sesuai dengan pasal 65 ayat 2 Undang-undang PerseroanTerbatas;

- Menyampaikan kepada Pemegang Saham pemberitahuan mengenaiRUPS tahunan minimal 28 hari sebelum pelaksanaan RUPS tersebut ;

- Memberikan dorongan kepada para Pemegang Saham untuk menghadiriRUPS dan menggunakan hak suaranya;

- Memberikan kesempatan yang memadai bagi Pemegang Saham untukmengajukan pertanyaan pada RUPS;

- Dan seterusnya.

Selanjutnya diberikan penilaian, misalnya nilai 5 untuk setiap jawaban "ya"dan 0 untuk tiap jawaban "tidak". Jadi misalkan dari 10 pertanyaan di bidangHak-hak Pemegang Saham tersebut perusahaan menjawab "ya" sebanyak 6kali dan menjawab "tidak" sebanyak 4 kali maka dalam bidang tersebutperusahaan akan memperoleh skor (6 x 5) + (4 x 0) = 30 (dari nilaimaksimum 50 atau 10 x 5)

Assessment diatas juga dilakukan untuk bidang-bidang lainnya. Misalnya dibidang Kebijakan Corporate Governance, perusahaan dapat menilaisendiri apakah pihaknya telah:

- Memiliki Kode atau Pedoman Corporate Governance secara tertulis, yangsecara jelas menjabarkan hak-hak Pemegang Saham, tugas dantanggung jawab Direksi dan Komisaris;

- Menyediakan akses bagi masyarakat untuk mengetahui kebijakanperusahaan mengenai investor;

- Menentukan organ yang bertanggung jawab (misalnya Komisaris) untukmemastikan bahwa perusahaan mentaati kode Corporate Governance;

- Memiliki Code of Conduct/Ethics bagi karyawannya;

- Aturan perilaku tersebut dikomunikasikan dan diimplementasikan dengan baik;

- Dan seterusnya.

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Dalam bidang Praktek Corporate Governance, dapat diteliti apakah didalam perusahaan:

- Direksi mengadakan pertemuan berkala secara teratur dengan Komisaris;

- Terdapat rencana strategis dan rencana usaha yang memberikan arahanbagi Direksi dan Komisaris dalam menjalankan tugas dan fungsinya;

- Direksi dan Komisaris mendapatkan pelatihan atau mempunyai latarbelakang yang memadai untuk menunjang pelaksanaan pekerjaaanya;

- Para anggota Komisaris maupun Direksi telah bebas dari benturankepentingan (conflict of interests);

- Ada sistem penilaian kinerja untuk Direksi maupun Komisaris;- Dan seterusnya.

Sementara itu dalam bidang Pengungkapan (Disclosure), dapat dinilaiapakah perusahaan telah:

- Menyediakan akses yang sama bagi Pemegang Saham dan analiskeuangan;

- Memberikan penjelasan yang memadai mengenai risiko usaha;

- Mengungkapkan remunerasi/kompensasi Direksi dan Komisaris secaramemadai;

- Mengungkapkan transaksi dengan pihak-pihak yang mempunyaihubungan istimewa;

- Menyajikan hasil kinerja keuangannya dan analisa manajemen melaluiinternet;

- Dan seterusnya.

Dan dalam bidang Audit, dapat dinilai apakah perusahaan telah:

- Mempunyai internal audit yang efektif;

- Diaudit oleh akuntan publik yang independen;

- Memiliki komite audit yang efektif;

- Menciptakan komunikasi yang efektif antara internal audit, external auditdan komite audit;

- Dan seterusnya.

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Selanjutnya, seperti halnya pada bidang hak pemegang saham, padabidang-bidang lainnya pun diberikan skor (misalnya untuk setiap jawaban"ya" diberikan nilai 5 sedangkan untuk setiap jawaban "tidak" diberikan nilai"0"). Dari hasil pemberian skor tersebut, misalnya didapat skor untuk:

- Hak-hak Pemegang Saham = 30 (dari nilai maks 50);- Kebijakan Corporate Governance = 45 (dari nilai maks 60);- Praktek-praktek Corporate Governance = 60 (dari nilai maks 80)- Pengungkapan (Disclosure) = 25 (dari nilai maks 40); dan- Audit = 30 (dari nilai maks 40).

Selanjutnya untuk menentukan skor keseluruhan digunakan metode rata-ratatertimbang (dengan pembobotan seperti dijelaskan di awal tulisan ini).Dengan demikian skor keseluruhan untuk perusahaan tersebut adalah:

{(30/50 x 20%) + (45/60 x 15%) + (60/80 x 30%) + (25/40 x 20%) +(30/40 x 15%)} = 69.5 % atau skor 69.5 dari skor tertinggi 100.

Dengan skor 69.5 tersebut, apakah artinya Corporate Governance diperusahaan tersebut baik atau buruk? Jawabannya relatif, karena tidak adastandar yang menyatakan berapa skor yang baik atau berapa skor yangburuk. Namun ada dua hal yang perlu diperhatikan. Pertama, perusahaanharus berusaha mencapai angka setinggi mungkin. Semakin mendekati 100maka skor Corporate Governance di perusahaan tersebut semakin baik.Kedua, kita harus berhati-hati dalam menggunakan skor CorporateGovernance ini untuk membandingkan antara berbagai perusahaan, apalagikalau karakteristik industrinya berbeda. Perusahaan yang berdasarkankuesioner tersebut skornya 69,5 belum tentu Corporate Governance-nyalebih buruk dibandingkan perusahaan lainnya yang skornya 75, demikianjuga sebaliknya. Dalam beberapa aspek Corporate Governance perusahaandengan skor 75 tersebut mungkin lebih baik dari yang skornya 69,5. Namunmungkin ada beberapa kelebihan Corporate Governance dari perusahaanberskor 69,5 yang tidak terekam secara baik melalui kuisioner tersebut. Halini dikarenakan Corporate Governance sesungguhnya bukanlah suatu halyang absolut yang bisa diukur secara eksak atau pasti dengan suatu alattertentu. Corporate Governance sangat kaya akan dimensi dan belum adaalat yang mampu mengukurnya secara sempurna.

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Perlu disadari bahwa metode penilaian mandiri (self assessment)mempunyai kelebihan dan kekurangan. Kelebihan dari metode ini adalahsederhana; suatu perusahaan dapat dengan mudah menilai sendiribagaimana nilai pelaksanaan Corporate Governance-nya dengan memberiangka kepada setiap bidang kuisioner dan menjumlahkannya. Sedangkankekurangannya adalah assessment yang dilakukan tidak independen karenadilakukan sendiri dan dapat menimbulkan pertanyaan apakah assessmenttelah dilakukan secara obyektif. Akibatnya mungkin timbul keraguan bagipihak di luar perusahaan (bahkan mungkin di dalam perusahaan sendiri)apakah penilaian mandiri tersebut telah dilaksanakan secara obyektif danapakah hasil penilaian mandiri tersebut telah benar-benar mencerminkankondisi Corporate Governance yang sesungguhnya terdapat di perusahaan.

