To:
Employment Social Security Insurance Implementing Body Attn.

COPY

CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 20/SEOJK.05/2014

REGARDING

MONTHLY REPORTS ON THE MANAGEMENT OF EMPLOYMENT SOCIAL SECURITY PROGRAMS FOR THE EMPLOYMENT SOCIAL SECURITY INSURANCE IMPLEMENTING BODY

In relation to the mandate of Article 16 paragraph (10) of Financial Services Authority Regulation Number 5/POJK.05/2013 dated December 31, 2013 concerning the Supervision of Social Security Insurance Implementing Bodies by the Financial Services Authority, it is necessary to regulate implementation provisions regarding the format and structure of monthly reports on the management of employment social security programs for the employment social security insurance implementing body in this Financial Services Authority Circular Letter as follows:

I. GENERAL PROVISIONS

1. Financial Services Authority, hereinafter abbreviated as OJK, is the Financial Services Authority as referred to in Law Number 21 of 2011 concerning the Financial Services Authority.

2. Employment Social Security Insurance Implementing Body, hereinafter abbreviated as BPJS Ketenagakerjaan, is a public legal entity established to implement programs for work accident insurance, old-age savings, pension, and death benefits as referred to in Law Number 24 of 2011 concerning the Employment Social Security Insurance Implementing Body.

3. Monthly Report on the Management of Employment Social Security Programs is a program management report covering the period from the 1st to the end of the current month and submitted according to the format and structure of the Monthly Report on the Management of Employment Social Security Programs and according to the procedures determined by the OJK.

II. FORMAT AND STRUCTURE OF MONTHLY REPORTS ON THE MANAGEMENT OF EMPLOYMENT SOCIAL SECURITY PROGRAMS

1. BPJS Ketenagakerjaan is required to prepare Monthly Reports on the Management of Employment Social Security Programs for each employment social security program for periods ending on January 31, February 28 or 29, March 31, April 30, May 31, June 30, July 31, August 31, September 30, October 31, November 30, and December 31.

2. The types of employment social security programs include:
   a. work accident insurance program; b. old-age savings program;
   c. pension program; and
   d. death benefits program.

3. The Monthly Report on the Management of Employment Social Security Programs includes:
   a. profile reports, consisting of:

1. general profile;
2. profile of the Board of Supervisors and Board of Directors;
3. organizational structure profile;
4. regional office and branch office profile;
5. workforce education level profile; and
6. certified skilled employee profile.
   b. recapitulation reports, consisting of:
7. membership recapitulation;
8. complaint recapitulation;
9. wages and contributions recapitulation;
10. claims/benefits recapitulation;
11. funds recapitulation for the old-age savings program and pension program;
12. employer recapitulation; and
13. membership target, contribution, and number of employers recapitulation.

4. BPJS Ketenagakerjaan is required to have an information system capable of processing and maintaining supporting data for the reports as referred to in item 3.

5. The OJK may request BPJS Ketenagakerjaan to submit supporting data as referred to in item 4 for the purpose of supervising BPJS Ketenagakerjaan.

6. The format, structure, and guidelines for preparing profile reports as referred to in item 3 letter a are contained in Appendix I, which is an integral part of this OJK Circular Letter.

7. The format, structure, and guidelines for preparing recapitulation reports as referred to in item 3 letter b are as follows:
   a. for membership of all programs, contained in Appendix II; b. for complaints of all programs, contained in Appendix III;
   c. for the work accident insurance program, contained in Appendix IV;
   d. for the old-age savings program, contained in Appendix V; e. for the pension program, contained in Appendix VI; and f. for the death benefits program, contained in Appendix VII, which are integral parts of this OJK Circular Letter.

8. The Monthly Report on the Management of Employment Social Security Programs must be accompanied by a Board of Directors' statement letter regarding Responsibility for the Management Report of Employment Social Security Programs, which is contained in Appendix VIII, which is an integral part of this OJK Circular Letter.

9. Supporting data for reports as referred to in item 4 are contained in Appendix IX, which is an integral part of this OJK Circular Letter.

III. TIME FOR SUBMISSION OF MONTHLY REPORTS ON THE MANAGEMENT OF EMPLOYMENT SOCIAL SECURITY PROGRAMS

1. BPJS Ketenagakerjaan is required to submit the Monthly Report on the Management of Employment Social Security Programs to the OJK no later than the 15th of the following month.

2. In the event that the 15th date as referred to in item 1 falls on a holiday, the Monthly Report on the Management of Employment Social Security Programs must be submitted on the first working day after the said holiday.

IV. PROCEDURES FOR SUBMISSION OF MONTHLY REPORTS ON THE MANAGEMENT OF EMPLOYMENT SOCIAL SECURITY PROGRAMS

1. Submission of the Monthly Report on the Management of Employment Social Security Programs is done in hardcopy and softcopy to the OJK, with the following provisions:
   a. for profile reports and the Board of Directors' statement letter regarding responsibility for the Monthly Report on the Management of Employment Social Security Programs, submitted in hardcopy; and b. for profile reports and recapitulation reports, submitted in softcopy.

2. Submission of the Monthly Report on the Management of Employment Social Security Programs in hardcopy as referred to in item 1 letter a is submitted via a letter signed by the Board of Directors and addressed to:
   Financial Services Authority attn. Director of Pension Fund and BPJS Ketenagakerjaan Supervision Sumitro Djojohadikusumo Building East Banteng Field Street Number 2-4 Jakarta 10710.

3. Submission of the Monthly Report on the Management of Employment Social Security Programs in hardcopy as referred to in item 1 letter a can be done in one of the following ways:
   a. handed over directly to the OJK office as referred to in item 2; b. sent via registered post office; or
   c. sent via a courier/courier service company.

4. Submission of the Monthly Report on the Management of Employment Social Security Programs in softcopy as referred to in item 1 letter b is done electronically (online) through the OJK data communication network system.

5. In the event that the OJK data communication network system as referred to in item 4 is not yet available, the Monthly Report on the Management of Employment Social Security Programs is submitted via the official BPJS Ketenagakerjaan email by attaching the softcopy of the profile report and recapitulation report in spreadsheet format to the email address lkb.bpjstek@ojk.go.id.

6. BPJS Ketenagakerjaan is deemed to have submitted the Monthly Report on the Management of Employment Social Security Programs with the following provisions:
   a. for submission online through the OJK data communication network system as referred to in item 4 or via email as referred to in item 5, proven by an email receipt from the OJK. b. for submission in hardcopy, proven by:

1. a receipt letter from the OJK, if the report is handed over directly to the OJK office as referred to in item 2; or
2. a delivery receipt from the post office or courier/courier service company, if the report is sent via the post office or courier/courier service company as referred to in item 3 letter b and letter c.

7. In the event of a change in the OJK office address as referred to in item 2 and/or a change in the OJK email address as referred to in item 5, the OJK will communicate the address change via letter or announcement.

V. CLOSING

The provisions in this Financial Services Authority Circular Letter shall take effect on the date of determination.

To ensure that everyone knows, order the announcement of this Financial Services Authority Circular Letter by placing it in the State Gazette of the Republic of Indonesia.

Determined in Jakarta on December 30, 2014

EXECUTIVE HEAD OF INSURANCE, PENSION FUND,
FINANCING INSTITUTION, AND
OTHER FINANCIAL SERVICE INSTITUTIONS SUPERVISOR FINANCIAL SERVICES AUTHORITY, Sincerely, FIRDAUS DJAELANI

STATE GAZETTE OF THE REPUBLIC OF INDONESIA YEAR 2015 NUMBER 9 DATED JANUARY 30, 2015

A copy in accordance with the original
Director of Legal Affairs I
Department of Law,
Sincerely,
Sudarmaji

APPENDIX I
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 20/SEOJK.05/2014 REGARDING MONTHLY REPORTS ON THE MANAGEMENT OF EMPLOYMENT SOCIAL SECURITY PROGRAMS FOR THE EMPLOYMENT SOCIAL SECURITY INSURANCE IMPLEMENTING BODY

CHAPTER I
GENERAL EXPLANATION

I. 1. PURPOSE OF REPORTING
The Monthly Report on the Management of Employment Social Security Programs, prepared according to the system established in this guideline book, is intended to collect and compile statistical data of the Employment Social Security Insurance Implementing Body for the purpose of:

1. External supervision of the Employment Social Security Insurance Implementing Body
2. Fulfillment of internal needs of the Employment Social Security Insurance Implementing Body
   To achieve these objectives, the Employment Social Security Insurance Implementing Body is required to submit reports accurately and completely within the established time limits.

I. 2. DATA PRESENTATION
The Monthly Report on the Management of Employment Social Security Programs must be presented completely and in accordance with actual conditions and must comply with applicable legislation. Furthermore, the Monthly Report on the Management of Employment Social Security Programs must be presented in Indonesian Rupiah.

I. 3. TYPES OF PROGRAMS
The Employment Social Security Insurance Implementing Body is required to prepare Monthly Reports on the Management of Employment Social Security Programs for each employment social security program as follows:

1. work accident insurance program;
2. old-age savings program;
3. pension program; and
4. death benefits program.

I. 4. FILLING OUT REPORT FORMS
Filling out report forms is done by entering data completely and in accordance with the request per field.

I. 5. SUBMISSION OF QUESTIONS
If there are unclear matters in the implementation of report preparation, the Employment Social Security Insurance Implementing Body may submit questions to the Financial Services Authority, Soemitro Djojohadikusumo Building, East Banteng Field Street No.2-4 Jakarta 10710, telephone 021-3858001, fax 021-3847437.

