Circular Letter of the Financial Services Authority Regarding Corporate Plans and Business Plans for Insurance Companies, Sharia Insurance Companies, Reinsurance Companies, and Sharia Reinsurance Companies

Companies ...
To:
Insurance Companies;
Sharia Insurance Companies;
Reinsurance Companies; and
Sharia Reinsurance Companies
at their respective locations.

COPY

CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 15/SEOJK.05/2014

REGARDING

CORPORATE PLANS AND BUSINESS PLANS
FOR INSURANCE COMPANIES, SHARIA INSURANCE COMPANIES, REINSURANCE COMPANIES, AND SHARIA REINSURANCE COMPANIES

In relation to the mandate of Article 68 paragraph (5) of the Financial Services Authority Regulation Number 2/POJK.05/2014 concerning Good Corporate Governance for Insurance Companies (State Gazette of the Republic of Indonesia Year 2014 Number 71, Supplement to the State Gazette of the Republic of Indonesia Number 5526), it is necessary to regulate the form, structure, and procedures for drafting and submitting corporate plans and business plans for insurance companies, Sharia insurance companies, reinsurance companies, and Sharia reinsurance companies in this Financial Services Authority Circular Letter as follows:

I. GENERAL PROVISIONS

Company means an insurance company, Sharia insurance company, reinsurance company, and Sharia reinsurance company.
Insurance Company means a general insurance company and a life insurance company.
Sharia Insurance Company means a Sharia general insurance company and a Sharia life insurance company.
Reinsurance Company means a company that conducts reinsurance business as referred to in the laws and regulations concerning insurance.
Sharia Reinsurance Company means a company that conducts Sharia reinsurance business as referred to in the laws and regulations concerning insurance.
Good Corporate Governance for the Company, hereinafter referred to as Good Corporate Governance, is the structure and process used and applied by the Company's organs to improve the achievement of business results objectives and optimize the Company's value for all stakeholders, particularly policyholders, insured parties, participants, and/or parties entitled to benefits, in an accountable manner and based on legislation and ethical values.
Corporate Plan is a written document describing the Company's activities planned over a 5 (five) year period to determine strategy or direction, and to make decisions to allocate owned resources (including capital and human resources) to achieve the Company's objectives.
Business Plan is a written document describing the Company's business activities planned over a 1 (one) and 3 (three) year period, including plans to improve business performance, and strategies to realize these plans according to established targets and timeframes, while still paying attention to the fulfillment of prudential regulations and the application of risk management.
Board of Directors is the Company organ that performs management functions as referred to in the laws and regulations concerning limited liability companies for Companies that are legal entities of limited liability companies or equivalent to the Board of Directors for Companies that are legal entities of cooperatives or joint ventures.
Board of Commissioners is the Company organ that performs supervisory and advisory functions as referred to in the laws and regulations concerning limited liability companies for Companies that are legal entities of limited liability companies or equivalent to the Board of Commissioners for Companies that are legal entities of cooperatives or joint ventures.
Sharia Supervisory Board is a part of the Company's organ that conducts business activities based on Sharia principles and performs supervision over the implementation of insurance and reinsurance business to ensure compliance with Sharia principles.
General Meeting of Shareholders, hereinafter abbreviated as GMS, is the general meeting of shareholders as referred to in the laws and regulations concerning limited liability companies for Companies that are legal entities of limited liability companies or equivalent to the GMS for Companies that are legal entities of cooperatives or joint ventures.
Financial Services Authority is an independent institution free from the interference of other parties, which has the functions, duties, and authorities for regulation, supervision, examination, and investigation as referred to in Law Number 21 of 2011 concerning the Financial Services Authority.
Executive Head of Supervision for Insurance, Pensions, Financing Institutions, and Other Financial Service Institutions, hereinafter referred to as Executive Head of Non-Bank Financial Industry Supervision, is a member of the Financial Services Authority Commissioners tasked with leading the implementation of supervision over non-bank financial service institutions.

II. STRATEGIC PLANS

Companies are required to formulate strategic plans in the form of Corporate Plans and Business Plans.
Insurance Companies and Reinsurance Companies that have Sharia units are required to formulate strategic plans that include non-Sharia based insurance or reinsurance business and Sharia based insurance or reinsurance business.
Corporate Plans as referred to in item 1 must be submitted to the Financial Services Authority every 5 (five) years.
Business Plans as referred to in item 1 must be submitted to the Financial Services Authority every 1 (one) year.