Namun demikian bukan berarti metode penilaian mandiri ini tidak adamanfaatnya. Metode penilaian mandiri tetap besar potensi manfaatnyasepanjang assessment tersebut dikerjakan secara jujur dan obyektif.Sedangkan kegunaan dari penilaian mandiri ini, terutama adalah untukmembantu perusahaan memahami kondisi Corporate Governance-nya,mengidentifikasi bidang-bidang Corporate Governance yang masih lemahdan memperbaiki bidang yang masih lemah tersebut.

Penilaian mandiri tidak dimaksudkan untuk memberi keyakinan kepadamasyarakat mengenai kondisi Corporate Governance-nya suatuperusahaan. Bila tujuan perusahaan adalah untuk memberikan keyakinankepada masyarakat mengenai Corporate Governance-nya, perusahaandapat meminta bantuan pihak yang independen untuk melakukanindependent assessment (seperti sertifikasi mutu pada ISO 9000). Pihakyang independen tersebut dapat berupa lembaga pemeringkat, akuntanpublik, maupun pihak-pihak lainnya yang mempunyai kompetensi di bidangCorporate Governance dan dapat melakukan assessment secara obyektif.Walaupun pada prakteknya ide sertifikasi Corporate Governance ini tidaklahmudah untuk disamakan secara persis dengan sertifikasi mutu pada ISO9000. Sebagai contoh sertifikasi ISO menjamin bahwa produk-produk yangdihasilkan sesuai standar mutu dan konsistensi yang dirumuskan denganbaik, sedangkan sertifikasi Corporate Governance berkaitan dengan sistemdan proses yang nyata di dalam sebuah perusaahaan. Sertifikasi CorporateGovernance berbeda dengan standar-standar ISO yang diakui dan terdaftarpada ISO. Namun yang tak kalah penting adalah juga karena CorporateGovernance, sebagaimana disebutkan di muka, sangat kaya dimensisehingga termasuk di dalam Corporate Governance ini adalah jugapersoalan moral conduct.

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Forum for Corporate Governance in Indonesia (FCGI)Corporate Governance Self Assessment Checklist

Tujuan Kuisioner iniKuisioner ini dibuat oleh Forum for Corporate Governance in Indonesia (FCGI)sebagai alat penilaian mandiri (self-assessment) yang disediakan untukperusahaan-perusahaan di Indonesia guna mengetahui dan menilai kualitastata kelola (governance) masing-masing perusahaan. Maksud dibuatnyakuisioner ini adalah untuk dipergunakan oleh setiap perusahaan tanpa melihatapakah itu badan usaha milik negara, perusahaan yang listed maupun yangbelum listed dipasar modal serta tanpa melihat bidang-bidang industri yangdikelola oleh perusahaan yang bersangkutan. Kuisioner ini dapat diisi secaramanual yaitu dengan mengisi kuisioner terlampir, ataupun secara online yaitumelalui situs FCGI pada www.fcgi.or.id. Kuisioner yang telah diisi hendaknyadapat dikirimkan kembali kepada FCGI, Citra Graha lantai 7 room 703, Jl. Jend.Gatot Subroto 35-36, Jakarta 12950 atau ditujukan kepada: Chris Copper,Gedung PWC, Jl. Rasuna Said Kav. C-3, Jakarta 12920.

Beberapa PembatasanHasil pengisian kuisioner ini hendaknya dapat ditanggapi secara hati-hati. Adabeberapa alasan yang mendasari hal ini: Pertama,Good corporate Governancebukan hanya pertanyaan apakah perusahaan telah memiliki proses yang tepat,akan tetapi lebih dari sekedar itu yaitu apakah proses-proses yangdipersyaratkan tersebut dijalankan secara efektif dalam rangka menciptakanGood Corporate Governance. Oleh karena itu suatu penilaian diperlukan untukmenafsirkan angka yang diperoleh dalam menjawab pertanyaan-pertanyaankuisioner ini, yang sebagian besar jawabannya adalah “ya” atau “tidak”. Kedua,karena kuisioner ini ditujukan untuk setiap perusahaan dalam pengertian yangluas, maka jangkauan pertanyaan-pertanyaannya pun bersifat luas pula.Sehingga pertanyaan-pertanyaan tersebut tidak terlampau mendetil ditujukanpada permasalahan-permasalahan Corporate Governance yang dihadapiperusahaan-perusahaan yang bergerak dalam industri tertentu. Akhirnya,sebagaimana umumnya penilaian mandiri, penilaian dalam mengevaluasikuisioner yang telah diisi sangat tergantung pada pengetahuan, pengalamandan obyektivitas para pihak yang bertanggungjawab untuk mengisi kuisioner ini.

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Hasil PenilaianTabel dibawah ini menujukkan skor dari 5 (lima) kelompok pertanyaan-pertanyaan dalam kuisioner terlampir. Sementara itu pertanyaan-pertanyaandi setiap kelompok memiliki bobot nilai masing-masing. Pengelompokanpertanyaan-pertanyaan tersebut disusun untuk menggambarkan pentingnyabidang-bidang yang dimaksud secara relatif. Dan hasilnya dapatdiperbandingkan dengan nilai rata-rata responden lain yang mengisikuisioner.

Pengelompokan Penilaian Bobot Nilai Rata-rata Tertinggi Rata-rata Tertinggi

1. Hak-hak Pemegang Saham 20%2. Kebijakan Corporate Governance 15%3. Praktek-praktek Corporate Governance 30%4. Pengungkapan (Disclosure) 20%5. Audit 15%

Total Nilai 100%

Perusahaan Survey Keseluruhan Industri (tertentu)

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Hak dan Kewajiban Pemegang Saham: Efektifitas perusahaan dalam melindungi hak-hak semua Pemegang saham, termasuk didalamnya kemampuan perusahaan untukmencegah Pemegang Saham mayoritas mengurangi nilai dan kepentinganPemegang Saham minoritas

1.1 Apakah RUPS tahunan diadakan 6 bulan setelahtahun buku dan sesuai dengan ketentuan Pasal 65 ayat (2) UU Perseroan Terbatas ?