CHAPTER II
MONTHLY REPORTS ON THE MANAGEMENT OF EMPLOYMENT SOCIAL SECURITY PROGRAMS FOR THE EMPLOYMENT SOCIAL SECURITY INSURANCE IMPLEMENTING BODY

I.1 GENERAL PROFILE OF THE EMPLOYMENT SOCIAL SECURITY INSURANCE IMPLEMENTING BODY

1. Institution Name : ...............................................................
2. Company Address
   a. Full Address : ...............................................................
   b. Ownership Status
   Building : ...............................................................
   c. Location Code : ...............................................................
   d. City Name : ...............................................................
   e. Postal Code : ...............................................................
3. Telephone and Fax
   a. Telephone : ...............................................................
   b. Fax : ...............................................................
4. Website : ...............................................................
5. NPWP (Taxpayer Identification Number) : ...............................................................
6. Number of Offices
   a. Number of Regional Offices : ...............................................................
   b. Number of Branch Offices : ...............................................................
7. Number of Workforce
   a. Head Office : ...............................................................
   b. Regional Office : ...............................................................
   c. Branch Office : ...............................................................
   d. Total : ...............................................................
8. Actuary Name : ...............................................................
9. Management
   a. Number of Directors : ...............................................................
   b. Number of Board of Supervisors : ...............................................................
10. Report Compiler and Person in Charge
    Person in Charge
    a. Full Name : ...............................................................
    b. Position : Director ………………………………………..
    c. Telephone : ...............................................................
    d. Fax : ...............................................................
    e. Email : ...............................................................
    Compiler
    a. Name : ...............................................................
    b. Position : ...............................................................
    c. Work Unit : ...............................................................
    d. Telephone : ...............................................................
    e. Fax : ...............................................................
    f. Email : ...............................................................
    Jakarta, ………
    Person in Charge of Report
    Name
    Director ……

I.2 EXPLANATION OF THE GENERAL PROFILE OF THE EMPLOYMENT SOCIAL SECURITY INSURANCE IMPLEMENTING BODY This form contains all information regarding the institutional profile of the Employment Social Security Insurance Implementing Body.

1. Institution Name
   Filled with the name of the Employment Social Security Insurance Implementing Body.

2. Company Address
   a. Full Address
   Filled with the full address according to the domicile of the head office of the Employment Social Security Insurance Implementing Body. b. Building Ownership Status Filled with the building ownership status, i.e., rented, owned, or borrowed.
   c. Location Code
   Filled with the location code as listed in the location code list for regencies/cities throughout Indonesia. d. City Name Filled with the city name according to the domicile of the head office of the Employment Social Security Insurance Implementing Body. e. Postal Code Filled with the postal code number of the domicile of the head office of the Employment Social Security Insurance Implementing Body.

3. Telephone and Fax
   a. Telephone
   Filled with the telephone number of the Employment Social Security Insurance Implementing Body. b. Fax Filled with the fax number of the Employment Social Security Insurance Implementing Body.

4. Website
   Filled with the website address of the Employment Social Security Insurance Implementing Body.

5. NPWP
   Filled with the NPWP of the Employment Social Security Insurance Implementing Body.

6. Number of Offices
   a. Number of Regional Offices
   Filled with the number of regional offices of the Employment Social Security Insurance Implementing Body. b. Number of Branch Offices Filled with the number of branch offices of the Employment Social Security Insurance Implementing Body.

7. Number of Workforce
   a. Head Office
   Filled with the number of workforce at the head office of the Employment Social Security Insurance Implementing Body. b. Regional Office Filled with the number of workforce at the regional office of the Employment Social Security Insurance Implementing Body.
   c. Branch Office
   Filled with the number of workforce at the branch office of the Employment Social Security Insurance Implementing Body.

8. Actuary Name
   Filled with the name of the actuary who performed actuarial calculations at the Employment Social Security Insurance Implementing Body in the relevant year.

9. Management
   a. Number of Directors
   Filled with the number of directors of the Employment Social Security Insurance Implementing Body. b. Number of Board of Supervisors Filled with the number of board of supervisors of the Employment Social Security Insurance Implementing Body.

10. Report Compiler and Person in Charge
    Filled with complete data for each personnel acting as the report compiler and the official in charge of the report. a. Person in Charge of Report

1. Full Name
   Filled with the full name of the person in charge of the report.
2. Position
   Filled with the position of a specific director who is the person in charge of the report, e.g., Finance Director.
3. Telephone
   Filled with the telephone number of the person in charge of the report.
4. Fax
   Filled with the fax number of the person in charge of the report.
5. Email
   Filled with the email address of the person in charge of the report. b. Report Compiler
6. Name
   Filled with the name of the report compiler.
7. Position
   Filled with the position of the report compiler.
8. Work Unit
   Filled with the work unit of the report compiler.
9. Telephone
   Filled with the telephone number of the report compiler.
10. Fax
    Filled with the fax number of the report compiler.
11. Email
    Filled with the email address of the report compiler.

II.1 PROFILE OF THE BOARD OF SUPERVISORS AND BOARD OF DIRECTORS OF THE EMPLOYMENT SOCIAL SECURITY INSURANCE IMPLEMENTING BODY

a. Profile of the Board of Supervisors
Report Period | Name of Board of Supervisors | Nomenclature | Position | Date of Appointment | Appointment Decision Number | Decision Date | Decision Subject (1) | (2) | (3) | (4) | (5) | (6) | (7)

b. Profile of the Board of Directors
Report Period | Name of Board of Directors | Nomenclature | Position | Date of Appointment | Appointment Decision Number | Decision Date | Decision Subject (1) | (2) | (3) | (4) | (5) | (6) | (7)

II.2 EXPLANATION OF THE PROFILE OF THE BOARD OF SUPERVISORS AND BOARD OF DIRECTORS OF THE EMPLOYMENT SOCIAL SECURITY INSURANCE IMPLEMENTING BODY This form contains information on the management of the Employment Social Security Insurance Implementing Body consisting of the Board of Supervisors and Board of Directors.

1. Report Period
   Filled with the date, month, and year of the end of the report period submitted.

2. Name of Board of Supervisors/Board of Directors
   Filled with the names of the Board of Supervisors/Board of Directors of the Employment Social Security Insurance Implementing Body.

3. Position Nomenclature
   Filled with the nomenclature of the positions of the Board of Supervisors/Board of Directors of the Employment Social Security Insurance Implementing Body.

4. Date of Appointment
   Filled with the date, month, and year of appointment.

5. Appointment Decision Number
   Filled with the number of the appointment decision for the Board of Supervisors and Board of Directors, e.g., KEP-123/MK/2013.

6. Decision Date
   Filled with the date, month, and year the decision was issued.

7. Decision Subject
   Filled with the subject of the appointment decision.

III.1 ORGANIZATIONAL STRUCTURE PROFILE OF THE EMPLOYMENT SOCIAL SECURITY INSURANCE IMPLEMENTING BODY

Report Period | Name of Work Unit | Name of Official | Structure Level | Parent Structure Name (1) | (2) | (3) | (4) | (5)

III.2 EXPLANATION OF THE ORGANIZATIONAL STRUCTURE PROFILE OF THE EMPLOYMENT SOCIAL SECURITY INSURANCE IMPLEMENTING BODY This form contains information on the organizational structure of the Employment Social Security Insurance Implementing Body.

1. Report Period
   Filled with the date, month, and year of the end of the report period submitted.

2. Name of Work Unit
   Filled with the name of the work unit according to the organizational structure of the Employment Social Security Insurance Implementing Body, e.g., Finance Division.

3. Name of Official
   Filled with the name of the official leading the organizational structure at the Employment Social Security Insurance Implementing Body.

4. Structure Level
   Filled with the organizational structure level up to the work unit at the Employment Social Security Insurance Implementing Body. No. Structure Level Code

5. Directorate 1

6. Division/Regional Office 2

7. Branch 3

8. Parent Structure Name
   Filled with the name of the parent organizational structure at the Employment Social Security Insurance Implementing Body, e.g., Finance Department.

IV.1 REGIONAL OFFICE AND BRANCH OFFICE PROFILE OF THE EMPLOYMENT SOCIAL SECURITY INSURANCE IMPLEMENTING BODY

Report Period | Office Type | Full Address | Location Code | Postal Code | Telephone | Fax | Total Employees (1) | (2) | (3) | (4) | (5) | (6) | (7) | (8)

IV.2 EXPLANATION OF THE REGIONAL OFFICE AND BRANCH OFFICE PROFILE OF THE EMPLOYMENT SOCIAL SECURITY INSURANCE IMPLEMENTING BODY This form contains information on the detailed list of regional office and branch office profiles of the Employment Social Security Insurance Implementing Body.

1. Report Period
   Filled with the date, month, and year of the end of the report period submitted.

2. Office Type
   Filled with the Office Type of the Employment Social Security Insurance Implementing Body:
   No. Office Type Code

3. Regional Office 1

4. Branch Office 2

5. Others 3

6. Full Address
   Filled with the full address of the office according to the domicile of the branch office of the Employment Social Security Insurance Implementing Body.

7. Location Code
   Filled with the location code as listed in the location code list for regencies/cities throughout Indonesia.

8. Postal Code
   Filled with the postal code number of the domicile of the branch office of the Employment Social Security Insurance Implementing Body.

9. Telephone
   Filled with the telephone number of the Employment Social Security Insurance Implementing Body.

10. Fax
    Filled with the fax number of the Employment Social Security Insurance Implementing Body.

11. Total Employees
    Filled with the number of employees of the Employment Social Security Insurance Implementing Body, including honorary staff.

V.1 WORKFORCE EDUCATION LEVEL PROFILE OF THE EMPLOYMENT SOCIAL SECURITY INSURANCE IMPLEMENTING BODY

Report Period | Education Level | Placement | Employment Status | Head Office | Outside Head Office | Male | Female | Total (1) | (2) | (3) | (4) | (5) | (6) | (7)

V.2 EXPLANATION OF THE WORKFORCE EDUCATION LEVEL PROFILE OF THE EMPLOYMENT SOCIAL SECURITY INSURANCE IMPLEMENTING BODY This form contains information on the detailed list of workforce education levels both at the head office and outside the head office of the Employment Social Security Insurance Implementing Body.

1. Report Period
   Filled with the date, month, and year of the end of the report period submitted.

2. Education Level
   Filled with the education level of the workforce of the Employment Social Security Insurance Implementing Body.

3. Placement
   Filled with the code for the education level of the workforce at the head office and outside the head office as listed in the appendix. a. Head Office No. Education Level Code

4. Elementary School (SD) 9110

5. Junior High School (SMP) 9120

6. Senior High School (SMA) 9130

7. D1 9140

8. D2 9150

9. D3 9160

10. S1/D4 9170

11. S2 9180

12. S3 9190

13. Foreign Workforce 9200
    b. Outside Head Office
    No. Education Level Code

14. Elementary School (SD) 9210

15. Junior High School (SMP) 9220

16. Senior High School (SMA) 9230

17. D1 9240

18. D2 9250

19. D3 9260

20. S1/D4 9270

21. S2 9280

22. S3 9290

23. Foreign Workforce 9300

24. Employment Status
    Filled with the employment status of the workforce at the Employment Social Security Insurance Implementing Body, e.g., permanent employees and non-permanent employees.

