2015-01-09

Regulation of the Head of the Commodity Futures Trading Regulatory Agency Number 19/BAPPEBTI/PER-SRG/01/2015 on Requirements and Procedures for Obtaining Approval as a Conformity Assessment Body in the Warehouse Receipt System

The Head of the Commodity Futures Trading Regulatory Agency (Bappebti) issued Regulation No. 19/BAPPEBTI/PER-SRG/01/2015 to establish the requirements and procedures for entities to obtain approval as Conformity Assessment Bodies within the Warehouse Receipt System. This regulation mandates that only approved bodies, such as inspection agencies, laboratories, and quality management certification bodies, may conduct conformity assessments, subject to specific general and technical accreditation or recommendation criteria. It further details the application process, required documentation, approval validity, and mandatory reporting obligations for any changes to the body's name, address, or management structure.

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Regulation of the Head of the Commodity Futures Trading Regulatory Agency

Number: 19/BAPPEBTI/PER-SRG/01/2015

2

  1. Presidential Regulation Number 47 of 2009 concerning the Formation and Organization of State Ministries, as amended several times, lastly with Presidential Regulation Number 13 of 2014 (State Gazette of the Republic of Indonesia Year 2014 Number 24);
  2. Presidential Regulation Number 24 of 2010 concerning the Position, Duties, and Functions of State Ministries as well as the Structure of Organizations, Duties, and Functions of Echelon I Ministries, as amended several times, lastly with Presidential Regulation Number 14 of 2014;
  3. Presidential Decree Number 69/M of 2013 concerning the Appointment of Echelon I Officials within the Ministry of Trade;
  4. Presidential Decree Number 121/P of 2014 concerning the Formation of Ministries and Appointment of Ministers of the Working Cabinet for the 2014-2019 Period;
  5. Minister of Trade Regulation Number 31/M-DAG/PER/7/2010 concerning the Organization and Working Structure of the Ministry of Trade, as amended by Minister of Trade Regulation Number 57/M-DAG/PER/10/2012;

DECREES: Determining: REGULATION OF THE HEAD OF THE COMMODITY FUTURES TRADING REGULATORY AGENCY CONCERNING REQUIREMENTS AND PROCEDURES FOR OBTAINING APPROVAL AS A CONFORMITY ASSESSMENT BODY IN THE WAREHOUSE RECEIPT SYSTEM.

Article 1 Approval as a Conformity Assessment Body in the Warehouse Receipt System may only be granted after meeting the provisions of Law Number 9 of 2006 concerning the Warehouse Receipt System, as amended by Law Number 9 of 2011, Government Regulation Number 36 of 2007 concerning the Implementation of Law Number 9 of 2006 concerning the Warehouse Receipt System, as amended by Government Regulation Number 70 of 2013, and this Regulation of the Head of the Commodity Futures Trading Regulatory Agency (Bappebti).

Article 2 (1) Conformity assessment activities in the Warehouse Receipt System may only be conducted by Conformity Assessment Bodies that have obtained approval from Bappebti. (2) Conformity Assessment Bodies as referred to in paragraph (1) include:

Regulation of the Head of the Commodity Futures Trading Regulatory Agency

Number: 19/BAPPEBTI/PER-SRG/01/2015 3

a. inspection agencies that issue Certificates for Warehouses; b. laboratories that issue test results in the form of Certificates of Goods Quality Test Results; and c. Quality Management System Certification Bodies that issue Quality Management Certificates.

Article 3 (1) Approval as referred to in Article 2 paragraph (1) may only be granted to Conformity Assessment Bodies that meet general requirements and technical requirements. (2) General requirements as referred to in paragraph (1) include: a. having at least 1 (one) year of experience in conformity assessment; b. having competent human resources to conduct conformity assessment; and c. having equipment used to support conformity assessment activities. (3) Technical requirements as referred to in paragraph (1), specifically for inspection agencies that issue Certificates for Warehouses and Quality Management System Certification Bodies that issue Quality Management Certificates, must possess an Accreditation Certificate from the National Accreditation Committee. (4) Technical requirements as referred to in paragraph (1), specifically for laboratories that issue test results in the form of Certificates of Goods Quality Test Results, must possess an Accreditation Certificate from the National Accreditation Committee or a recommendation letter from the Directorate of Goods Quality Development of the Ministry of Trade. (5) Recommendation letters as referred to in paragraph (4) may only be obtained by laboratories that issue test results in the form of Certificates of Goods Quality Test Results that meet the following requirements: a. having relevant equipment to be used in conducting conformity assessment; b. having competent personnel to conduct conformity assessment and sampling; c. having testing methods; d. having quality assurance of test results; e. having proof of measurement traceability (equipment calibration);

Regulation of the Head of the Commodity Futures Trading Regulatory Agency

Number: 19/BAPPEBTI/PER-SRG/01/2015 4

f. being able to handle tested goods; and g. being able to provide accurate, clear, and objective test result reports in accordance with specific instructions in the testing method.