1.2 Apakah semua Pemegang Saham diberi tahu mengenai adanya RUPS tahunan paling sedikit 28 hari sebelumnya ?

1.3 Apakah ada usaha untuk mendorong semua Pemegang Saham agar menghadiri RUPS dan memberikan suaranya dalam RUPS tersebut?

1.4 Apakah ada usaha untuk mendorong semua Pemegang Saham agar menghadiri RUPS Luar biasa?

1.5 Apakah semua Pemegang Saham diberikan hak untukmenempatkan sahamnya pada saat pimpinanperusahaan menambah modal perusahaan kurang dari 5%?

1.6 Nilailah bagaimana informasi keuangan perusahaandisediakan kepada Pemegang Saham untuk membuat keputusan berinventasi, khususnya dalam hal:1. informasi yang tepat dan dapat dipercaya?2. disampaikan tepat waktu?3. diberikan untuk menunjukkan Perbandingan?

Ya(5) Tidak(0)

Ya(5) Tidak(0)

tidakada

ada berusaha dengankeras

Nilai

1 2 3 4 5

tidakada

ada berusahadengankeras

1 2 3 4 5

Ya(5) Tidak(0) T/J(5)

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

sangatrendah rata-rata

sangat tinggi

1.0 Hak-hak Pemegang Saham

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1.9 Apakah Pemegang Saham diberi cukup waktu untukmengajukan pertanyaan di dalam RUPS ?

1.10 Apakah RUPS memutuskan hal-hal berikut ?

- Penunjukan Direksi dan Komisaris ?

- Penilaian kinerja Direksi dan Komisaris ?

- Kompensasi untuk Direksi dan Komisaris ?

- Penujukkan auditor ekstern ?

Total Nilai

Bobot angka (Total Nilai dibagi nilai maksimumyang mungkin diperoleh (85) lalu dikalikan dengan bobot 20%)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

1.7 Nilailah begaimana informasi non-keuangan (mis :informasi tentang Direktur dan Komisaris) disediakan kepada Pemegang Saham, Khususnya dalam hal- informasi yang tepat dan dapat dipercaya ?- disampaikan tepat waktu ?- termasuk informasi non-keuangan yang penting

untuk menjelaskan kinerja perusahaan?

1.8 Apakah Pemegang Saham diberikan kesempatan yang cukup untuk menerima dan memeriksa laporankeuangan sehingga dapat mengajukan pertanyaan yang diagendakan dalam RUPS tahunan?

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

sangat rendah rata-rata

sangattinggi

Ya(5) Tidak(0)

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Struktur dan Pengaturan Direksi dan Komisaris : Kemampuan Komisaris secara independen untuk menilaiKinerja manajemen dan membuat manajemen bertanggung jawab terhadap Pemegang Saham dan paraPihak Pemegang Kepentingan (Stakeholders)

2.1 Apakah perusahaan anda memiliki Pedoman Corporate Governanceyang tertulis dimana di dalamnya mengatur secara rinci hak-hak Pemegang Saham dan tugas Direksi dan Komisaris ?

2.2 Apakah perusahaan anda memiliki Pedoman Corporate Governanceyang tertulis dimana didalamnya dirinci aturan-aturan mengenai penyingkapan (disclosure) ?

2.3 Apakah kebijakan perusahaan mengenai investor publikdapat diperoleh dengan mudah oleh pihak regulator dan masyarakat umum ?

2.2.1 Apabila “Ya” dimanakah diperolehnya ?

2.4 Apakah Komisaris, sejauh itu diperbolehkan bedasarkan hukum secara khusus bertanggung jawab atas jaminan kepatuhan terhadap Pedoman Corporate Governance perusahaan ?

2.5 Apakah perusahaan anda mempunyai pejabat khusus(semacam compliance officer) yang bertugas untuk memastikan bahwa perusahaan sepenuhnya taat pada hukum dan peraturan perundang-undangan yang ada ?

2.6 Apakah perusahaan anda mempunyai Pedoman Etik dan Tingkah Laku (Code of Conduct/Ethics) yang tertulis ?

2.7 Apakah Code of Conduct/Ethics tersebut didistribusikan kepada semua karyawan perusahaan ?

2.8 Apakah Code of Conduct/Ethics tersebut tersedia bagi para Pemegang Saham ?

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Nilai

2.0 Kebijakan Corporate Governance

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2.9 Apakah Code of Conduct/Ethics tersebut mencakup masalah sebagai berikut :

- Standar etika terhadap nasabah, pengecer dan pihak lainnya yang relevan?

- Harapan perusahaan terhadap manajemen dan karyawannya?

- Kerahasian informasi tentang perusahaan lain ?

- Kerahasian tentang karyawannya ?

- Pentingnya kepatuhan terhadap hukum dan peraturan perundangundangan ?

2.10 Apakah semua karyawan dan manejemen perusahaan secara berkala diminta menegaskan secara tertulis bahwa mereka taat pada Code of Conduct/Ethics ?

Total Nilai

Bobot Angka (Total Nilai dibagi angka maksimum yang mungkin diperoleh (70) lalu dikalikan dengan bobot 15%)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

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3.0 Praktek Corporate Governance

3.1 Apakah Direksi secara teratur mengadakan rapat dengan Komisaris ?

3.2 Siapakah yang menyusun strategi bisnis perusahaan,Direksi ataukah Komisaris ?

3.3 Berapa jumlah anggota Direksi ? (0-4 orang=0;5-12 orang=5; lebih dari 12=2)

3.4 Berapa jumlah anggota Komisaris?(0-2 orang=0;3-12 orang=5; lebih dari 12=2)

3.5 Berapa jumlah Direksi dan Komisaris “Independen”*?(tidak ada=0;kurang dari 20%=2; jika 20% atau lebih=5)* Silahkan lampirkan rumusan menurut perusahaan anda tentangapa itu “Independen” pada akhir kuisioner ini.

3.6 Berapa jumlah Direksi yang memiliki kepentingan keuangan*1 dalam jangka pendek - dalam perusahaan ?(lebih dari separuhnya=0 ;kurang dari separuhnya=2 ; tidak ada=5)- atau pada afiliasi perusahaan ? (lebih dari separuhnya=0 ;kurang dari separuhnya=2 ; tidak ada=5)

3.7 Berapa kali setahun Direksi mengadakan rapat formal?(4-11 kali=2 ; 12 kali atau lebih=5)

3.8 Berapa kali dalam setahun Komisaris mengadakan rapat formal? ( 2-6 kali=2 ; 6 kali atau lebih=5)

3.9 Apakah terdapat potensi benturan kepentingan (conflict of interest)antara perusahaan dengan Direksi dan Komisaris?

3.10 Apakah perusahaan memiliki daftar saham yang dimiliki oleh anggota Direksi dan Komisaris?

3.11 Apakah perusahaan memiliki daftar saham yang dimiliki oleh anggota keluarga Direksi dan Komisaris?

3.12 Sejauh sesuai dengan hukum yang berlaku, apakah perusahaanmempunyai kebijakan intern yang tertulis mengenai anggota Direksi dengan kedudukan rangkap sebagai direktur pada perusahaan lain?