25. Male
    Filled with the number of male workforce at the Employment Social Security Insurance Implementing Body.

26. Female
    Filled with the number of female workforce at the Employment Social Security Insurance Implementing Body.

27. Total
    Filled with the total number of male and female workforce at the Employment Social Security Insurance Implementing Body.

VI.1 CERTIFIED SKILLED EMPLOYEE PROFILE OF THE EMPLOYMENT SOCIAL SECURITY INSURANCE IMPLEMENTING BODY

Report Period | Employee Name | Position | Date of Appointment | Field of Expertise | Qualification (1) | (2) | (3) | (4) | (5) | (6)

VI.2 CERTIFIED SKILLED EMPLOYEE PROFILE OF THE EMPLOYMENT SOCIAL SECURITY INSURANCE IMPLEMENTING BODY This form contains information on the detailed list of certified skilled employee profiles both at the head office and outside the head office of the Employment Social Security Insurance Implementing Body.

1. Report Period
   Filled with the date, month, and year of the end of the report period submitted.

2. Employee Name
   Filled with the name of the certified employee of the Employment Social Security Insurance Implementing Body.

3. Position
   Filled with the name of the expert position of the Employment Social Security Insurance Implementing Body.

4. Date of Appointment
   Filled with the date, month, and year the expert started their position at the Employment Social Security Insurance Implementing Body.

5. Field of Expertise
   Filled with the field of expertise of the certified employee of the Employment Social Security Insurance Implementing Body. No. Field of Expertise Code

6. Accounting, Audit and Finance 1

7. Insurance and Risk Management 2

8. Information Technology 3

9. Actuarial 4

10. Others 5

11. Qualifications
    Filled with the qualifications of experts from the Employment Social Security Implementing Agency.

No. Field of Expertise Qualification

1. Accounting, Audit and Finance CFA/WMI/CPA/
   CISA/Akuntan/CA/QIA/
   CFE/CIA/Other
2. Insurance and Risk Management AAIJ/AAAIJ/AAIK/
   AAAIK/FLMI/ANZIF/
   ACII/BSMR/AAK/AAAK/
   CRMP/Other
3. Information Technology Vendor Specific/Non
   Vendor Specific/Other
4. Actuarial FSAI/ASAI/Other
5. Other

EXECUTIVE HEAD OF SUPERVISOR
OF INSURANCE, PENSION FUNDS,
LENDING INSTITUTIONS, AND
OTHER FINANCIAL SERVICE INSTITUTIONS
FINANCIAL SERVICES AUTHORITY,
Signed.
Copy matches the original FIRDAUS DJAELANI
Director of Legal Affairs I
Legal Department,
Signed.
Signed. Signed.
Sudarmaji

APPENDIX II
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 20/SEOJK.05/2014 CONCERNING MONTHLY REPORT ON THE MANAGEMENT OF EMPLOYMENT SOCIAL SECURITY PROGRAMS FOR THE EMPLOYMENT SOCIAL SECURITY IMPLEMENTING AGENCY

PARTICIPANT RECAPITULATION REPORT
The participant recapitulation report for all employment social security programs is as follows:

1. work accident insurance program;
2. old age benefit program;
3. pension program; and
4. death benefit program.

I.1 PARTICIPANT RECAPITULATION PER PARTICIPANT SEGMENT Report Period Regional Office Branch Office Wage Recipients Non-Wage Recipients Construction Service Workers Employer Participant Container/Type of Business Project Participants (1) (2) (3) (4) (5) (6)

I.2 EXPLANATION OF PARTICIPANT RECAPITULATION PER PARTICIPANT SEGMENT This form contains all information regarding the recapitulation of participants per participant segment of the Employment Social Security Implementing Agency:

1. Report Period
   Filled with the date, month, and year of the end of the reporting period submitted.
2. Regional Office
   Filled with the name of the regional office of the Employment Social Security Implementing Agency.
3. Branch Office
   Filled with the name of the branch office of the Employment Social Security Implementing Agency.
4. Wage Recipients
   Filled with the number of employers and active participants in the wage recipient participant segment of the Employment Social Security Implementing Agency.
5. Non-Wage Recipients
   Filled with the number of containers/types of business and active participants in the non-wage recipient participant segment of the Employment Social Security Implementing Agency.
6. Construction Service Workers
   Filled with the number of projects and active participants in the construction service worker participant segment of the Employment Social Security Implementing Agency.

No. Participant Segment Code
Wage Recipients 1

1. State Organizers 1.1
2. Private Employees/SOEs 1.2
3. Other Workers 1.3
   Non-Wage Recipients 2
4. Self-Employed Workers 2.1
5. Individual Workers 2.2
6. Other Workers 2.3
   Construction Service Workers 3

II.1 PARTICIPANT RECAPITULATION PER BUSINESS GROUP, GENDER AND LABOR FORCE Report Period Regional Office Branch Office Participant Segment

II.2 EXPLANATION OF PARTICIPANT RECAPITULATION PER BUSINESS GROUP, GENDER AND LABOR FORCE This form contains all information regarding the recapitulation of participants per business group, gender and labor force of the Employment Social Security Implementing Agency:

1. Report Period
   Filled with the date, month, and year of the end of the reporting period submitted.
2. Regional Office
   Filled with the name of the regional office of the Employment Social Security Implementing Agency.
3. Branch Office
   Filled with the name of the branch office of the Employment Social Security Implementing Agency.
4. Participant Segment
   Filled with the participant segment of the Employment Social Security Implementing Agency.
5. Counterparty
   Filled with the counterparty of participants of the Employment Social Security Implementing Agency.

No. Participant Segment Code
Wage Recipients 1

1. State Organizers 1.1

2. Private Employees/SOEs 1.2

3. Other Workers 1.3
   Non-Wage Recipients 2

4. Self-Employed Workers 2.1

5. Individual Workers 2.2

6. Other Workers 2.3
   Construction Service Workers 3

Agriculture, Fisheries, Plantations &
Forestry
2. Mining 2
3. Basic Industry & Chemicals 3
4. Various Industries 4

6. Total
   Filled with the total number of participant counterparties of the Employment Social Security Implementing Agency.

7. Gender
   Filled with the gender of participants in the employment social security program.

8. Total
   Filled with the total number of male and female participants of the Employment Social Security Implementing Agency.

9. In
   Filled with the number of participants who entered as participants of the Employment Social Security Implementing Agency.

10. Out
    Filled with the number of participants who exited as participants of the Employment Social Security Implementing Agency.

11. Active
    Filled with the number of active participants in the Employment Social Security Implementing Agency.

12. Non-Active
    Filled with the number of non-active participants in the Employment Social Security Implementing Agency.

13. Total
    Filled with the number of active and inactive participants in the Employment Social Security Implementing Agency.

14. Consumer Goods Industry 5

15. Property and Real Estate 6

16. Energy, Telecommunications & Transportation 7

17. Finance & Investment 8

18. Trade & Services 9

III.1 PARTICIPANT RECAPITULATION BY AGE GROUP AND NATIONALITY Report Period Regional Office Branch Office Participant Segment Age Group Nationality 1 2 3 4 5 6 7 8 9 10 11 12 13 Total Indonesian Citizens Foreign Citizens Total

III.2 EXPLANATION OF PARTICIPANT RECAPITULATION PER AGE GROUP This form contains all information regarding the recapitulation per age group and nationality of the Employment Social Security Implementing Agency:
Report Period
Filled with the date, month, and year of the end of the reporting period submitted.

1. Regional Office
   Filled with the name of the regional office of the Employment Social Security Implementing Agency.
2. Branch Office
   Filled with the name of the branch office of the Employment Social Security Implementing Agency.
3. Participant Segment
   Filled with the participant segment of the Employment Social Security Implementing Agency.

No. Participant Segment Code
Wage Recipients 1

1. State Organizers 1.1

2. Private Employees/SOEs 1.2

3. Other Workers 1.3
   Non-Wage Recipients 2

4. Self-Employed Workers 2.1

5. Individual Workers 2.2

6. Other Workers 2.3
   Construction Service Workers 3

7. Age Group
   Filled with the age group of participants of the Employment Social Security Implementing Agency.

No. Age Group Code

1. Under 20 years old 1

2. Above 20 - 25 years old 2

3. Above 25 - 30 years old 3

4. Above 30 - 35 years old 4

5. Above 35 - 40 years old 5

6. Above 40 - 45 years old 6

7. Above 45 - 50 years old 7

8. Above 50 - 55 years old 8

9. Above 55 - 60 years old 9

10. Above 60 - 65 years old 10

11. Above 65 - 70 years old 11

12. Above 70 - 75 years old 12

13. Above 75 years old 13

14. Total
    Filled with the number of participants based on the age group of participants of the Employment Social Security Implementing Agency.

15. Indonesian Citizens
    Filled with participants of the Employment Social Security Implementing Agency who are Indonesian citizens.

16. Foreign Citizens
    Filled with participants of the Employment Social Security Implementing Agency who are foreign citizens.

17. Total
    Filled with the total number of participants of the Employment Social Security Implementing Agency who are Indonesian and foreign citizens.

EXECUTIVE HEAD OF SUPERVISOR
OF INSURANCE, PENSION FUNDS,
LENDING INSTITUTIONS, AND
OTHER FINANCIAL SERVICE INSTITUTIONS
FINANCIAL SERVICES AUTHORITY,
Signed.
Copy matches the original FIRDAUS DJAELANI
Director of Legal Affairs I
Legal Department,
Signed.
Signed. Signed.
Sudarmaji

APPENDIX III
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 20/SEOJK.05/2014 CONCERNING MONTHLY REPORT ON THE MANAGEMENT OF EMPLOYMENT SOCIAL SECURITY PROGRAMS FOR THE EMPLOYMENT SOCIAL SECURITY IMPLEMENTING AGENCY

COMPLAINT RECAPITULATION REPORT
The complaint recapitulation report for all employment social security programs is as follows:

1. work accident insurance program (JKK);
2. old age benefit program (JHT);
3. pension program (JP); and
4. death benefit program (JKM).

I.1 EMPLOYMENT SOCIAL SECURITY IMPLEMENTING AGENCY CALL CENTER COMPLAINT RECAPITULATION Report Period Complaint Type Program Type Number Resolution JKK JHT JP JKM Completed Not Completed (1) (2) (3) (4) (5) (6)

I.2 EXPLANATION OF EMPLOYMENT SOCIAL SECURITY IMPLEMENTING AGENCY CALL CENTER COMPLAINT RECAPITULATION This form contains all information regarding the recapitulation of complaints of participants of the Employment Social Security Implementing Agency:

1. Report Period
   Filled with the date, month, and year of the end of the reporting period submitted.
2. Complaint Type
   Filled with the type of complaint of participants of the Employment Social Security Implementing Agency.