Article 4 Applications to obtain Approval as a Conformity Assessment Body as referred to in Article 2 paragraph (1) must be submitted to the Head of Bappebti by referring to Form Number SRG-LPK07 and attaching documents as required in Attachment 1 of Form Number SRG-LPK07.

Article 5 (1) Bappebti conducts research on the authenticity of documents against the originals and assesses the required documents. (2) At the latest 45 (forty-five) working days after the completion of the assessment of requirement completeness as referred to in paragraph (1), Bappebti grants Approval or Rejection of the application. (3) Bappebti grants Approval as a Conformity Assessment Body using Form Number SRG-LPK08. (4) Bappebti conveys rejection of the Approval application as a Conformity Assessment Body using Form Number SRG-LPK09.

Article 6 (1) Changes to the name and/or address of the Conformity Assessment Body must be reported to the Head of Bappebti at the latest 5 (five) working days after the change, by referring to Form Number SRG-LPK10 and attaching documents as required in Attachment 1 of Form Number SRG-LPK10. (2) Changes to the Board of Directors and/or Directors of the Conformity Assessment Body must be reported to the Head of Bappebti by referring to Form Number SRG-LPK11 and attaching documents as required in Attachment 1 of Form Number SRG-LPK11.

Article 7 Changes to the scope of conformity assessment by the Conformity Assessment Body must be reported to the Head of Bappebti at the latest 5 (five) working days after the change occurs.

APPENDIX REGULATION OF THE HEAD OF THE COMMODITY FUTURES TRADING REGULATORY AGENCY NUMBER: 19/BAPPEBTI/PER-SRG/01/2015 CONCERNING REQUIREMENTS AND PROCEDURES FOR OBTAINING APPROVAL AS A CONFORMITY ASSESSMENT BODY IN THE WAREHOUSE RECEIPT SYSTEM

FORM NUMBER SRG-LPK07: Application for Approval as a Conformity Assessment Body in the Warehouse Receipt System ATTACHMENT 1 FROM FORM NUMBER SRG-LPK07: List of Document Completeness in the Framework of Application for Approval as a Conformity Assessment Body in the Warehouse Receipt System ATTACHMENT 2 FROM FORM NUMBER SRG-LPK07: Application Form for Approval as a Conformity Assessment Body in the Warehouse Receipt System

FORM NUMBER SRG-LPK08: Decision of the Head of the Commodity Futures Trading Regulatory Agency concerning Approval as a Conformity Assessment Body for Warehouse Inspection/Goods Quality Testing/Management Certification in the Warehouse Receipt System

FORM NUMBER SRG-LPK09: Rejection of Application for Approval as a Conformity Assessment Body in the Warehouse Receipt System

FORM NUMBER SRG-LPK10: Application for Change of Name and/or Address of Conformity Assessment Body in the Warehouse Receipt System ATTACHMENT 1 FROM FORM NUMBER SRG-LPK10: List of Document Completeness in the Framework of Change of Name and/or Address of Conformity Assessment Body in the Warehouse Receipt System ATTACHMENT 2 FROM FORM NUMBER SRG-LPK10: Application Form for Report of Change of Name and/or Address of Conformity Assessment Body

FORM NUMBER SRG-LPK11: Report of Change of Management of Conformity Assessment Body in the Warehouse Receipt System ATTACHMENT 1 FROM FORM NUMBER SRG-LPK11: List of Document Completeness for Report of Change of Management of Conformity Assessment Body in the Warehouse Receipt System ATTACHMENT 2 FROM FORM NUMBER SRG-LPK11: Application Form for Report in the Framework of Change of Management of Conformity Assessment Body

Appendix to the Regulation of the Head of the Commodity Futures Trading Regulatory Agency Number: 19/BAPPEBTI/PER-SRG/01/2015 1