III. CORPORATE PLANS

Corporate Plans must at least include:
a. evaluation of the implementation of the previous Corporate Plan period; b. the Company's current position;
c. assumptions used in formulating the Corporate Plan; and
d. objectives, targets, and strategies for their achievement.
Evaluation of the implementation of the previous Corporate Plan period as referred to in item 1 letter a must at least include:
a. evaluation of the implementation of the previous Corporate Plan period, conducted by comparing the Corporate Plan with the Business Plan and the realization of each year; b. achievement of established objectives and deviations that occurred;
c. implementation of established strategies and policies; and
d. obstacles faced and problem-solving efforts undertaken.
The Company's current position as referred to in item 1 letter b must at least include:
a. analysis used by the Company in formulating the Corporate Plan; b. targets established by the Company in the Corporate Plan; and
c. strategies used by the Company to achieve the Corporate Plan.
Assumptions used in formulating the Corporate Plan as referred to in item 1 letter c must at least include:
a. macro assumptions such as national economic growth assumptions, exchange rates, inflation rates, and average insurance industry growth; and b. micro assumptions including factors affecting the Company's operational activities originating from within.
Objectives, targets, and strategies for their achievement as referred to in item 1 letter d must at least include:
a. objectives to be achieved at the end of the Corporate Plan period linked to the Company's vision and mission; b. Company targets including growth rates and Company health, as well as targets for fields/units of activity (targets) quantitatively and specifically each year;
c. strategies used each year, including corporate strategies according to the Company's position, business strategies, and functional strategies for each field/unit of activity;
d. general and functional policies that provide flexibility boundaries and serve as guidelines for management in implementing strategies/activity programs; e. activity programs to be implemented each year; f. a matrix of linkages between targets, strategies, policies, and activity programs describing the Company's development direction in detail; g. assumptions for formulating financial projections; h. cash flow projections for each year over 5 (five) years;
i. financial position/balance sheet projections for each year over 5 (five) years;
j. comprehensive profit/loss projections for each year over 5 (five) years; k. projections of minimum risk-based capital financial health ratio ratios, projections of non-minimum risk-based capital financial health ratio ratios, and projections of profitability ratios; and
l. other matters related to the Company's activities.