No. Complaint Type Code
1.
Complaint of BPJS Ketenagakerjaan Participant Card/KPJ 2.
Complaint of Insurance Claim Payment/Old Age Benefit Program 3.
Complaint of Insurance Claim Payment/Death Benefit Program 4.
Complaint of Insurance Claim Payment/Work Accident Insurance Program
5. Complaint of Participant Registration 5
6. Complaint of BPJS Ketenagakerjaan - Mobile 6
7. Complaint of BPJS Ketenagakerjaan - Website 7
8. Complaint of Electronic Payment System 8
9. Other Complaints 9

3. Program Type
   Filled with the number of complaints of participants of the Employment Social Security Implementing Agency for each program.
4. Number
   Filled with the total number of complaints of participants of the Employment Social Security Implementing Agency.
5. Completed
   Filled with the number of complaints that have been resolved by the Employment Social Security Implementing Agency.
6. Completed
   Filled with the number of complaints that have been resolved by the Employment Social Security Implementing Agency.

II.1 EMPLOYMENT SOCIAL SECURITY IMPLEMENTING AGENCY PARTICIPANT SATISFACTION SURVEY RECAPITULATION Report Period Regional Office Branch Office Dissatisfied Less Satisfied Fairly Satisfied Satisfied Very Satisfied Total Number % Number % Number % Number % Number % (1) (2) (3) (4) (5)

II.2 EXPLANATION OF EMPLOYMENT SOCIAL SECURITY IMPLEMENTING AGENCY PARTICIPANT SATISFACTION SURVEY RECAPITULATION This form contains all information regarding the recapitulation of the participant satisfaction survey of the employment social security implementing agency.

1. Report Period
   Filled with the date, month, and year of the end of the reporting period submitted.
2. Regional Office
   Filled with the name of the regional office of the Employment Social Security Implementing Agency.
3. Branch Office
   Filled with the name of the branch office of the Employment Social Security Implementing Agency.
4. Satisfaction Level
   Filled with the satisfaction level of participants of the Employment Social Security Implementing Agency.
5. Total
   Filled with the total assessment of participants based on the results of the Employment Social Security Implementing Agency's survey on participant satisfaction levels.

EXECUTIVE HEAD OF SUPERVISOR
OF INSURANCE, PENSION FUNDS,
LENDING INSTITUTIONS, AND
OTHER FINANCIAL SERVICE INSTITUTIONS
FINANCIAL SERVICES AUTHORITY,
Signed.
Copy matches the original FIRDAUS DJAELANI
Director of Legal Affairs I
Legal Department,
Signed.
Signed. Signed.
Sudarmaji

APPENDIX IV
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 20/SEOJK.05/2014 CONCERNING MONTHLY REPORT ON THE MANAGEMENT OF EMPLOYMENT SOCIAL SECURITY PROGRAMS FOR THE EMPLOYMENT SOCIAL SECURITY IMPLEMENTING AGENCY

MONTHLY REPORT ON THE MANAGEMENT
OF THE WORK ACCIDENT INSURANCE PROGRAM
OF THE EMPLOYMENT SOCIAL SECURITY IMPLEMENTING AGENCY

I. PARTICIPANT RECAPITULATION
This form contains all information regarding the recapitulation of participants in the work accident insurance program.

A.1 PARTICIPANT RECAPITULATION PER PARTICIPANT SEGMENT Report Period Regional Office Branch Office Wage Recipients Non-Wage Recipients Construction Service Workers Employer Participants Container/Type of Business Project Participants (1) (2) (3) (4) (5) (6)

A.2 EXPLANATION OF PARTICIPANT RECAPITULATION PER PARTICIPANT SEGMENT This form contains all information regarding the recapitulation of participants per participant segment of the work accident insurance program:

1. Report Period
   Filled with the date, month, and year of the end of the reporting period submitted.
2. Regional Office
   Filled with the name of the regional office of the work accident insurance program.
3. Branch Office
   Filled with the name of the branch office of the work accident insurance program.
4. Wage Recipients
   Filled with the number of employers and active participants in the wage recipient participant segment of the work accident insurance program.
5. Non-Wage Recipients
   Filled with the number of containers/types of business and active participants in the non-wage recipient participant segment of the work accident insurance program.
6. Construction Service Workers
   Filled with the number of projects and active participants in the construction service worker participant segment of the work accident insurance program.

No. Participant Segment Code
Wage Recipients 1

1. State Organizers 1.1
2. Private Employees/SOEs 1.2
3. Other Workers 1.3
   Non-Wage Recipients 2
4. Self-Employed Workers 2.1
5. Individual Workers 2.2
6. Other Workers 2.3
   Construction Service Workers 3

B.1 PARTICIPANT RECAPITULATION PER BUSINESS GROUP, GENDER AND LABOR FORCE Report Period Regional Office Branch Office Participant Segment

B.2 EXPLANATION OF PARTICIPANT RECAPITULATION PER BUSINESS GROUP, GENDER AND LABOR FORCE This form contains all information regarding the recapitulation of participants per business group, gender and labor force of the work accident insurance program:

1. Report Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office
   Filled with the name of the regional office of the Employment Social Security Implementing Agency.

3. Branch Office
   Filled with the name of the branch office of the Employment Social Security Implementing Agency.

4. Participant Segment
   Filled with the participant segment of the work accident insurance program.

5. Counterparty
   Filled with the counterparty of participants of the Employment Social Security Implementing Agency.

6. Agriculture, Fisheries, Plantations &
   Forestry

7. Mining 2

8. Basic Industry & Chemicals 3

9. Various Industries 4

10. Consumer Goods Industry 5

No. Participant Segment Code
Wage Recipients 1

1. State Organizers 1.1

2. Private Employees/SOEs 1.2

3. Other Workers 1.3
   Non-Wage Recipients 2

4. Self-Employed Workers 2.1

5. Individual Workers 2.2

6. Other Workers 2.3
   Construction Service Workers 3

7. Property and Real Estate 6

8. Energy, Telecommunications & Transportation 7

9. Finance & Investment 8

10. Trade & Services 9

11. Total
    Filled with the total number of participant counterparties of the Employment Social Security Implementing Agency.

12. Gender
    Filled with the gender of participants in the work accident insurance program.

13. Total
    Filled with the total number of male and female participants in the work accident insurance program.

14. In
    Filled with the number of participants who entered as participants in the work accident insurance program.

15. Out
    Filled with the number of participants who exited as participants in the work accident insurance program.

16. Active
    Filled with the number of active participants in the work accident insurance program.

17. Non-Active
    Filled with the number of non-active participants in the work accident insurance program.

18. Total
    Filled with the number of active and inactive participants in the work accident insurance program.

C.1 PARTICIPANT RECAPITULATION PER AGE GROUP AND NATIONALITY Report Period Regional Office Branch Office Participant Segment Age Group Nationality 1 2 3 4 5 6 7 8 9 10 11 12 13 Total Indonesian Citizens Foreign Citizens Total

C.2 EXPLANATION OF PARTICIPANT RECAPITULATION PER AGE GROUP This form contains all information regarding the recapitulation of participants per age group and nationality of the work accident insurance program:

1. Report Period
   Filled with the date, month, and year of the end of the reporting period submitted.
2. Regional Office
   Filled with the name of the regional office of the Employment Social Security Implementing Agency.
3. Branch Office
   Filled with the name of the branch office of the Employment Social Security Implementing Agency.
4. Participant Segment
   Filled with the participant segment of the work accident insurance program.
5. Age Group
   Filled with the age group of participants in the work accident insurance program.

No. Age Group Code

1. Under 20 years old 1
2. Above 20 - 25 years old 2
3. Above 25 - 30 years old 3
4. Above 30 - 35 years old 4
5. Above 35 - 40 years old 5
6. Above 40 - 45 years old 6

No. Participant Segment Code
Wage Recipients 1

1. State Organizers 1.1

2. Private Employees/SOEs 1.2

3. Other Workers 1.3
   Non-Wage Recipients 2

4. Self-Employed Workers 2.1

5. Individual Workers 2.2

6. Other Workers 2.3
   Construction Service Workers 3

7. Above 45 - 50 years old 7

8. Above 50 - 55 years old 8

9. Above 55 - 60 years old 9

10. Above 60 - 65 years old 10

11. Above 65 - 70 years old 11

12. Above 70 - 75 years old 12

13. Above 75 years old 13

14. Total
    Filled with the number of participants based on the age group of participants in the work accident insurance program.

15. Indonesian Citizens
    Filled with participants in the work accident insurance program who are Indonesian citizens.

16. Foreign Citizens
    Filled with participants in the work accident insurance program who are foreign citizens.

17. Total
    Filled with the total number of participants in the work accident insurance program who are Indonesian and foreign citizens.

II.1 RECAPITULATION OF WAGES AND CONTRIBUTIONS OF THE WORK ACCIDENT INSURANCE PROGRAM Report Period Regional Office Branch Office Participant Segment Wage Group Contribution Levying Contributions Received 1 2 3 4 5 Total Participants Employer Total Due Paid In Advance Total (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)

II.2 EXPLANATION OF RECAPITULATION OF WAGES AND CONTRIBUTIONS OF THE WORK ACCIDENT INSURANCE PROGRAM This form contains all information regarding the detailed list of wages and contributions of the work accident insurance program

1. Report Period
   Filled with the date, month, and year of the end of the reporting period submitted.
2. Regional Office
   Filled with the name of the regional office of the Employment Social Security Implementing Agency.
3. Branch Office
   Filled with the name of the branch office of the Employment Social Security Implementing Agency.
4. Participant Segment
   Filled with the participant segment of the work accident insurance program.
5. Wage Group
   Filled with the wage group of participants in the work accident insurance program.

No. Wage Group Code

1. 0-2 million/month 1

2. 2- 5 million/month 2

3. 5-10 million/month 3

4. 10-50 million/month 4

5. 50 million/month 5

No. Participant Segment Code
Wage Recipients 1

1. State Organizers 1.1

2. Private Employees/SOEs 1.2

3. Other Workers 1.3
   Non-Wage Recipients 2

4. Self-Employed Workers 2.1

5. Individual Workers 2.2

6. Other Workers 2.3
   Construction Service Workers 3

7. Total
   Filled with the total number of participants based on the wage group of the work accident insurance program.

8. Participants
   Filled with the due contributions that are the burden of participants in the work accident insurance program.