FORM NUMBER: SRG-LPK07 (company/institution letterhead) Number: ...............,.......................20... Attachment: Subject: Application for Approval as Conformity Assessment Body in the Warehouse Receipt System. To: The Head of the Commodity Futures Trading Regulatory Agency at J A K A R T A

Hereby, we, the undersigned, as the ....................................... (position) (company/institution name) ……………................ submit an application to obtain Approval as a Conformity Assessment Body in the Warehouse Receipt System which will carry out activities as: an inspection agency issuing Certificates for Warehouses / a laboratory issuing test results in the form of Certificates of Goods Quality Test Results / a Quality Management System Certification Body issuing Quality Management Certificates.*)

As consideration material, we attach the following supporting documents:

  1. List of Document Completeness in the Framework of Application for Approval as a Conformity Assessment Body in the Warehouse Receipt System (Attachment 1 from Form Number SRG-LPK07);
  2. Application Form for Approval as a Conformity Assessment Body in the Warehouse Receipt System (Attachment 2 from Form Number SRG-LPK07).

This application is submitted, and we thank you for your attention. ..........................................,20...... Applicant, (Clear Name) .................................................. (Position) *) choose one

Appendix to the Regulation of the Head of the Commodity Futures Trading Regulatory Agency Number: 19/BAPPEBTI/PER-SRG/01/2015 2

ATTACHMENT 1 FROM FORM NUMBER: SRG-LPK07 LIST OF DOCUMENT COMPLETENESS IN THE FRAMEWORK OF APPLICATION FOR APPROVAL AS A CONFORMITY ASSESSMENT BODY IN THE WAREHOUSE RECEIPT SYSTEM

No. Document Yes No

  1. Photocopy of legal documents of the Company/Institution (Photocopy of establishment deed, Limited Liability Company/State-Owned Enterprise/Regional-Owned Enterprise/Cooperative/Other Institution* including amendments that have been notarized by the competent official, or Establishment Decree including amendments*)
  2. Company/Institution Profile containing at least vision and mission, business description, capital structure (equity), head office and branch office addresses, list of profiles of directors/board members and commissioners/supervisors, and services provided.
  3. Photocopy of Taxpayer Identification Number (Limited Liability Company/State-Owned Enterprise/Regional-Owned Enterprise/Cooperative/Other Institution*)
  4. Photocopy of accreditation certificate including the scope of accreditation as a Conformity Assessment Body from the National Accreditation Committee**), or Recommendation Letter from the Directorate of Goods Quality Development – Ministry of Trade after receiving mentoring for 1 (one) year or having experience in Goods quality assessment for more than 1 (one) year.***)
  5. Organizational Structure and List of Personnel of the Conformity Assessment Body (In the case of application submission as a testing laboratory, must have at least 1 (one) sample collector and 1 (one) goods quality tester).
  6. List of equipment used to support the scope of conformity assessment activities.
  7. Photocopy of competency-based training certificates in the field of Goods Quality Testing/Quality Management/Warehouse Inspection*) issued by competent institutions.
  8. Quality Manual, Work Procedures, and Work Instructions which at least cover:***) a. personnel; b. testing methods; c. equipment; d. measurement traceability (calibration); e. handling of tested Goods; f. quality assurance of test results; and g. reporting of test results.
  9. Example format of Conformity Assessment Certificate. *) Choose one **) For Warehouse Inspection Bodies and Quality Management System Certification Bodies, as well as Testing Laboratories that already have accreditation from the National Accreditation Committee. ***) specifically for Conformity Assessment Bodies as testing laboratories that do not yet have accreditation from the National Accreditation Committee.

Appendix to the Regulation of the Head of the Commodity Futures Trading Regulatory Agency Number: 19/BAPPEBTI/PER-SRG/01/2015 3

ATTACHMENT 2 FROM FORM NUMBER: SRG-LPK07 APPLICATION FORM FOR APPROVAL AS A CONFORMITY ASSESSMENT BODY IN THE WAREHOUSE RECEIPT SYSTEM

  1. Applicant Name : ................................................................................
  2. Identity Number : ................................................................................ (ID Card/Passport*)
  3. Applicant Position : ................................................................................
  4. Applicant Address : ................................................................................ ................................................................................ (Street Name & Number) .............................................. (City & Postal Code) .....................................................
  5. Company/Institution Name : .................................................................................
  6. Company/Institution Address : ................................................................................ ................................................................................ (Street Name & Number) .............................................. (City & Postal Code) .....................................................
  7. Telephone Number, e-mail : .................................................................................. and Fax .................................................................................
  8. Scope of Assessment : ................................................................................. Existing Conformity .................................................................................