3.13 Silakan periksa komite-komite berikut ini (apabila ada) yang secara aktif berfungsi dalam perusahaan anda:

- Komite Audit (untuk mengawasi auditor intern dan ekstern)

- Komite Kompensasi (untuk menilai kompensasi Direksi, Komisaris, dan manajemen)

- Komite Nominasi (untuk menseleksi anggota Direksi dan Komisaris)

- Komite Kepatuhan (untuk memastikan ketaatan perusahaan terhadap hukum dan peraturan perundang-undangan)

- Komite Manajemen Risiko (untuk pengawasan dan manajemen risiko)

- Komite Eksekutif (untuk menilai kembali keputusan manajemen)

- Komite Asuransi (untuk menilai kebijakan asuransi perusahaan)

- Lain-lain (silakan dirinci)

Ya(5) Tidak(0)

Nilai

Komisaris DireksiTidak

keduannya

Komisaris Direksi

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Tidak ada nilai

Tidak ada nilai

5 angka

5 angka

5 angka

5 angka

5 angka

5 angka

5 angka

3.0 Praktek Corporate Governance

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3.14 Apakah ada sistem penilaian kinerja formal untuk Direksi?

3.15 Apakah ada sistem penilaian kerja formal untuk Komisaris?

3.16 Seberapa seringkah penilaian kinerja terhadap Direksi? (Apabila ada, maka nilainya=5)

3.17 Seberapa seringkah penilaian kinerja terhadap Komisaris? (Apabila ada, maka nilainya=5)

3.18 Kapan terjadi perubahan Direksi? (Apabila ada, maka nilainya=5)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

per tahun

per tahun

setiap tahun

3.19 Kapan terjadi perubahan Komisaris ? (Apabila ada, maka nilainya=5) setiap tahun

3.20 Adakah proses pengangkatan internal untuk anggota Direksi ?

3.21 Adakah proses pengangkatan internal untuk anggota Komisaris ?

3.22 Apakah para kandidat tersebut diberi surat pengangkatan tertulis sebagai Komisaris ?

3.23 Apakah para kandidat tersebut diberi surat pengangkatan tertulis sebagai Direksi ?

3.24 Apakah jenis kompensasi yang diberikan kepada Direksi ?

- Gaji (terlepas dari kinerjanya)

- Bonus (yang tergantung dari kinerjanya)

- Stock Options

- Lain-lain (silahkan dirinci)

3.25 Apakah jenis kompensasi yang diberikan kepada Komisaris ?

- Gaji (terlepas dari kinerjanya)

- Bonus (yang tergantung dari kinerjanya)

- Stock options

- Lain-lain (silahkan dirinci)

3.26 Apakah peran, tanggung jawab dan wewenang yang diserahkan kepada Komisaris dan Direksi diuraikan secara jelas ?

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Tidak ada nilai

Ya(5) Tidak(0)

Tidak ada nilai

5 angka

5 angka

5 angka

5 angka

dikurangi (minus) 5 angka

5 angka

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3.27 Apakah Direksi mempunyai prosedur rapat yang efektif (misalnya, agenda rapat dan dokumen-dokumen dibagikan sebelumnya) ?

3.28 Apakah Komisaris mempunyai prosedur rapat yang efektif (misalnya, agenda rapat dandokumen-dokumen dibagikan sebelumnya) ?

3.29 Apakah rapat Direksi dan Komisaris dibuatkan berita acaranya ?

3.30 Seberapa seringkah Direksi memantau hasil bisnis ? (4-11 kali=2 ; 12 kali atau lebih=5)

3.31 Apakah Komisaris memberi masukan kepada Direksi mengenai strategi perusahaan ?

3.32 Apakah Komisaris memberi masukan kepada Direksi mengenai kebijakan perusahaan ?

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

per tahun

Ya(5) Tidak(0)

Ya(5) Tidak(0)

3.33 Apakah Komisaris memberi masukan kepadaDireksi mengenai kinerja perusahaan ?

3.34 Apakah visi dan misi, rencana bisnis dan rencana strategi menjadi tanggung jawab Direksi ?

3.35 Apakah Direksi dan Komisaris mengidentifikasi dan menyeleksi ahli dari luar bila keahlian yang dibutuhkan tidak dimiliki oleh Direksi ataupun staf perusahaan ?

3.36 Apakah anggota Direksi dan Komisaris diberikan pelatihan sebagai suatu pengantar?

3.37 Apakah anggota Direksi dan Komisaris diberikan kesempatan untuk mengikuti pelatihan secara terus menerus?

Total Nilai

Bobot Nilai (Total Nilai dibagi angka maksimum yang mungkin diperoleh (235), kemudian dikalikandengan bobot 30 %)

*1 Kepentingan Keuangan dirumuskan sebagai memiliki saham, warrants, convertible bonds, hutangpada perusahaan, maupun hubungan bisnis, misalnya sebagai pemasok atau nasabah perusahaan

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

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Disclosure: ketelitian dan ketepatan waktu perusahaan menyingkap kedudukan keuangannya. Keadaanperusahaan dan prospek-prospeknya, dan informasi non-keuangan lain, serta kemungkinan investorprospektif memperoleh informasi tersebut.Penyingkapan informasi non-keuangan meliputi susunan kepemi-likan perusahaan, corporate governance dan pedoman etika lainnya, yang seharusnya diketahui umum.

4.1 Apakah perusahaan anda menyediakaninformasi yang sama apakah itu kepada Pemegang Saham maupun analis investasi ?

4.2 Apakah perusahaan menerbitkan laporan keuangan dan analisa manajemennya untuk dibagikan kepada para analis ?

4.3 Apakah perusahaan menempatkan laporan keuangan dan analisa manajemennya di internet ?

4.4 Seberapa seringkah perusahaan menyampaikan uraian kondisi perusahaan kepada para analis ? (jika 1-3 kali=2 ; 4 atau lebih=5)

4.5 Apakah laporan yang dipersiapkan untuk RUPS tahunan hanya berisi informasi secukupnya ataurincian yang lebih dari secukupnya sehingga

memungkinkan analis investasi menilai kinerja keuangan dan kinerja non-keuangan perusahaan anda ?