9. Employers
   Filled with the due contributions that are the burden of employers in the work accident insurance program.

10. Total
    Filled with the total due contributions that are the burden of participants and employers in the work accident insurance program.

11. Due
    Filled with the due contributions of the work accident insurance program.

12. Paid in advance
    Filled with the contributions paid in advance for the work accident insurance program.

13. Total
    Filled with the total of due contributions and contributions paid in advance for the work accident insurance program.

III.1 RECAPITULATION OF CLAIMS OF THE WORK ACCIDENT INSURANCE PROGRAM Report Period Regional Office Branch Office Participant Segment Claim Type Claim Status 1 2 3 4 5 Total 1 2 3 4 Number Value Number Value Number Value Number Value (1) (2) (3) (4) (5) (6) (7)

III.2 EXPLANATION OF RECAPITULATION OF CLAIMS OF THE WORK ACCIDENT INSURANCE PROGRAM This form contains all information regarding the recapitulation of claims of the work accident insurance program of the Employment Social Security Implementing Agency:

1. Report Period
   Filled with the date, month, and year of the end of the reporting period submitted.
2. Regional Office
   Filled with the name of the regional office of the Employment Social Security Implementing Agency.
3. Branch Office
   Filled with the name of the branch office of the Employment Social Security Implementing Agency.
4. Participant Segment
   Filled with the participant segment of the work accident insurance program.
5. Claim Type
   Filled with the type of claim of the work accident insurance program.

No. Claim Type Code

1. Functional Disability 1
2. Partial Disability 2
3. Permanent Total Disability 3
4. Death 4
5. Recovery Cases 5

No. Participant Segment Code
Wage Recipients 1

1. State Organizers 1.1

2. Private Employees/SOEs 1.2

3. Other Workers 1.3
   Non-Wage Recipients 2

4. Self-Employed Workers 2.1

5. Individual Workers 2.2

6. Other Workers 2.3
   Construction Service Workers 3

7. Total
   Filled with the number per claim type of participants in the work accident insurance program.

8. Claim Status
   Filled with the number and value of claims of participants in the work accident insurance program according to claim status.

No. Claim Status Code

1. Submitted 1
2. Determined 2
3. Rejected 3
4. Paid 4

IV.1 RECAPITULATION OF EMPLOYERS OF THE WORK ACCIDENT INSURANCE PROGRAM Report Period Regional Office Branch Office Participant Segment Number Employers Number Participants Contributions (1) (2) (3) (4) (5) (6) (7)

IV.2 EXPLANATION OF RECAPITULATION OF EMPLOYERS OF THE WORK ACCIDENT INSURANCE PROGRAM This form contains all information regarding the recapitulation of employers of the work accident insurance program of the Employment Social Security Implementing Agency:

1. Report Period
   Filled with the date, month, and year of the end of the reporting period submitted.
2. Regional Office
   Filled with the name of the regional office of the Employment Social Security Implementing Agency.
3. Branch Office
   Filled with the name of the branch office of the Employment Social Security Implementing Agency.
4. Participant Segment
   Filled with the participant segment of the work accident insurance program.

No. Participant Segment Code
Wage Recipients 1

1. State Organizers 1.1

2. Private Employees/SOEs 1.2

3. Other Workers 1.3
   Non-Wage Recipients 2

4. Self-Employed Workers 2.1

5. Individual Workers 2.2

6. Other Workers 2.3
   Construction Service Workers 3

7. Number of Employers
   Filled with the number of employers in the work accident insurance program.

8. Number of Participants
   Filled with the number of participants in the work accident insurance program.

9. Contributions
   Filled with the amount of contributions received by the Employment Social Security Implementing Agency.

V.1 RECAPITULATION OF PARTICIPANT TARGETS, CONTRIBUTIONS, AND NUMBER OF EMPLOYERS OF THE WORK ACCIDENT INSURANCE PROGRAM Report Period Regional Office Branch Office Participant Segment Number Employers Number Participants Contributions (1) (2) (3) (4) (5) (6) (7)

V.2 EXPLANATION OF RECAPITULATION OF PARTICIPANT TARGETS, CONTRIBUTIONS, AND NUMBER OF EMPLOYERS OF THE WORK ACCIDENT INSURANCE PROGRAM This form contains all information regarding the recapitulation of participant targets, contributions, and number of employers of the employment social security program of the Employment Social Security Implementing Agency:

1. Report Period
   Filled with the date, month, and year of the end of the reporting period submitted.
2. Regional Office
   Filled with the name of the regional office of the Employment Social Security Implementing Agency.
3. Branch Office
   Filled with the name of the branch office of the Employment Social Security Implementing Agency.
4. Participant Segment
   Filled with the participant segment of the work accident insurance program.

No. Participant Segment Code
Wage Recipients 1

1. State Organizers 1.1

2. Private Employees/SOEs 1.2

3. Other Workers 1.3
   Non-Wage Recipients 2

4. Self-Employed Workers 2.1

5. Individual Workers 2.2

6. Other Workers 2.3
   Construction Service Workers 3

7. Number of Employers
   Filled with the target number of employer participants in the work accident insurance program.

8. Number of Participants
   Filled with the target number of participants in the work accident insurance program.

9. Contributions
   Filled with the target contributions of the work accident insurance program.

EXECUTIVE HEAD OF SUPERVISOR
OF INSURANCE, PENSION FUNDS,
LENDING INSTITUTIONS, AND OTHER FINANCIAL
SERVICE INSTITUTIONS
FINANCIAL SERVICES AUTHORITY,
Signed.
Copy matches the original FIRDAUS DJAELANI
Director of Legal Affairs I
Legal Department,
Signed.
Signed. Signed.
Sudarmaji

APPENDIX V
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 20/SEOJK.05/2014 CONCERNING MONTHLY REPORT ON THE MANAGEMENT OF EMPLOYMENT SOCIAL SECURITY PROGRAMS FOR THE EMPLOYMENT SOCIAL SECURITY IMPLEMENTING AGENCY

MONTHLY REPORT ON THE MANAGEMENT OF OLD AGE SECURITY PROGRAM

SOCIAL SECURITY ADMINISTRATION BODY FOR EMPLOYMENT (BPJS KETENAGAKERJAAN)

I. PARTICIPANT RECAPITULATION

This form contains all information regarding the recapitulation of participation in the old age security program.

A.1 PARTICIPANT RECAPITULATION BY PARTICIPANT SEGMENT OF THE OLD AGE SECURITY PROGRAM

Report Period	Regional Office	Branch Office	Wage Earners	Non-Wage Earners
			Employer	Participant	Business Container/Type	Participant
(1)	(2)	(3)	(4)	(5)

A.2 EXPLANATION OF PARTICIPANT RECAPITULATION BY PARTICIPANT SEGMENT OF THE OLD AGE SECURITY PROGRAM

This form contains all information regarding the recapitulation of participation by participant segment of the old age security program:

1. Report Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office
   Filled with the name of the regional office of the old age security program.

3. Branch Office
   Filled with the name of the branch office of the old age security program.

4. Wage Earners
   Filled with the number of employers and participants in the wage earner segment of the old age security program.

5. Non-Wage Earners
   Filled with the number of business containers/types and participants in the non-wage earner segment of the old age security program.

No.	Participant Segment	Code
	Wage Earner Workers	1
1.	State Organizers	1.1
2.	Private Employees/SOEs	1.2
3.	Other Workers	1.3
	Non-Wage Earner Workers	2
4.	Self-Employed Workers	2.1
5.	Individual Workers	2.2
6.	Other Workers	2.3
	Construction Service Workers	3

B.1 PARTICIPANT RECAPITULATION BY BUSINESS GROUP, GENDER, AND WORKFORCE

Report Period	Regional Office	Branch Office	Participant Segment

B.2 EXPLANATION OF PARTICIPANT RECAPITULATION BY BUSINESS GROUP, GENDER, AND WORKFORCE

This form contains all information regarding the recapitulation of participation by business group, gender, and workforce of the old age security program:

1. Report Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office
   Filled with the name of the regional office of the Social Security Administration Body for Employment.

3. Branch Office
   Filled with the name of the branch office of the Social Security Administration Body for Employment.

4. Participant Segment
   Filled with the participant segment of the old age security program.

5. Counterparty
   Filled with the counterparty of the Social Security Administration Body for Employment.

No.	Business Group	Code
1.	Agriculture, Fisheries, Plantations & Forestry	1
2.	Mining	2
3.	Basic Industry & Chemicals	3
4.	Various Industries	4
5.	Consumer Goods Industry	5
6.	Property and Real Estate	6
7.	Energy, Telecommunications & Transportation	7
8.	Finance & Investment	8
9.	Trade & Services	9

6. Total
   Filled with the total number of counterparty of the Social Security Administration Body for Employment.

7. Gender
   Filled with the number of participants in the old age security program according to gender.

8. Total
   Filled with the total number of male and female participants in the old age security program.

9. Enter
   Filled with the number of participants who entered as participants in the old age security program.

10. Exit
    Filled with the number of participants who exited as participants in the old age security program.

11. Active
    Filled with the number of participants who are active in the old age security program.

12. Non-Active
    Filled with the number of participants who are non-active in the old age security program.

13. Total
    Filled with the number of active and inactive participants in the old age security program.

No.	Participant Segment	Code
	Wage Earner Workers	1
1.	State Organizers	1.1
2.	Private Employees/SOEs	1.2
3.	Other Workers	1.3
	Non-Wage Earner Workers	2
4.	Self-Employed Workers	2.1
5.	Individual Workers	2.2
6.	Other Workers	2.3
	Construction Service Workers	3

C.1 PARTICIPANT RECAPITULATION BY AGE GROUP AND NATIONALITY

Report Period	Regional Office	Branch Office	Participant Segment	Age Group	Nationality
				1	2	3	4	5	6	7	8	9	10	11	12	13	Total
																	Indonesian Citizens	Foreign Citizens	Total

C.2 EXPLANATION OF PARTICIPANT RECAPITULATION BY AGE GROUP

This form contains all information regarding the recapitulation of participation by age group and nationality of the old age security program:

1. Report Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office
   Filled with the name of the regional office of the Social Security Administration Body for Employment.