IV. BUSINESS PLANS

Business Plans must at least include:
a. executive summary; b. management policies and strategies;
c. application of risk management and compliance;
d. the Company's current performance; e. projected financial statements along with assumptions used; f. projections of ratios and other specific items; g. capital plans; h. investment plans;
i. reinsurance plans;
j. product development and insurance product marketing plans for Insurance Companies and Sharia Insurance Companies, or reinsurance program development plans for Reinsurance Companies and Sharia Reinsurance Companies; k. organizational and human resources (HR) development plans;
l. information technology system development plans;
m. office network development and/or change plans; and n. other information.
The executive summary as referred to in item 1 letter a must at least include:
a. the Company's vision, mission, strategic values (corporate value), and organizational structure; b. the Company's policy direction containing information regarding the direction and policy of business development to be undertaken by the Company in the short term of 1 (one) year ahead and the medium term of 3 (three) years ahead;
c. key financial indicators including at least the Company's performance as of the end of September in the year of Business Plan formulation and projections of capital, solvency ratios, liquidity ratios, investment adequacy ratios, and other financial ratios, as well as risk level assessments, particularly asset and liability risks, insurance risks, and operational risks; and
d. short-term activity targets of the Company for the next 1 (one) year and medium-term activity targets of the Company for the next 3 (three) years.
Management policies and strategies referred to in item 1 letter b must at least include:
a. analysis of the Company's position in facing business competition containing analysis conducted at the industry level and against groups of Companies with similar characteristics; b. management policies containing general information on Company policies established by management to develop the Company's business in the future;
c. risk management and compliance policies containing information on steps to implement risk management formulated based on evaluation of the Company's risk profile and improvement efforts to be undertaken, as well as explanations regarding policies in implementing compliance functions;
d. business development strategies containing information on strategic steps to achieve the Company's established business objectives, including explanations regarding organizational and information technology development strategies, and strategies to anticipate changes in external conditions; and e. HR development strategies and remuneration policies which must at least include information on general policies regulating the provision of salaries, allowances, incentives, and other financial facilities to members of the Board of Commissioners, members of the Board of Directors, and employees, including to the Sharia Supervisory Board.
Application of risk management and compliance as referred to in item 1 letter c must at least include:
a. application of risk management, including risk profile assessments for all risks identified by the Company; b. application of Good Corporate Governance; and
c. application of compliance with Sharia principles for Sharia Insurance Companies, Sharia Reinsurance Companies, Insurance Companies, and Reinsurance Companies that have Sharia units.
The Company's current performance as referred to in item 1 letter d must at least include financial performance covering premium income or contribution aspects for Sharia based insurance or reinsurance business, investment results, profit, and capital both qualitatively and quantitatively.
Projected financial statements along with assumptions used as referred to in item 1 letter e must at least include:
a. financial position; b. comprehensive profit/loss;
c. cash flow; and
d. assumptions using optimistic, normal, and pessimistic assumptions. These assumptions must include both micro and macro assumptions.
Projections of ratios as referred to in item 1 letter f must at least include projections of core financial ratios and other specific items that can provide information for assessing capital conditions, solvency, liquidity, investment, and liabilities.
Capital plans as referred to in item 1 letter g must at least include plans for capital changes including plans for capital additions from existing or new shareholders, plans for capital additions through the capital market, and other capital additions, including working capital for Sharia units.
Investment plans as referred to in item 1 letter h must at least include:
a. plans for the composition of investment types; b. estimated investment returns for each type of investment; and
c. considerations underlying the plans for the composition of investment types.
Reinsurance plans as referred to in item 1 letter i must at least include:
a. details of maximum self-retention for each risk or event after reinsurance placement, according to business class/line of business; b. details of primary reinsurers including names, addresses, and countries of origin;
c. descriptions of self-retention including proportional automatic reinsurance support and/or non-proportional automatic reinsurance support; and
d. significant proportions of programs underwritten by one reinsurer or reinsurers affiliated with one insurance business group, additional information about reasons for selecting the aforementioned reinsurers, including details of guarantees provided and financial health.
Product development and insurance product marketing plans for Insurance Companies and Sharia Insurance Companies, or reinsurance program development plans for Reinsurance Companies and Sharia Reinsurance Companies as referred to in item 1 letter j must at least include:
a. insurance product development plans for Insurance Companies and Sharia Insurance Companies which must at least include:

lines of business to be developed for the next 1 (one) year;
product development studies considering data as follows:
a) community needs or demand for similar insurance products; b) marketing trends of similar insurance products by other insurance companies; c) availability of resources owned by the company to market similar insurance products; d) risk and loss profiles appropriate for the insurance products to be marketed and the target market segments; e) cost profiles appropriate for the products to be marketed; f) the company's current investment portfolio performance; g) investment portfolios appropriate for the insurance products to be marketed; h) capital; and i) risks that may arise for the company and their mitigation.
new product issuance plans which must at least include:
a) name of the new product (if already determined); b) line of business; c) type of coverage; d) risks covered; e) promised benefits; f) coverage period; g) marketing methods; h) target market; i) issuance or implementation schedule; j) objectives/benefits for the Company or policyholders; and k) risks that may arise. b. insurance product marketing plans must at least include distribution channels used and cooperation with third parties which must at least include:
name of the third party;
information regarding affiliation relationships with the third party;
business field of the third party;
name and general description of the product;
type of cooperation; and
duration of marketing cooperation.
c. reinsurance program development plans for Reinsurance Companies and Sharia Reinsurance Companies must at least include:
lines of business to be developed for the next 1 (one) year;
reinsurance program development studies considering data as follows:
a) needs or demand of other companies for similar reinsurance programs; b) marketing trends of similar reinsurance programs by other Reinsurance Companies and Sharia Reinsurance Companies; c) availability of resources owned by Reinsurance Companies and Sharia Reinsurance Companies to market similar reinsurance programs; d) risk and loss profiles appropriate for the reinsurance programs to be marketed and the target market segments; e) cost profiles appropriate for the reinsurance programs to be marketed; f) current investment portfolio performance of Reinsurance Companies and Sharia Reinsurance Companies; g) investment portfolios appropriate for the reinsurance programs to be marketed; h) capital; and i) risks that may arise for Reinsurance Companies and Sharia Reinsurance Companies and their mitigation. d. HR development plans related to insurance product development.