..........................................,20...... Applicant, (Company Stamp) (Clear Name) ............................................... (Head/CEO*) *) Choose one

Appendix to the Regulation of the Head of the Commodity Futures Trading Regulatory Agency Number: 19/BAPPEBTI/PER-SRG/01/2015 4

FORM NUMBER: SRG-LPK08 DECISION OF THE HEAD OF THE COMMODITY FUTURES TRADING REGULATORY AGENCY NUMBER ....................... CONCERNING APPROVAL AS A CONFORMITY ASSESSMENT BODY FOR WAREHOUSE INSPECTION/GOODS QUALITY TESTING/MANAGEMENT QUALITY CERTIFICATION IN THE WAREHOUSE RECEIPT SYSTEM*) TO ……………………………. THE HEAD OF THE COMMODITY FUTURES TRADING REGULATORY AGENCY, Reading : Application Letter for Approval as a Conformity Assessment Body in the Warehouse Receipt System submitted by (name company/institution)...…………..... Number ……………... date ……… ; Considering : that your application has met the requirements and on the basis of that it can be considered to grant approval as a Conformity Assessment Body in the Warehouse Receipt System; Recalling : 1. Law Number 32 of 1997 concerning Commodity Futures Trading (Gazette of the Republic of Indonesia Year 1997 Number 93, Supplement to the Gazette of the Republic of Indonesia Number 3720) as amended by Law Number 10 of 2011 (Gazette of the Republic of Indonesia Year 2011 Number 79, Supplement to the Gazette of the Republic of Indonesia Number 5232); 2. Law Number 9 of 2006 concerning the Warehouse Receipt System (Gazette of the Republic of Indonesia Year 2006 Number 59, Supplement to the Gazette of the Republic of Indonesia Number 4630) as amended by Law Number 9 of 2011 (Gazette of the Republic of Indonesia Year 2011 Number 78, Supplement to the Gazette of the Republic of Indonesia Number 5231); 3. Government Regulation Number 36 of 2007 concerning the Implementation of Law Number 9 of 2006 concerning the Warehouse Receipt System (Gazette of the Republic of Indonesia Year 2007 Number 79, Supplement to the Gazette of the Republic of Indonesia Number 4735) as amended by Government Regulation Number 70 of 2013 (Gazette of the Republic of Indonesia Year 2013 Number 172, Supplement to the Gazette of the Republic of Indonesia Number 5459); 4. Presidential Regulation Number 47 of 2009 concerning the Formation and Organization of State Ministries as amended several times lastly with Presidential Regulation Number 13 of 2014 (Gazette of the Republic of Indonesia Year 2014 Number 24); 5. Presidential Regulation Number 24 of 2010 concerning the Position, Duties, and Functions of State Ministries as well as the Structure of Organizations, Duties, and Functions of Echelon I Ministries as amended several times, lastly with Presidential Regulation Number 14 of 2014;

Appendix to the Regulation of the Head of the Commodity Futures Trading Regulatory Agency Number: 19/BAPPEBTI/PER-SRG/01/2015 5

  1. Presidential Decree Number 69/M of 2013 concerning the Appointment of Echelon I Officials within the Ministry of Trade;
  2. Presidential Decree Number 121/P of 2014 concerning the Formation of Ministries and Appointment of Ministers of the Working Cabinet for the Period of Year 2014-2019;
  3. Minister of Trade Regulation Number 31/M-DAG/PER/7/2010 concerning the Organization and Working Structure of the Ministry of Trade as amended by Minister of Trade Regulation Number 57/M-DAG/PER/10/2012;
  4. Regulation of the Head of the Commodity Futures Trading Regulatory Agency Number 19/BAPPEBTI/PER-SRG/01/2015 concerning Requirements and Procedures for Obtaining Approval as a Conformity Assessment Body in the Warehouse Receipt System;

DECREES: Determining: FIRST : Granting Approval as a Conformity Assessment Body for Warehouse Inspection/Goods Quality Testing/Management Quality Certification*) in the Warehouse Receipt System to ................... (full name of the Conformity Assessment Body) with an address at .........……....... (full address of the Conformity Assessment Body). SECOND : This approval is valid as long as the concerned party is still active conducting activities according to its function as referred to in the FIRST clause. THIRD : This Decision of the Head of the Commodity Futures Trading Regulatory Agency shall take effect from the date of establishment.