3. Branch Office
   Filled with the name of the branch office of the Social Security Administration Body for Employment.

4. Participant Segment
   Filled with the participant segment of the old age security program.

5. Age Group
   Filled with the age group of participants in the old age security program.

No.	Age Group	Code
1.	Under 20 years	1
2.	Above 20 - 25 years	2
3.	Above 25 - 30 years	3
4.	Above 30 - 35 years	4
5.	Above 35 - 40 years	5
6.	Above 40 - 45 years	6
7.	Above 45 - 50 years	7
8.	Above 50 - 55 years	8
9.	Above 55 - 60 years	9
10.	Above 60 - 65 years	10
11.	Above 65 - 70 years	11
12.	Above 70 - 75 years	12
13.	Above 75 years	13

6. Total
   Filled with the number of participants based on the age group of participants in the old age security program.

7. Indonesian Citizens
   Filled with participants in the old age security program who are Indonesian citizens.

8. Foreign Citizens
   Filled with participants in the old age security program who are foreign citizens.

9. Total
   Filled with the number of participants in the old age security program who are Indonesian and foreign citizens.

No.	Participant Segment	Code
	Wage Earner Workers	1
1.	State Organizers	1.1
2.	Private Employees/SOEs	1.2
3.	Other Workers	1.3
	Non-Wage Earner Workers	2
4.	Self-Employed Workers	2.1
5.	Individual Workers	2.2
6.	Other Workers	2.3
	Construction Service Workers	3

II.1 RECAPITULATION OF WAGES AND CONTRIBUTIONS OF THE OLD AGE SECURITY PROGRAM

Report Period	Regional Office	Branch Office	Participant Segment	Wage Group	Contribution Burden	Contributions Received
				1	2	3	4	5	Total Participant	Employer	Total	Due Date	Paid in Advance	Total
(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)	(9)	(10)	(11)	(12)

II.2 EXPLANATION OF RECAPITULATION OF WAGES AND CONTRIBUTIONS OF THE OLD AGE SECURITY PROGRAM

This form contains all information regarding the recapitulation of wages and contributions of the old age security program.

1. Report Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office
   Filled with the name of the regional office of the Social Security Administration Body for Employment.

3. Branch Office
   Filled with the name of the branch office of the Social Security Administration Body for Employment.

4. Participant Segment
   Filled with the participant segment of the old age security program.

No.	Participant Segment	Code
	Wage Earner Workers	1
1.	State Organizers	1.1
2.	Private Employees/SOEs	1.2
3.	Other Workers	1.3
	Non-Wage Earner Workers	2
4.	Self-Employed Workers	2.1
5.	Individual Workers	2.2
6.	Other Workers	2.3
	Construction Service Workers	3

5. Wage Group
   Filled with the wage group of participants in the old age security program.

No.	Wage Group	Code
1.	0-2 million/month	1
2.	>2-5 million/month	2
3.	>5-10 million/month	3
4.	>10-50 million/month	4
5.	>50 million/month	5

6. Total
   Filled with the total number of participants based on the wage group of the old age security program.

7. Participant
   Filled with the due contribution that is the burden of participants in the old age security program.

8. Employer
   Filled with the due contribution that is the burden of employers in the old age security program.

9. Total
   Filled with the total due contribution that is the burden of participants and employers in the old age security program.

10. Due Date
    Filled with the due contribution of the old age security program.

11. Paid in Advance
    Filled with contributions paid in advance for the old age security program.

12. Total
    Filled with the total amount of due contributions and contributions paid in advance for the old age security program.

III.1 RECAPITULATION OF FUNDS OF THE OLD AGE SECURITY PROGRAM

Report Period	Regional Office	Branch Office	Participant Segment	Beginning Balance	Contributions Current Year	Development Results	Amalgamation/Adjustment	Ending Balance

III.2 EXPLANATION OF RECAPITULATION OF FUNDS OF THE OLD AGE SECURITY PROGRAM

This form contains all information regarding the detailed list of funds of the old age security program of the Social Security Administration Body for Employment.

1. Report Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office
   Filled with the name of the regional office of the Social Security Administration Body for Employment.

3. Branch Office
   Filled with the name of the branch office of the Social Security Administration Body for Employment.

4. Participant Segment
   Filled with the participant segment of the old age security program.

5. Beginning Balance
   Filled with the beginning balance of the old age security program.

6. Contributions Current Year
   Filled with contributions for the current year of the old age security program.

No.	Participant Segment	Code
	Wage Earner Workers	1
1.	State Organizers	1.1
2.	Private Employees/SOEs	1.2
3.	Other Workers	1.3
	Non-Wage Earner Workers	2
4.	Self-Employed Workers	2.1
5.	Individual Workers	2.2
6.	Other Workers	2.3
	Construction Service Workers	3

7. Development Results
   Filled with the development results of the old age security program.

8. Amalgamation/Adjustment
   Filled with the value of amalgamation (merging of old age security accounts of participants who move workplaces)/adjustment of the old age security program.

9. Ending Balance
   Filled with the ending balance of the old age security program.

IV.1 RECAPITULATION OF CLAIMS OF THE OLD AGE SECURITY PROGRAM

Report Period	Regional Office	Branch Office	Participant Segment	Type of Benefit	Number of Claims
					1	2	3	4	5	6	Total Lump Sum	Monthly	Total
(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)	(9)	(10)

IV.2 EXPLANATION OF RECAPITULATION OF CLAIMS OF THE OLD AGE SECURITY PROGRAM

This form contains all information regarding the recapitulation of funds of the old age security program of the Social Security Administration Body for Employment.

1. Report Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office
   Filled with the name of the regional office of the Social Security Administration Body for Employment.

3. Branch Office
   Filled with the name of the branch office of the Social Security Administration Body for Employment.

4. Participant Segment
   Filled with the participant segment of the old age security program.

No.	Participant Segment	Code
	Wage Earner Workers	1
1.	State Organizers	1.1
2.	Private Employees/SOEs	1.2
3.	Other Workers	1.3
	Non-Wage Earner Workers	2
4.	Self-Employed Workers	2.1
5.	Individual Workers	2.2
6.	Other Workers	2.3
	Construction Service Workers	3

5. Type of Benefit
   Filled with the type of benefit of the old age security program.

No.	Type of Benefit	Code
1.	Retirement age (55 years)	1
2.	Death	2
3.	Total permanent disability	3
4.	Participation above 10 years	4
5.	Civil Servants/TNI/Police	5
6.	Leaving RI territory	6

6. Total
   Filled with the total number of participants receiving each type of benefit of the old age security program.

7. Lump Sum
   Filled with the number of claims submitted at once as payment of old age security benefits.

8. Monthly
   Filled with the number of claims submitted partially as payment of old age security benefits.

9. Total
   Filled with the total claims submitted at once and partially as payment of old age security benefits.

10. Amount
    Filled with the amount of money paid by the Social Security Administration Body for Employment to pay old age security benefits.

V.1 RECAPITULATION OF BENEFITS OF THE OLD AGE SECURITY PROGRAM

Report Period	Regional Office	Branch Office	Participant Segment	Type of Benefit	Payment Method of Benefits	Number of Participants	Value of Benefits
						Lump Sum	Monthly

V.2 EXPLANATION OF RECAPITULATION OF BENEFITS OF THE OLD AGE SECURITY PROGRAM

This form contains all information regarding the recapitulation of benefits of the old age security program of the Social Security Administration Body for Employment:

1. Report Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office
   Filled with the name of the regional office of the Social Security Administration Body for Employment.

3. Branch Office
   Filled with the name of the branch office of the Social Security Administration Body for Employment.

4. Participant Segment
   Filled with the participant segment of the old age security program.

No.	Participant Segment	Code
	Wage Earner Workers	1
1.	State Organizers	1.1
2.	Private Employees/SOEs	1.2
3.	Other Workers	1.3
	Non-Wage Earner Workers	2
4.	Self-Employed Workers	2.1
5.	Individual Workers	2.2
6.	Other Workers	2.3
	Construction Service Workers	3

5. Type of Benefit
   Filled with the type of benefit of the old age security program.

No.	Type of Benefit	Code
1.	Retirement age (55 years)	1
2.	Death	2
3.	Total permanent disability	3
4.	Participation above 10 years	4
5.	State Organizers	5
6.	Leaving RI territory	6

6. Payment Method of Benefits
   Filled with the payment method of benefits of the old age security program, for example cash, non-cash, transfer, etc.

7. Lump Sum
   Filled with the number of participants who submitted claims at once as payment of old age security benefits.

8. Monthly
   Filled with the number of participants who submitted claims monthly as payment of old age security benefits.

9. Value of Benefits
   Filled with the value of benefits paid in the old age security program.

VI.1 RECAPITULATION OF EMPLOYERS OF THE OLD AGE SECURITY PROGRAM

Report Period	Regional Office	Branch Office	Participant Segment	Number of Employers	Number of Participants	Contributions
(1)	(2)	(3)	(4)	(5)	(6)	(7)

VI.2 EXPLANATION OF RECAPITULATION OF EMPLOYERS OF THE OLD AGE SECURITY PROGRAM

This form contains all information regarding the recapitulation of employers of the old age security program of the Social Security Administration Body for Employment:

1. Report Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office
   Filled with the name of the regional office of the Social Security Administration Body for Employment.

3. Branch Office
   Filled with the name of the branch office of the Social Security Administration Body for Employment.

4. Participant Segment
   Filled with the participant segment of the old age security program.

No.	Participant Segment	Code
	Wage Earner Workers	1
1.	State Organizers	1.1
2.	Private Employees/SOEs	1.2
3.	Other Workers	1.3
	Non-Wage Earner Workers	2
4.	Self-Employed Workers	2.1
5.	Individual Workers	2.2
6.	Other Workers	2.3
	Construction Service Workers	3

5. Number of Employers
   Filled with the number of employers who include their employees in the old age security program.

6. Number of Participants
   Filled with the number of participants in the old age security program.

7. Contributions
   Filled with contributions received by the Social Security Administration Body for Employment in the old age security program.

VII.1 RECAPITULATION OF PARTICIPATION TARGETS, CONTRIBUTIONS, AND NUMBER OF EMPLOYERS OF THE OLD AGE SECURITY PROGRAM

Report Period	Regional Office	Branch Office	Participant Segment	Number of Employers	Number of Participants	Contributions
(1)	(2)	(3)	(4)	(5)	(6)	(7)

VII.2 EXPLANATION OF RECAPITULATION OF PARTICIPATION TARGETS, CONTRIBUTIONS, AND NUMBER OF EMPLOYERS OF THE OLD AGE SECURITY PROGRAM

This form contains all information regarding the recapitulation of participation targets, contributions, and number of employers of the old age security program of the Social Security Administration Body for Employment:

1. Report Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office
   Filled with the name of the regional office of the Social Security Administration Body for Employment.