4.6 Apakah laporan tahunan memberikan gambaran hal-hal berikut ini:

- sistem manajemen risiko

- tujuan dan strategi bisnis

- kepemilikan silang saham perusahaan dan jaminan hutang bersilang

- penilaian manajemen tentang iklim bisnis dan risiko

- nama-nama Komisaris dan Direksi

- besarnya nilai kompensasi Direksi dan Komisaris

- pekerjaan utama lainnya dari Komisaris

- praktek-praktek corporate governance

kl i t t d k k d

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

per tahun

1 2 3 4 5

hanya infosecukupnya

lebih dari rinciansecukupnya

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Nilai

4.0 Penyingkapan (Disclosure) terhadap Kebijakan dan Praktek-praktek tertentu

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- klaim atas aset dan kekayaan dan kasus-kasus di pengadilan

- transaksi para pihak yang berhubungan

- potensi benturan kepentingan yang ada

- kepemilikan saham Komisaris, Direksi, atau anggota keluarganya dalam perusahaan atau perusahaan yangterafiliasi

4.7 Apakah perusahaan menelusuri perubahan-perubahan dalam struktur kepemilikannya, sehingga dengan demikian dapat diketahui setiap blok pemberi suara ?

4.8 Apabila "Ya", dimanakah informasi tersebut dibuka ?

Total Nilai

Bobot Nilai (Total Nilai dibagi angka maksimum yang mungkin diperoleh (90), kemudian dikalikan dengan bobot 20 %)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Tidak ada nilai

Ya(5) Tidak(0)

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5.1 Nilailah kualitas dari:

- Audit Internal

- Komite Audit

- Audit External

5.2 Berapakah anggota Komite Audit perusahaan anda? (2-3 orang=2 ; 4 orang atau lebih=5)

5.3 Berapakah diantaranya adalah anggota"Independen" * ?

(bila ada=2 ; bila mayoritas=5)

5.4 Apakah Komite Audit selalu mengadakanrapat secara teratur?

5.5 Apakah Komite Audit secara teratur melapor kepada Komisaris?

5.6 Apakah Komite Audit secara teratur mengadakan rapat dengan auditor ekstern?

Total Nilai

Bobot Nilai (Total Nilai dibagi angka maksimum yang mungkin diperoleh (40) lalu dikalikan dengan bobot 15%)

*"Independen" dirumuskan sebagai tidakmemiliki kepentingan keuangan dalam perusahaan,atau hubungan yang penting dengan Pemegang Sahamutama, manajemen, pemasok, ataupun nasabah.

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

Ya(5) Tidak(0)

Ya(5) Tidak(0)

Ya(5) Tidak(0)

rendah rata-rata sangat tinggi Nilai

5.0 Audit

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6. Informasi umum untuk mengklasifikasikan perusahaan

Pertanyaan-pertanyaan berikut ini adalah tentang fakta perusahaan anda dan kepemilikannya yang diperlukan untukmengklasifikasi peserta survei ini.Informasi yang anda berikan akan dianggap rahasia, dan tidak akan diumumkan kecuali dengan izin sebelumnya dari anda

Nama Perusahaan :

Nama orang yang mengisi/diberi kuasa untuk mengisi kuisioner :

Kedudukan di dalam perusahaan :

Alamat e-mail anda atau alamat rinci lainnya yang dapat dihubungi :

6.1 Bagaimana aset bersih perusahaan anda pada data laporan neraca (laporan laba rugi) terakhir?- Kurang dari atau sama dengan Rp 200.000.000;- Lebih dari Rp 200.000.000; namun kurang atau

sama dengan 10 milyar Rupiah - Lebih dari 10 milyar Rupiah

6.2 Termasuk ke dalam industri apakah perusahaan anda?- Keuangan (Bank, Asuransi, lembaga keuangan lainnya)

- Manufacturing

- Jasa

- Peralatan/Energi

- Lain-lain (Mohon dirinci:

6.3 Apakah perusahaan anda listed di bursa?

6.4 Dengan memfokuskan Pemegang Saham yang mengendalikan perusahaan anda (bila ada):

6.4.1 Berapa jumlah direktur dalam susunan Direksi yang mewakili kelompok pengendali tersebut ?

6.4.2 Apakah Komisaris Utama dan Direktur Utama, apakah itubergabung ataupun ditunjuk oleh Pemegang Saham pengendali?

)

Ya Tidak

BUMN ?Perusahaan milik keluarga ?Cabang perusahaan multinasional ?

Ya Tidak hanya Direktur Utama

hanya Komisaris Utama T/J

YaYaYa

TidakTidakTidak

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Corporate Governance Self Assessment Checklist

A Self Assessment for Company’s Corporate Governance Practices

Of late Corporate Governance has become a more and more dronedbuzzword. Many people ask, how one can know whether a company hasimplemented well the principles of Corporate Governance. It seems that it isnot difficult for a company to state that they already adhere to the basicprinciples of Corporate Governance, reflecting the principles of transparency,responsibility, accountability, and fairness. However, an evaluation or asystematic assessment must be made to make sure that a company hasalready really implemented Corporate Governance.

For that, there are actually already some tools, which can be used bycompanies for self assessment, to know whether the Corporate Governanceof a company is already well implemented. One of the tools for said selfassessment has been developed by FCGI (Forum for Corporate Governancein Indonesia). This tool is in the form of a set of questionnaires which can becompleted by the companies themselves and furthermore the companiesgive an evaluation or scores objectively towards those replies. (For furtherinformation please look at www.fcgi.or.id or through e-mail to [email protected])

Through mentioned questionnaire companies can make an evaluation orassessment at some sections of Corporate Governance, where at saidrespective sections has been put weight. In mentioned FCGI questionnaire,weight has been put at 5 sections, being:

1. Shareholders rights (20%)2. Corporate Governance policy (15%)3. Corporate Governance practices (30%)4. Disclosure (20%)5. Audit (15%)

Let us see at the samples of items that are included in the scope of therespective sections. In the shareholders rights, for instance, we can give anevaluation, whether the company:

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- has held the Annual General Meeting of Shareholders (GmoS) within theperiod of 6 months after the accounting year end, in accordance withchapter 65 paragraph 2 of the Indonesian company law (UUPT);

- has submitted to the shareholders the notification regarding the Annual Meeting of Shareholders at least 28 days before GMoS is held;

- has encouraged the shareholders to attend GMoS and to make use oftheir voting rights;

- has given enough opportunity to the shareholders to put questions atGmoS;

- Etc.

Furthermore give scorings, for instance 5 points for each answer "yes" and 0points for answer "No". So for instance of the 10 questions in the section ofsaid shareholders rights, the company is answering 6 times "yes" andanswering 4 times "no", for this section the company will obtain the score of(6 X 5) + (4 X 0) = 30 (of the maximum score of 50 or 10 X 5).