Established in Jakarta on date............................... HEAD OF THE COMMODITY FUTURES TRADING REGULATORY AGENCY, ................................................

COPY of the Decision of the Head of the Commodity Futures Trading Regulatory Agency is sent to:

  1. Minister of Trade of the Republic of Indonesia;
  2. Secretary General of the Ministry of Trade;
  3. Inspector General of the Ministry of Trade;
  4. Secretaries and Heads of Bureaus within Bappebti;
  5. Head of the local Trade Department at Level I and II. *) choose one

Appendix to the Regulation of the Head of the Commodity Futures Trading Regulatory Agency Number: 19/BAPPEBTI/PER-SRG/01/2015 6

FORM NUMBER: SRG-LPK09 Number: ............., .....................20... Attachment: Subject: Rejection of Application for Approval as a Conformity Assessment Body in the Warehouse Receipt System. To: ……………………..... at ...............................

Referring to your letter Number: ...................... dated ....................... regarding ..................................., after examining your application, it is hereby decided that your application is rejected because it does not meet the requirements as follows:

  1. ...........................................................................................................
  2. ............................................................................................................
  3. ...........................................................................................................

Thus, please understand. HEAD OF THE COMMODITY FUTURES TRADING REGULATORY AGENCY, .........................................

Copy to:

  1. Secretaries and Heads of Bureaus within Bappebti;
  2. Head of the local Trade Department at Level I and II.

Appendix to the Regulation of the Head of the Commodity Futures Trading Regulatory Agency Number: 19/BAPPEBTI/PER-SRG/01/2015 7

FORM NUMBER: SRG-LPK10 (company/institution letterhead) Number: ...................., ...............20... Attachment: Subject: Application for Change of Name and/or Address *) of the Conformity Assessment Body in the Warehouse Receipt System. To: The Head of the Commodity Futures Trading Regulatory Agency at J A K A R T A

Hereby we submit a report of Change of Name and/or Address*) of the Conformity Assessment Body in the Warehouse Receipt System (Company/Institution Name) ............... As consideration material, we attach the following supporting documents:

  1. List of Document Completeness in the Framework of Change of Name and/or Address *) of the Conformity Assessment Body in the Warehouse Receipt System (Attachment 1 from Form Number SRG-LPK10);
  2. Application Form for Report in the Framework of Change of Name and/or Address *) of the Conformity Assessment Body in the Warehouse Receipt System (Attachment 2 from Form Number SRG-LPK10).

This application is submitted, and we thank you for your attention. ......................, .......................20..... Reporter (Clear Name) ............................................... (Head/CEO*) *) Choose one

Appendix to the Regulation of the Head of the Commodity Futures Trading Regulatory Agency Number: 19/BAPPEBTI/PER-SRG/01/2015 8

ATTACHMENT 1 FROM FORM NUMBER: SRG-LPK10 LIST OF DOCUMENT COMPLETENESS IN THE FRAMEWORK OF CHANGE OF NAME AND/OR ADDRESS*) OF THE CONFORMITY ASSESSMENT BODY IN THE WAREHOUSE RECEIPT SYSTEM

No. Document Yes No

  1. Photocopy of legal documents of the Conformity Assessment Body in the Warehouse Receipt System (Photocopy of establishment deed of Limited Liability Company /State-Owned Enterprise/Regional-Owned Enterprise/Cooperative/ Other Institution* including amendments that have been notarized by the competent official.*)
  2. Photocopy of Taxpayer Identification Number (Limited Liability Company/State-Owned Enterprise/Regional-Owned Enterprise/Cooperative/Other Institution*.)
  3. List of office/laboratory addresses used to support conformity assessment activities.
  4. Example of Conformity Assessment Certificate. *) Choose one

Appendix to the Regulation of the Head of the Commodity Futures Trading Regulatory Agency Number: 19/BAPPEBTI/PER-SRG/01/2015 9

ATTACHMENT 2 FROM FORM NUMBER: SRG-LPK10 APPLICATION FORM FOR REPORT OF CHANGE OF NAME AND/OR ADDRESS*) OF THE CONFORMITY ASSESSMENT BODY

  1. Reporter Name : ........................................................................
  2. Identity Number : ........................................................................ (ID Card/Passport*)
  3. Reporter Position : ........................................................................
  4. Reporter Address : ........................................................................ …………………………………………………………...