3. Branch Office
   Filled with the name of the branch office of the Social Security Administration Body for Employment.

4. Participant Segment
   Filled with the participant segment of the old age security program.

No.	Participant Segment	Code
	Wage Earner Workers	1
1.	State Organizers	1.1
2.	Private Employees/SOEs	1.2
3.	Other Workers	1.3
	Non-Wage Earner Workers	2
4.	Self-Employed Workers	2.1
5.	Individual Workers	2.2
6.	Other Workers	2.3
	Construction Service Workers	3

5. Number of Companies
   Filled with the target number of employer participants in the old age security program.

6. Number of Workforce
   Filled with the target number of participants in the old age security program.

7. Contributions
   Filled with the target contributions of the old age security program.

EXECUTIVE HEAD OF INSURANCE SUPERVISOR,
PENSION FUNDS,
FINANCING INSTITUTIONS,
AND OTHER FINANCIAL SERVICE INSTITUTIONS
FINANCIAL SERVICES AUTHORITY,

Signed.
FIRDAUS DJAELANI
Director of Legal Affairs I
Legal Department,

Signed.
Signed.
Sudarmaji

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APPENDIX VI

LETTER OF THE FINANCIAL SERVICES AUTHORITY

NUMBER 20/SEOJK.05/2014

CONCERNING

MONTHLY REPORT ON THE MANAGEMENT OF EMPLOYMENT SOCIAL SECURITY PROGRAMS FOR THE SOCIAL SECURITY ADMINISTRATION BODY FOR EMPLOYMENT

MONTHLY REPORT ON THE MANAGEMENT OF PENSION SECURITY PROGRAMS

SOCIAL SECURITY ADMINISTRATION BODY FOR EMPLOYMENT (BPJS KETENAGAKERJAAN)

I. PARTICIPANT RECAPITULATION

This form contains all information regarding the recapitulation of participation in the pension security program.

A.1 PARTICIPANT RECAPITULATION BY SEGMENT OF THE PENSION SECURITY PROGRAM

Report Period	Regional Office	Branch Office	Wage Earners	Non-Wage Earners
			Employer	Participant	Business Container/Type	Participant
(1)	(2)	(3)	(4)	(5)

A.2 EXPLANATION OF PARTICIPANT RECAPITULATION BY PARTICIPANT SEGMENT

This form contains all information regarding the recapitulation of participation by participant segment of the pension security program:

1. Report Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office
   Filled with the name of the regional office of the pension security program.

3. Branch Office
   Filled with the name of the branch office of the pension security program.

4. Wage Earners
   Filled with the number of employers and participants in the wage earner segment of the pension security program.

5. Non-Wage Earners
   Filled with the number of business containers/types and participants in the non-wage earner segment of the pension security program.

No.	Participant Segment	Code
	Wage Earner Workers	1
1.	State Organizers	1.1
2.	Private Employees/SOEs	1.2
3.	Other Workers	1.3
	Non-Wage Earner Workers	2
4.	Self-Employed Workers	2.1
5.	Individual Workers	2.2
6.	Other Workers	2.3
	Construction Service Workers	3

B.1 PARTICIPANT RECAPITULATION BY BUSINESS GROUP, GENDER, AND WORKFORCE

Report Period	Regional Office	Branch Office	Participant Segment

B.2 EXPLANATION OF PARTICIPANT RECAPITULATION BY BUSINESS GROUP, GENDER, AND WORKFORCE

This form contains all information regarding the recapitulation of participation by business group, gender, and workforce of the Pension Security program:

1. Report Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office
   Filled with the name of the regional office of the Social Security Administration Body for Employment.

3. Branch Office
   Filled with the name of the branch office of the Social Security Administration Body for Employment.

4. Participant Segment
   Filled with the participant segment of the Pension Security program.

No.	Participant Segment	Code
	Wage Earner Workers	1
1.	State Organizers	1.1
2.	Private Employees/SOEs	1.2
3.	Other Workers	1.3
	Non-Wage Earner Workers	2
4.	Self-Employed Workers	2.1
5.	Individual Workers	2.2
6.	Other Workers	2.3
	Construction Service Workers	3

5. Counterparty
   Filled with the counterparty of participants of the Social Security Administration Body for Employment.

No.	Business Group	Code
1.	Agriculture, Fisheries, Plantations & Forestry	1
2.	Mining	2
3.	Basic Industry & Chemicals	3
4.	Various Industries	4
5.	Consumer Goods Industry	5
6.	Property and Real Estate	6
7.	Energy, Telecommunications & Transportation	7
8.	Finance & Investment	8
9.	Trade & Services	9

6. Total
   Filled with the total number of counterparty participants of the Social Security Administration Body for Employment.

7. Gender
   Filled with the gender of participants in the pension security program.

8. Total
   Filled with the total number of male and female participants in the pension security program.

9. Enter
   Filled with the number of participants who entered as participants in the pension security program.

10. Exit
    Filled with the number of participants who exited as participants in the pension security program.

11. Active
    Filled with the number of participants who are active in the pension security program.

12. Non-Active
    Filled with the number of participants who are non-active in the pension security program.

13. Total
    Filled with the number of active and inactive participants in the pension security program.

C.1 PARTICIPANT RECAPITULATION BY AGE GROUP AND NATIONALITY

Report Period	Regional Office	Branch Office	Participant Segment	Age Group	Nationality
				1	2	3	4	5	6	7	8	9	10	11	12	13	Total
																	Indonesian Citizens	Foreign Citizens	Total

C.2 EXPLANATION OF PARTICIPANT RECAPITULATION BY AGE GROUP

This form contains all information regarding the recapitulation of participation by age group and nationality of the pension security program:

1. Report Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office
   Filled with the name of the regional office of the Social Security Administration Body for Employment.

3. Branch Office
   Filled with the name of the branch office of the Social Security Administration Body for Employment.

4. Participant Segment
   Filled with the participant segment of the pension security program.

5. Age Group
   Filled with the age group of participants in the pension security program.

No.	Age Group	Code
1.	Under 20 years	1
2.	Above 20 - 25 years	2
3.	Above 25 - 30 years	3
4.	Above 30 - 35 years	4
5.	Above 35 - 40 years	5
6.	Above 40 - 45 years	6
7.	Above 45 - 50 years	7
8.	Above 50 - 55 years	8
9.	Above 55 - 60 years	9
10.	Above 60 - 65 years	10
11.	Above 65 - 70 years	11
12.	Above 70 - 75 years	12
13.	Above 75 years	13

6. Total
   Filled with the number of participants based on the age group of participants in the pension security program.

7. Indonesian Citizens
   Filled with participants in the pension security program who are Indonesian citizens.

8. Foreign Citizens
   Filled with participants in the pension security program who are foreign citizens.

9. Total
   Filled with the number of participants in the pension security program who are Indonesian and foreign citizens.

No.	Participant Segment	Code
	Wage Earner Workers	1
1.	State Organizers	1.1
2.	Private Employees/SOEs	1.2
3.	Other Workers	1.3
	Non-Wage Earner Workers	2
4.	Self-Employed Workers	2.1
5.	Individual Workers	2.2
6.	Other Workers	2.3
	Construction Service Workers	3

II.1 RECAPITULATION OF WAGES AND CONTRIBUTIONS OF THE PENSION SECURITY PROGRAM

Report Period	Regional Office	Branch Office	Participant Segment	Wage Group	Contribution Burden	Contributions Received
				1	2	3	4	5	Total Participant	Employer	Total	Due Date	Paid in Advance	Total
(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)	(9)	(10)	(11)	(12)

II.1 EXPLANATION OF RECAPITULATION OF WAGES AND CONTRIBUTIONS OF THE PENSION SECURITY PROGRAM

This form contains all information regarding the recapitulation of wages and contributions of the pension security program.

1. Report Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office
   Filled with the name of the regional office of the Social Security Administration Body for Employment.

3. Branch Office
   Filled with the name of the branch office of the Social Security Administration Body for Employment.

4. Participant Segment
   Filled with the participant segment of the pension security program.

No.	Participant Segment	Code
	Wage Earner Workers	1
1.	State Organizers	1.1
2.	Private Employees/SOEs	1.2
3.	Other Workers	1.3
	Non-Wage Earner Workers	2
4.	Self-Employed Workers	2.1
5.	Individual Workers	2.2
6.	Other Workers	2.3
	Construction Service Workers	3

5. Wage Group
   Filled with the wage group of participants in the pension security program.

No.	Wage Group	Code
1.	0-2 million/month	1
2.	>2-5 million/month	2
3.	>5-10 million/month	3
4.	>10-50 million/month	4
5.	>50 million/month	5

6. Total
   Filled with the total number of participants based on the wage group of the pension security program.

7. Participant
   Filled with the contribution that is the burden of participants in the pension security program.

8. Employer
   Filled with the contribution that is the burden of employers in the pension security program.

9. Total
   Filled with the total contribution that is the burden of participants and employers in the pension security program.

10. Due Date
    Filled with the due contribution of the pension security program.

11. Paid in Advance
    Filled with contributions paid in advance for the pension security program.

12. Total
    Filled with the total amount of due contributions and contributions paid in advance for the pension security program.

III.1 RECAPITULATION OF FUNDS OF THE PENSION SECURITY PROGRAM

Report Period	Regional Office	Branch Office	Participant Segment	Beginning Balance	Contributions Current Year	Development Results	Ending Balance
(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)

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III.2 EXPLANATION OF RECAPITULATION OF FUNDS FOR THE PENSION INSURANCE PROGRAM

This form contains all information regarding the recapitulation of funds for the pension insurance program of the Social Security Implementing Agency for Employment (Badan Penyelenggara Jaminan Sosial Ketenagakerjaan).

1. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office
   Filled with the name of the regional office of the Social Security Implementing Agency for Employment.