Above said assessment is also to be done for other sections. For instance inthe sector of Corporate Governance policy, the company can appraisethemselves whether they:

- have a written code of corporate governance wherein clearly explains therights of the shareholders, the duties and responsibility of the Board ofDirectors and Board of Commissioners;

- make available access for the public to know the company’s policyregarding public investors;

- have set up an organ responsible (for instance the Board ofCommissioners) to ascertain that the company adheres to the code ofCorporate Governance;

- have a written code of conduct/ethics for the employees;

- have a written code of conduct/ethics informed and implemented well

- Etc.

In the section of Corporate Governance practices, can be examined whetherin the company:

- the Board of Directors is holding periodical meetings regularly with theBoard of Commissioners;

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- exists a strategic plan and an operational plan giving guidance to theBoard of Directors and the Board of Commissioners to execute their taskand function;

- the Board of Directors and the Board of Commissioners have been giventraining or have a proper background enabling them to do theirassignments;

- the members of the Board of Commissioners and of the Board of Directorsare disengaged of conflict of interests;

- is there a performance appraisal system for the Board of Directors as wellas for the Board of Commissioners;

- Etc.

In the section Policy and disclosure practices can be appraised whetherthe company:

- has made available the same access for the shareholders and financialanalysts;

- has given proper explanations about business risks;

- has properly disclosed the remuneration to the Board of Directors and the Board of Commissioners;

- has disclosed the related party transactions;

- has presented the results of the financial performance and themanagement’s analysis through the internet;

- Etc.

In the Audit section, can be appraised whether the company already:

- has an effective internal audit

- has been audited by an independent public accountant

- has an effective audit committee

- has developed an effective communication between the internal audit, the external audit and the audit committee

- Etc.

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Furthermore, like in the section of the rights of the shareholders, in the othersections also can given scores (for instance for each answer "yes" a score of5 is given, while for each answer "no" a score of 0 is given). From the resultsof these scorings, is for instance obtained a score for the rights ofshareholders = 30 (of a maximum score of 50), Corporate Governancepolicy = 45 (of a maximum score of 60), Corporate Governance practices= 60 (of a maximum score of 80), disclosure practices = 25 (of a maximumscore of 40), audit =30 (of a maximum score of 40). Furthermore to determinethe total score the weighted average method is used (with the weights asexplained at the beginning of this article). Herewith the total score for saidcompany is:

{(30/50 X 20%) + (45/60 X 15 %) + (60/80 X 30%) + (25/40 X 20%) + (30/40X 15%)} = 69,5% or score 69,5 of the highest score 100.

With this score of 69,5, does this mean that the Corporate Governance ofsaid company is good or bad? The answer is relative, because there is nostandard stating what score is good or what score is bad. However, there aretwo things which must be paid attention to. First, the company has to try toreach the highest score as possible. Second, we have to be cautious in usingthis Corporate Governance score, in comparing several companies,especially if the characteristics of industry are different. If a company, basedon the questionnaire is scoring 69,5 the Corporate Governance is not said tobe worse in comparison with another company scoring 75, and also the otherway round. In some aspects the Corporate Governance of a company withsaid score of 75, is maybe better than that with a score of 69,5. But there aremaybe some strong points of the Corporate Governance of the company withthe 69,5 score, which are not recorded well through said questionnaire. Thatis because Corporate Governance is actually not something absolute whichcan be measured exactly or with certainty by using a special tool. CorporateGovernance has many dimensions and there is no tool yet able to measureit perfectly.

We have to be aware that the self assessment method has strong as well asweak points. The strong point of the self assessment method is simple; acompany can easily appraise on its own what grade the implementation ofcorporate governance is, by giving points to each section of the questionnaireand cast it up. While the weak point is that the assessment is not doneindependently as it is done on its own, and can raise questions whether the

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assessment is done objectively. As a result it may raise questions fromoutside the company (even from inside the company itself) whether this selfassessment is done objectively and whether the result of this self assessmentreally reflects the real Corporate Governance condition of the company.

Nevertheless this does not mean that this self assessment has no benefit.The potential for benefit of this self assessment is still great, as long as theassessment is done fairly and objectively. While the use of the result of thisself assessment, especially is to help the company to understand itsCorporate Governance condition, to identify the still weak sections of theCorporate Governance and to better the still weak sections.

The self assessment is not meant to convince the public about the company’sCorporate Governance condition. If the company’s aim is to convince thepublic about its Corporate Governance, the company can ask for anindependent party to do this assessment (like quality certifications at ISO9000). Mentioned independent party can be a government institution, apublic accountant, as well as other parties having competition in theCorporate Governance sector and can do assessments objectively. Giventhat the most recognized international certification is the InternationalStandards Organization (ISO9000) certification, parallels are often drawnbetween corporate governance certification and ISO certification. However,there are differences between ISO certification and Corporate Governancecertification; ISO certification assures that products are produced by meetingwell-defined standards of quality and consistency, Corporate Governancecertification is of the tangible systems and processes within a company,certification is against the recognized ISO standards and certification isprovided by authorized parties registered with ISO. Therefore, it is not fair todraw parallels between corporate governance certification and ISOcertification.

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Forum for Corporate Governance in Indonesia (FCGI) Corporate Governance Self Assessment Checklist

Purpose of this questionnaire

This questionnaire has been developed by the Forum for CorporateGovernance in Indonesia (FCGI) as a self assessment tool for Indonesiancompanies to review and evaluate the quality of their governance practices. It isintended that this questionnaire can be used by any company, regardless ofwhether they are a state owned entity, a listed company or a private company,and regardless of the industry in which the company operates.The questionnaire can be completed manually, using the attachedquestionnaire, or on-line by visiting the FCGI website at: www.fcgi.or.id . Completed questionnaires should be returned to FCGI, Citra Graha Floor 7Room 703, Jl. Jend. Gatot Subroto 35-36, Jakarta 12950, or care of: ChrisCooper, Gedung PwC, Jl. Rasuna Said, Kav C-3, Jakarta 12920.

Limitations

The results of this questionnaire should be treated with caution. Goodcorporate governance is not only a question of having appropriate procces inplace in the company, those processes must also be operating effectively for thesake of good governance. Judgement is therefore required in interpreting thescore that is achieved when answering the questions in the survey, whichlargely require "yes" or "no" answers. Secondly, because the questionnaire isintended to cover a broad range of companies, it is necessarily wide in itsscope, and it does not necessarily address all possible issues of corporategovernance that should be considered by companies in particular industrygroups and / or regulatory regimes. Finally, as with any self-assessment system,the quality of the evaluation depends greatly on the knowledge, experience andobjectivity of the person or people responsible for completing the questionnaire.