(Street Name & Number) ..................................... ••••• (City & Postal Code) 5. Company/ Institution Name : Old............................................................... New…………………………………………………….. 6. Taxpayer Identification Number : …………………………………………………………… 7. Company/ Institution Address : Old............................................................... New…………………………………………………….. 8. Telephone Number, e-mail and Fax : .................................................................. ..........................................,20...... Reporter, (Company Stamp) (Clear Name) ............................................... (Head/CEO*) *) Choose one

Appendix to the Regulation of the Head of the Commodity Futures Trading Regulatory Agency Number: 19/BAPPEBTI/PER-SRG/01/2015 10

FORM NUMBER: SRG-LPK11 (company/institution letterhead) Number: ...................., ...............20... Attachment: Subject: Report of Change of Management

Appendix to the Regulation of the Head of the Commodity Futures Trading Regulatory Agency Number: 19/BAPPEBTI/PER-SRG/01/2015 11

FORM NUMBER: SRG-LPK11 (Continued)

To: The Head of the Commodity Futures Trading Regulatory Agency at J A K A R T A

Hereby we submit a report of Change of Management of the Conformity Assessment Body in the Warehouse Receipt System (Company/Institution Name) ............... As consideration material, we attach the following supporting documents:

  1. List of Document Completeness for Report of Change of Management of Conformity Assessment Body in the Warehouse Receipt System (Attachment 1 from Form Number SRG-LPK11);
  2. Application Form for Report in the Framework of Change of Management of Conformity Assessment Body (Attachment 2 from Form Number SRG-LPK11).

This application is submitted, and we thank you for your attention. ......................, .......................20..... Reporter (Clear Name) ............................................... (Head/CEO*) *) Choose one

Appendix to the Regulation of the Head of the Commodity Futures Trading Regulatory Agency Number: 19/BAPPEBTI/PER-SRG/01/2015 12

ATTACHMENT 1 FROM FORM NUMBER: SRG-LPK11 LIST OF DOCUMENT COMPLETENESS FOR REPORT OF CHANGE OF MANAGEMENT OF THE CONFORMITY ASSESSMENT BODY IN THE WAREHOUSE RECEIPT SYSTEM

No. Document Yes No

  1. Photocopy of legal documents of the Conformity Assessment Body in the Warehouse Receipt System (Photocopy of establishment deed of Limited Liability Company /State-Owned Enterprise/Regional-Owned Enterprise/Cooperative/ Other Institution* including amendments that have been notarized by the competent official.*)
  2. Photocopy of Taxpayer Identification Number (Limited Liability Company/State-Owned Enterprise/Regional-Owned Enterprise/Cooperative/Other Institution*.)
  3. List of new Board of Directors/Management members.
  4. Photocopy of Identity Cards (ID Card/Passport) of new Board of Directors/Management members.
  5. Example of Conformity Assessment Certificate. *) Choose one

Appendix to the Regulation of the Head of the Commodity Futures Trading Regulatory Agency Number: 19/BAPPEBTI/PER-SRG/01/2015 13

ATTACHMENT 2 FROM FORM NUMBER: SRG-LPK11 APPLICATION FORM FOR REPORT IN THE FRAMEWORK OF CHANGE OF MANAGEMENT OF THE CONFORMITY ASSESSMENT BODY

  1. Reporter Name : ........................................................................
  2. Identity Number : ........................................................................ (ID Card/Passport*)
  3. Reporter Position : ........................................................................
  4. Reporter Address : ........................................................................ …………………………………………………………...

(Street Name & Number) ..................................... ••••• (City & Postal Code) 5. Company/ Institution Name : ................................................................................. 6. Taxpayer Identification Number : ................................................................................. 7. Old Management Members : a. Name : ........................................................................ Position : ........................................................................ b. Name : ........................................................................ Position : ........................................................................ 8. New Management Members : a. Name : ........................................................................ Position : ........................................................................ b. Name : ........................................................................ Position : ........................................................................ 9. Telephone Number, e-mail and Fax : .................................................................. ..........................................,20...... Reporter, (Company Stamp) (Clear Name) ............................................... (Head/CEO*) *) Choose one