3. Branch Office
   Filled with the name of the branch office of the Social Security Implementing Agency for Employment.

4. Participant Segment
   Filled with the participant segment of the pension insurance program.

5. Beginning Balance
   Filled with the beginning balance of the pension insurance program.

6. Current Year Contributions
   Filled with the current year contributions of the pension insurance program.

7. Development Results
   Filled with the development results of the pension insurance program.

8. Ending Balance
   Filled with the ending balance of the pension insurance program.

No.	Participant Segment	Code
Wage-Earning Workers	1
1. State Organizers	1.1
2. Private Employees/SOEs	1.2
3. Other Workers	1.3
Non-Wage-Earning Workers	2
4. Self-Employed Workers	2.1
5. Individual Workers	2.2
6. Other Workers	2.3
Construction Service Workers	3

IV.1 RECAPITULATION OF CLAIMS FOR THE PENSION INSURANCE PROGRAM

Reporting Period	Regional Office	Branch Office	Participant Segment	Type of Benefit	Number of Claims	Total
					Lump Sum	Monthly	Total
(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)	(9)	(10)

IV.2 EXPLANATION OF RECAPITULATION OF CLAIMS FOR THE PENSION INSURANCE PROGRAM

This form contains all information regarding the recapitulation of claims for the pension insurance program of the Social Security Implementing Agency for Employment:

1. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office
   Filled with the name of the regional office of the Social Security Implementing Agency for Employment.

3. Branch Office
   Filled with the name of the branch office of the Social Security Implementing Agency for Employment.

4. Participant Segment
   Filled with the participant segment of the pension insurance program.

No.	Participant Segment	Code
Wage-Earning Workers	1
1. State Organizers	1.1
2. Private Employees/SOEs	1.2
3. Other Workers	1.3
Non-Wage-Earning Workers	2
4. Self-Employed Workers	2.1
5. Individual Workers	2.2
6. Other Workers	2.3
Construction Service Workers	3

5. Type of Benefit
   Filled with the type of benefit of the pension insurance program.

No.	Type of Benefit	Code
1. Normal Pension	1
2. Disability Pension	2
3. Widow/Orphan Pension	3
4. Child Pension	4
5. Parent Pension	5

6. Total
   Filled with the total number of participants receiving each type of pension insurance benefit.

7. Lump Sum
   Filled with the number of claims submitted as a lump sum payment for pension insurance benefits.

8. Monthly
   Filled with the number of claims submitted as monthly payments for pension insurance benefits.

9. Total
   Filled with the total claims submitted as lump sum and partial payments for pension insurance benefits.

10. Amount
    Filled with the amount of money paid by the Social Security Implementing Agency for Employment to pay pension insurance benefits.

V.1 RECAPITULATION OF EMPLOYERS FOR THE PENSION INSURANCE PROGRAM

Reporting Period	Regional Office	Branch Office	Participant Segment	Number of Companies	Number of Participants	Contributions
(1)	(2)	(3)	(4)	(5)	(6)	(7)

V.2 EXPLANATION OF RECAPITULATION OF EMPLOYERS FOR THE PENSION INSURANCE PROGRAM

This form contains all information regarding the recapitulation of employers for the pension insurance program of the Social Security Implementing Agency for Employment:

1. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office
   Filled with the name of the regional office of the Social Security Implementing Agency for Employment.

3. Branch Office
   Filled with the name of the branch office of the Social Security Implementing Agency for Employment.

4. Participant Segment
   Filled with the participant segment of the pension insurance program.

No.	Participant Segment	Code
Wage-Earning Workers	1
1. State Organizers	1.1
2. Private Employees/SOEs	1.2
3. Other Workers	1.3
Non-Wage-Earning Workers	2
4. Self-Employed Workers	2.1
5. Individual Workers	2.2
6. Other Workers	2.3
Construction Service Workers	3

5. Number of Companies
   Filled with the number of companies that include their employees in the pension insurance program.

6. Number of Participants
   Filled with the number of participants in the pension insurance program.

7. Contributions
   Filled with the contributions received by the Social Security Implementing Agency for Employment in the pension insurance program.

VI.1 EXPLANATION OF RECAPITULATION OF PARTICIPATION TARGETS, CONTRIBUTIONS, AND NUMBER OF EMPLOYERS FOR THE PENSION INSURANCE PROGRAM

Reporting Period	Regional Office	Branch Office	Participant Segment	Number of Employers	Number of Participants	Contributions
(1)	(2)	(3)	(4)	(5)	(6)	(7)

VI.2 EXPLANATION OF RECAPITULATION OF PARTICIPATION TARGETS, CONTRIBUTIONS, AND NUMBER OF EMPLOYERS FOR THE PENSION INSURANCE PROGRAM

This form contains all information regarding the recapitulation of participation targets, contributions, and number of employers for the employment social security program of the Social Security Implementing Agency for Employment:

1. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office
   Filled with the name of the regional office of the Social Security Implementing Agency for Employment.

3. Branch Office
   Filled with the name of the branch office of the Social Security Implementing Agency for Employment.

4. Participant Segment
   Filled with the participant segment of the pension insurance program.

No.	Participant Segment	Code
Wage-Earning Workers	1
1. State Organizers	1.1
2. Private Employees/SOEs	1.2
3. Other Workers	1.3
Non-Wage-Earning Workers	2
4. Self-Employed Workers	2.1
5. Individual Workers	2.2
6. Other Workers	2.3
Construction Service Workers	3

5. Number of Employers
   Filled with the target number of employer participants in the pension insurance program.

6. Number of Participants
   Filled with the target number of participants in the pension insurance program.

7. Contributions
   Filled with the target contributions for the pension insurance program.

EXECUTIVE HEAD OF INSURANCE, PENSION FUNDS, FINANCING INSTITUTIONS, AND OTHER FINANCIAL SERVICE INSTITUTIONS SUPERVISOR FINANCIAL SERVICES AUTHORITY,

Signed

FIRDAUS DJAELANI
Director of Legal Affairs I
Legal Department,

Signed

Signed

Sudarmaji

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APPENDIX VII

FINANCIAL SERVICES AUTHORITY CIRCULAR
NUMBER 20/SEOJK.05/2014

CONCERNING

MONTHLY REPORT ON THE MANAGEMENT OF SOCIAL SECURITY EMPLOYMENT PROGRAMS FOR THE SOCIAL SECURITY IMPLEMENTING AGENCY FOR EMPLOYMENT

MONTHLY REPORT ON THE MANAGEMENT OF DEATH INSURANCE PROGRAMS FOR THE SOCIAL SECURITY IMPLEMENTING AGENCY FOR EMPLOYMENT

I. RECAPITULATION OF PARTICIPATION

This form contains all information regarding the recapitulation of participation in the death insurance program.

A.1 RECAPITULATION OF PARTICIPATION PER PARTICIPANT SEGMENT

Reporting Period	Regional Office	Branch Office	Wage-Earning Workers	Non-Wage-Earning Workers	Construction Service Workers	Employers	Participants - Business Type/Unit	Participants - Project	Participants
(1)	(2)	(3)	(4)	(5)	(6)

A.2 EXPLANATION OF RECAPITULATION OF PARTICIPATION PER PARTICIPANT SEGMENT

This form contains all information regarding the recapitulation of participation per participant segment of the death insurance program:

1. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office
   Filled with the name of the regional office of the death insurance program.

3. Branch Office
   Filled with the name of the branch office of the death insurance program.

4. Wage-Earning Workers
   Filled with the number of employers and active participants in the wage-earning worker segment of the death insurance program.

5. Non-Wage-Earning Workers
   Filled with the number of business types/units and active participants in the non-wage-earning worker segment of the death insurance program.

6. Construction Service Workers
   Filled with the number of projects and active participants in the construction service worker segment of the death insurance program.

No.	Participant Segment	Code
Wage-Earning Workers	1
1. State Organizers	1.1
2. Private Employees/SOEs	1.2
3. Other Workers	1.3
Non-Wage-Earning Workers	2
4. Self-Employed Workers	2.1
5. Individual Workers	2.2
6. Other Workers	2.3
Construction Service Workers	3

B.1 RECAPITULATION OF PARTICIPATION PER BUSINESS GROUP, GENDER, AND WORKFORCE

Reporting Period	Regional Office	Branch Office	Participant Segment

B.2 EXPLANATION OF RECAPITULATION OF PARTICIPATION PER BUSINESS GROUP, GENDER, AND WORKFORCE

This form contains all information regarding the recapitulation of participation per business group, gender, and workforce of the death insurance program:

1. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office
   Filled with the name of the regional office of the Social Security Implementing Agency for Employment.

3. Branch Office
   Filled with the name of the branch office of the Social Security Implementing Agency for Employment.

4. Participant Segment
   Filled with the participant segment of the death insurance program.

5. Counterparty
   Filled with the counterparty of the Social Security Implementing Agency for Employment participants.

No.	Business Group	Code
1. Agriculture, Fisheries, Plantations & Forestry	1
2. Mining	2
3. Basic Industry & Chemicals	3
4. Various Industries	4
5. Consumer Goods Industry	5
6. Property and Real Estate	6
7. Energy, Telecommunications & Transportation	7
8. Finance & Investment	8
9. Trade & Services	9

6. Total
   Filled with the total number of counterparty participants of the Social Security Implementing Agency for Employment.

7. Gender
   Filled with the gender of participants in the employment social security program.

8. Total
   Filled with the total number of male and female participants in the death insurance program.

9. In
   Filled with the number of participants who entered as participants in the death insurance program.

10. Out
    Filled with the number of participants who left as participants in the death insurance program.

11. Active
    Filled with the number of active participants in the death insurance program.

12. Non-Active
    Filled with the number of non-active participants in the death insurance program.

13. Total
    Filled with the total number of active and inactive participants in the death insurance program.

No.	Participant Segment	Code
Wage-Earning Workers	1
1. State Organizers	1.1
2. Private Employees/SOEs	1.2
3. Other Workers	1.3
Non-Wage-Earning Workers	2
4. Self-Employed Workers	2.1
5. Individual Workers	2.2
6. Other Workers	2.3
Construction Service Workers	3

C.1 RECAPITULATION OF PARTICIPATION PER AGE GROUP AND NATIONALITY

Reporting Period	Regional Office	Branch Office	Participant Segment	Age Group	Nationality
				1	2	3	4	5	6	7	8	9	10	11	12	13	Total

4. division name;
5. tax identification number; and
6. counterparty (according to the counterparty table).

VI. Supporting Data for the Complaint Recapitulation Report includes:

1. reporting period;
2. reporter name;
3. complaint type;
4. date of complaint submission; and
5. date of complaint resolution.

VII. Supporting Data for the Participant, Contribution, and Employer Recapitulation Report includes:

1. reporting period;
2. participant group;
3. location (according to the location table);
4. number of participants;
5. number of employers; and
6. contribution value.

Location Table

Signed.
Copy in accordance with the original
Legal Director 1
Legal Department,
Signed.
Sudarmaji