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Results

The table below shows the summary scores from the 5 separate sections of theattached questionnaire. While all questions in each section have scoredequally, the sections themselves have been weighted to reflect the relativeimportance of each area. The results can be compared with the average scoresof other participants in the survey.

[Relevant] indusrtyWhole survey

Summary Scores Weightings Score Average Top Average Top

1. Shareholder rights 20%2. Corporate governance policy 15%3. Corporate governance practices 30%4. Disclosure 20%5. Audit 15%

Total score 100%

Company

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Shareholder Rights and Responsibilities: the effectiveness of the company inprotecting the rights of all of its shareholders, including its ability to preventmajority shareholders from diluting the value and interests of minority shareholders

1.1 Is the annual meeting of shareholders conducted within 6 months after the accounting year end in accordance with the regulation chapter 65 (2) of the company law ?

1.2 Are all shareholders given at least 28 days notice of the annual shareholders' meeting ?

1.3 Are efforts made to encourage all shareholders to attend and vote during the annual shareholder meeting ?

1.4 Are efforts made to encourage other shareholders to attend and vote during special shareholder meetings?

1.5 Are all shareholders given the right to subscribe when the company's Board increases its share capital by less than 5%?

1.6 Please rate the way financial information is providedto all shareholders to assist investment decisions,especially in terms of:

1. reliable and accurate information?2. transmitted on time?3. presented to show comparisons?

1.7 Please rate the way non-financial information (e.g. Information on the Directors and Commissioners) is provided to all shareholders, especially in terms of:- reliable and accurate information?- transmitted on time?- includes important non-financial information to

explain performance?

Yes(5) No(0)

Yes(5) No(0)

no effort Indifferent extra effort

Score

1 2 3 4 5

no effort Indifferent extra effort

1 2 3 4 5

Yes(5) No(0) N/A(5)

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

VeryLow Average

VeryHigh

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

VeryLow Average

VeryHigh

1.0 Shareholder Rights

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1.8 Is there adequate opportunity for shareholders to receive and review the financial reports in order to ask for questions to be put on the Agenda at the annual shareholders' meeting? Yes(5) No(0)

1.9 Is there adequate time given during the annualshareholders' meeting for shareholders to ask questions ?

1.10 Does the annual meeting of shareholders decide the following items ?

- appointment of BoC and BoD ?

- evaluation of BoC and BoD performance?

- compensation of BoD and BoC?

- appointment of external auditors?

Total score

Weighted score (total score divided bymaximum possible score (85) then multiplied by weighting of 20%)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

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Board Structure and Governance: the ability of the Board of Commissioners to provideindependent oversight of management performance and hold management accountable toshareholders and other relevant stakeholders

2.1 Does your company have a written code of corporate governance wherein the rights of shareholders, duties of the Boards are specified?

2.2 Does your company have a written code of corporate governance wherein the rules of disclosure are specified?

2.3 Are the policies of the company regarding public investors easily available to the regulators and to the public?

2.2.1 If so where are they available?

2.4 Is the Board of Commissioners, to the extentpermissible under the law, specifically made responsible for ensuring adherence to the code of corporate governance ?

2.5 Does the company have a compliance officer whose task it is to ensure full compliance of the company with existing laws and regulations ?

2.6 Does the company have a written code of conduct / ethics ?

2.7 Is the code of conduct distributed to all employees ?

2.8 Is the code of conduct available to shareholders ?

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Score

2.0 Corporate Governance Policy

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2.8 Is the code of conduct available to shareholders ?

2.9 Does the code of conduct take into account the following issues?

- ethical standards in dealing with customers, vendors and other relevant parties?

- company expectations of management and employees?

- the privacy of information about outsider companies?

- the privacy of information about employees?

- the importance of compliance with laws and regulations?

2.10 Are all employees required to confirm periodically in writing that they have complied with the code of conduct

Total score

Weighted score (total score divided by maximumpossible score (70) then multiplied by weighting of 15%)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

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3.0 Corporate Governance Practices

3.1 Does the BoD have regular meetings with the BoC?

3.2 Who sets the corporate business strategy of the company, the BoC or BoD?

3.3 How many members sit on the BoD? (0-4=0 points; 5-12=5 points;over 12=2 points)

3.4 How many members sit on the BoC? (0-2=0 points; 3-12=5 points;over 12=2 points)

3.5 How many members of the BoC and BoD are independent Commissioners or Directors*? (if none=0 points; if less than 20%=2 points; if 20% or more=5 points)* Please attach your company's definitionof "independent" to the end of this questionnaire

3.6 How many members of the BoC have a short term financial interest *1 - in the company (if more than half=0 points; less than half= 2 points; none=5 points)- or its affiliates? (if more than half=0 points; less than half= 2 points; none=5 points)

3.7 How many times a year does the BoD conduct formal meetings? (if 4-11=2 points; if 12 or more=5 points)

3.8 How many times a year does the BoC conduct formal meetings? (if 2-6=2 points; if 6 or more=5 points)

3.9 Are there any potential conflicts of interest between the company and the members of its BoC or BoD?

Yes(5) No(0)

Score

BoC BoD Both

BoC BoD

Yes(5) No(0)

Not scored

3.0 Corporate Governance Practices

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3.10 Does the company have a list of the shares owned by the members of the BoD and BoC?

3.11 Does the company have a list of the shares owned by the families of the members of the BoD and BoC?

3.12 Consistent with the prevailing laws does the company have an internal written policy regarding BoD members having concurrent positions as directors in other companies?

3.13 Check which of these committees (if any) are actively functioning in your company:

- Audit Committee (for supervising the external and internal auditors)

- Compensation Committee (for reviewing BoC, BoD & managementcompensation)

- Nomination Committee (for selecting BoD and BoC members)

- Compliance Committee (for adherence to laws and regulations)

- Risk Management Committee (for control and management of risk)

- Executive Committee (for reviewing management decisions)

- Insurance Committee (for reviewing the insurance policies of the company)

- Other (please specify)

3.14 Is there a formal performance appraisal system for the BoD?

3.15 Is there a formal performance appraisal system for the BoC?

3.16 How often is the performance appraisal review of the BoD? (if any=5 points)

3.17 How often is the performance appraisal review of the BoC? (if any=5 points)

3.18 When is the timing of changes to the BoD? (if any=5 points)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

per year

per year

Not scored

every years

5 points

5 points

5 points

5 points

5 points

5 points

5 points

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3.19 When is the timing of changes to the BoC? (if any=5 points) every ____ years

3.20 Is there an internal nomination process for the BoC?

3.21 Is there an internal nomination process for the BoD?

3.22 Are candidates given a written appointment letter as Commissioners?

3.23 Are candidates given a written appointment letter as Directors?

3.24 What are the types of compensation given to Directors?

- Salary independent of performance

- Bonus dependent on performance

- Stock options

- Other (pls specify)

3.25 What are the types of compensation given to Commissioners?

- Salary Independent of performance

- Bonus dependent on performance

- Stock options

- Other (pls specify)

3.26 Are the roles, responsibilities and delegated authority of the BoC and BoD clearly spelled out in writing?

3.27 Does the BoD have effective meeting procedures (for example, are meeting agendas and board papers distributed in advance)?

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Not Scored

Yes(5) No(0)

Yes(5) No(0)

Not Scored

5 points

5 points

5 points

5 points

negative 5 points

5 points

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3.35 Do the BoD and BoC identify and select external specialists when needed expertise is notpossessed by existing directors or staff?

3.36 Are members of the BoD and BoC givenintroduction training?

3.37 Are members of the BoC and BoD provided with the opportunity of ongoingtraining

Total Score

Weighted score (total score divided by maximum possible score (235) then multipliedby weighting of 30%)

*1 Financial interest is defined as owning shares, warrants, convertible bonds or debt to the companyas well as any business relationship such as a supplier orcustomer of the company

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

3.28 Does the BoC have effective meeting procedures (for example, are meeting agendas and board papers distributed in advance)?

3.29 Are the BoD and BoC meetings minuted?

3.30 How often does the BoD actively monitor the results of the business? (if 4-11 points =2 ; if 12 or more =5 points)

3.31 Does the BoC give input to the BoD on matters of strategy?

3.32 Does the BoC give input to the BoD on matters of policy?

3.33 Does the BoC give input to the BoD on matters concerning company performance?

Yes(5) No(0)

Yes(5) No(0)

per year

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

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Disclosure: the accuracy and timeliness with which the company discloses its financial position, condition and prospects, andother non financial information, and also the ability of existing and prospective investors to access this information.Disclosure of non financial matters, includes such matters as the company’s ownership structure, corporate governance andethics guidelines, which should be a matter of public record.

4.1 Does your company provide shareholders and investment analysts equal access to information?

4.2 Does the company publish its financial results and management analysis for distribution to analysts?

4.3 Does the company post its financial results and management analysis on the internet?

4.4 How frequently does the company conductanalyst briefings?

(If 1-3 times=2 points; 4 or more=5 points)

4.5 Do the reports prepared for the annual shareholders meeting contain only basic information of sufficient details to enable investment analysts to assess the financial and non-financial performance of the corporation?

4.6 Does the annual report describe the following:

- risk management systems

- business goals and strategies

- cross-shareholdings and cross debt guarantees

- management assessment of business climate and risks

- names of Commissioners and Directors

- Commissioners and Directors compensation rates

- principal external jobs held by the Commissioners

- corporate governance practices of the company

- material claims and court cases

- related party transactions

- existing and potential conflicts of interest

- shareholding of Commissioners, Directorsor their family members in the company orits related companies

Yes(5) No(0)

per year

1 2 3 4 5

only basic info

more than sufficient detail

Yes(5) No(0)

Score

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

4.0 Disclosure Policies and Practices

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4.7 Does the company track changes in its ownership structure so that any and all voting blocks are known ?

4.8 If so, where is this information disclosed?

Total Score

Weighted score (total score divided by maximum possible score (90) then multipliedby weighting of 20%)

Yes(5) No(0)

Not scored

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5.0 Audit

5.1 Please rate the quality of:

- Internal Audit

- Audit Committee

- External Audit

5.2 How many members does your Audit Committee have? (if 2-3=2 points; 4 or more=5 points)

5.3 How many of these members areindependent * ?

(if any=2 points; if majority=5 points)

5.4 Does the Audit Committee have regular meetings?

5.5 Does the Audit Committee report regularly to the BoC?

5.6 Does the Audit Committee have regular meetings with the externalauditors?

Total Score

Weighted score (total score divided by maximum possible score (40) then multipliedby weighting of 15%)

*”independence” is defined here as having no financial interest in the company or significantrelationships with major shareholders, management, suppliers or customers

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

Yes(5) No(0)

Yes(5) No(0)

Yes(5) No(0)

ScoreVery low Average Very High

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6. General Information for Classification of the Company

The following questions are facts about your corporation and its ownership that are required to classify the respondentsin the survey.The information which you provide will be held confidentially, and will not be disclosed without prior permission from you.

Name of the company :

Name of person who completed/ authorised this questionnaire:

Position in the company:

Your e-mail address or other contact details:

6.1 What is the net assets of your corporation at the latest balance sheet date?Less than or equal to 200,000,000 RupiahMore than 200,000,000, less or equal to 10 trillion Rupiah More than 10 trillion Rupiah

6.2 What industry does your corporation belong to?Financial (Bank, Insurance, Other Financial Institution)ManufacturingServicesUtility/Energy

Other (Please specify:_____________________________)

6.3 Is your company: a listed company?

6.4 Please focus on the present controlling shareholders of your corporation (if any):

6.4.1 How many directors in the Board represent this controlling group?

6.4.2 Are the Chairman of the Commissioners and the President Director either affiliated with or appointed by the controlling shareholders?

Yes No

State Owned Enterprise ?Family controlled company ?Subsidiary of Multinational company?

YesYesYes

Yes No CEO only Chairman only NA

NoNoNo

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Penerbitan Booklet ini dimungkinkan berkat dukungan penuh dariThis publication is made possible through the support of:

1. AAJ Integrasi2. Akzo Nobel3. Cipta Niaga, PT. (Persero)4. Damen Shipyards5. Danareksa, PT. (Persero)6. Delft Instruments7. Elnusa Pan Pacific8. ING Barings9. Insight Consulting10. Inti, PT. (Persero)11. Integrasi Software, PT.12. KPMG Accountants NV13. Kustodian Sentral Efek Indonesia, PT.14. Matahari Putra Prima Tbk., PT.15. Ministry of Foreign Affairs of the Netherlands16. Mitra Investdana Sekurindo, PT.17. P&O Nedlloyd18. PricewaterhouseCoopers19. Rabobank

20. Salim Indoplantations, PT.21. Shell Nederland BV22. Unilever

23. VNO-NCW24. Partnership for Governance Reform in Indonesia25. Harian Umum REPUBLIKA

Tulisan-tulisan FCGI mengenai Corporate Governance terbit setiap bulan padasuplemen “PROBIS” di Harian REPUBLIKA

FCGI Articles on Corporate Governance is published monthly in the “PROBIS”supplement of REPUBLIKA Newspaper

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