Organizational and HR development plans as referred to in item 1 letter k must at least include:
a. organizational development plans containing plans for the formation/change of work units and/or committees adjusted to the size and complexity of the Company's business; b. HR development plans containing:

plans for HR quantity needs;
plans for HR education and training needs and education/training cost/budget plans according to applicable regulations; and
c. plans for the utilization of foreign labor and outsourcing which include plans for the use of labor outside permanent labor, both foreign and local, including the number and fields of assignment.

Information technology system development plans as referred to in item 1 letter l must at least meet the following requirements:
a. can provide current and accurate information regarding the underwriting portfolio and risk and loss profiles; and b. can support reporting to the Financial Services Authority.
Office network development and/or change plans as referred to in item 1 letter m must at least include plans for opening and merging offices outside the head office.
Other information as referred to in item 1 letter n must at least include information that needs to be submitted because it affects the Company's business activities, which is not mentioned in the scope of the Business Plan as referred to in item 1 letters a through m.

Examples:

merger, acquisition, and consolidation plans;
underwriting portfolio transfer plans;
changes in insurance business field plans;
changes in business activities from non-Sharia based to Sharia based plans.

V. PROCEDURES FOR FORMULATING CORPORATE PLANS AND BUSINESS PLANS

The Board of Directors is required to formulate concepts of Corporate Plans and Business Plans.
The Board of Directors together with the Board of Commissioners discusses the Corporate Plans and Business Plans.
The Board of Directors requests approval from the GMS for the concepts of Corporate Plans and Business Plans to be established as the Company's Corporate Plans and Business Plans.
Approval from the GMS as referred to in item 3 can be conducted through physical meetings or through decision-making with circulated proposals (circular resolution) for Companies that are legal entities of limited liability companies as referred to in the limited liability company laws.
Corporate Plans and Business Plans are established in Board of Directors' decrees.

VI. FORM AND STRUCTURE OF CORPORATE PLANS AND BUSINESS PLANS, BUSINESS PLAN REALIZATION REPORTS, AND BOARD OF COMMISSIONERS SUPERVISION RESULTS REPORTS

The form and structure of Corporate Plans, Business Plans, Business Plan realization reports, and Board of Commissioners supervision results reports are as follows:
a. for Insurance Companies and Reinsurance Companies as referred to in Annex I, II, V, and VIII; b. for Insurance Companies and Reinsurance Companies that have Sharia units as referred to in Annex I, III, VI, and IX; and
c. for Sharia Insurance Companies and Sharia Reinsurance Companies as referred to in Annex I, IV, VII, and X;
which are an inseparable part of this Financial Services Authority Circular Letter.
In the event there is other information that needs to be submitted by the Company in Corporate Plans and Business Plans but its format is not regulated in this Financial Services Authority Circular Letter, the format for submitting such information is left to the Company.

VII. TIME AND PROCEDURES FOR SUBMISSION AND CHANGES TO CORPORATE PLANS AND BUSINESS PLANS

Companies are required to submit Corporate Plans and Business Plans that have been approved by the GMS.
Corporate Plans and Business Plans as referred to in item 1 must be submitted to the Executive Head of Non-Bank Financial Industry Supervision no later than October 31 before the year the Corporate Plans and Business Plans begin.
Corporate Plans and Business Plans as referred to in item 1 must be accompanied by proof of shareholder approval either through the GMS or decision-making with circulated proposals (circular resolution) for Companies that are legal entities of limited liability companies.
The Financial Services Authority may request the Company to make adjustments to the Corporate Plans and/or Business Plans in the following cases:

Perusahaan ... a plan a. the submitted Corporate Plan and Business Plan are assessed as not fully meeting the provisions of the Financial Services Authority Circular Letter and/or other insurance sector regulations; b. the company fails to meet the minimum solvency target, thereby being required to submit a financial rehabilitation plan; and/or
c. other conditions as determined by the Financial Services Authority that may affect the Company's ability to fulfill the Corporate Plan and/or Business Plan.
5. The Company must submit adjustments to the Corporate Plan and Business Plan within the time limit specified in the Financial Services Authority's letter.
6. A Company may only make changes to the Corporate Plan 1 (one) time and must be submitted no later than the end of the first year of the current period, except in the event of:
a. a change in ownership resulting in a change of company control; or b. a change in macroeconomic conditions that significantly affects the company's condition. Example: The 2015 to 2019 Corporate Plan can only be changed no later than the end of 2015.
7. A Company may only make changes to the Business Plan 1 (one) time and must be submitted no later than the end of June of the current year.
8. Changes to the Corporate Plan and Business Plan must be submitted no later than 15 (fifteen) working days before the implementation of the Corporate Plan and Business Plan changes.
Example:
a. The 2015 to 2019 Corporate Plan can only be changed no later than the end of 2015. In the event the Company wishes to change the Corporate Plan on November 1, 2015, the Company is required to submit the change plan on October 15, 2015. b. The 2015 to 2017 Business Plan can only be changed no later than the end of June 2015. In the event the Company wishes to change the Business Plan on June 1, 2015, then

IX. REPORT ...
The Company is required to submit the change plan on May 15, 2015.
9. In the event that the final deadline for submitting the Corporate Plan and Business Plan, as well as changes or adjustments as referred to in item 2, item 5, and item 8, falls on a holiday, the Corporate Plan and Business Plan, as well as changes or adjustments, must be submitted on the next working day.
10. The Company is required to submit to the Head of the Executive Supervisor of Non-Bank Financial Industry the Corporate Plan and Business Plan, reports on changes and adjustments, reports on the realization of the business plan, and reports on the results of the Supervisory Board's supervision in electronic form (soft copy) placed in a sealed envelope.

VIII. BUSINESS REALIZATION REPORT

The Company is required to submit a report on the realization of the Business Plan annually.
The report as referred to in item 1 must be submitted to the Financial Services Authority no later than 2 (two) months after the relevant period ends.
In the event that the final deadline for submitting the Business Realization Report as referred to in item 2 falls on a holiday, the Business Realization Report must be submitted on the next working day.
The report as referred to in item 1 includes:
a. General realization reports consisting of:

an explanation of the achievement of the Business Plan;
financial ratios and specific items;
an explanation of deviations from the Business Plan realization;
follow-up actions on the achievement of the Business Plan; and
other information.
b. Detailed reports of the Company's activities consisting of:
reports on the realization of the development and/or change of office networks;
reports on the realization of the use of foreign labor and knowledge transfer to accompanying personnel;
reports on the realization of training/teaching by foreign labor; and
reports on the realization of product development.

For ...
IX. SUPERVISORY BOARD OVERSIGHT RESULTS REPORT ON THE IMPLEMENTATION OF THE BUSINESS PLAN
The Company is required to submit a report on the results of the Supervisory Board's supervision regarding the implementation of the Business Plan annually.
The report as referred to in item 1 must be submitted to the Financial Services Authority no later than 2 (two) months after the relevant period ends.
In the event that the final deadline for submitting the Supervisory Board's oversight results report on the implementation of the business plan as referred to in item 2 falls on a holiday, the Supervisory Board's oversight results report on the implementation of the business plan must be submitted on the next working day.
The report as referred to in item 1 must at least include:
a. the Supervisory Board's assessment of factors affecting the company's overall performance; b. the Supervisory Board's assessment of the Business Plan realization regarding non-financial factors; and
c. the Supervisory Board's recommendations regarding efforts to improve company performance.

X. ADDRESS FOR SUBMISSION OF CORPORATE PLAN AND BUSINESS PLAN
The Corporate Plan and Business Plan, as well as changes and adjustments as referred to in Roman VII, the Business Realization Report as referred to in Roman VIII, and the Supervisory Board's oversight results report on the implementation of the Business Plan as referred to in Roman IX, are submitted via a letter signed by the Board of Directors addressed to:

For Insurance Companies and Reinsurance Companies:
Head of the Executive Supervisor of Non-Bank Financial Industry Financial Services Authority u.p. Director of Insurance Supervision and BPJS Kesehatan Sumitro Djojohadikusumo Building, 14th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710
Company ...
For Insurance Companies and Reinsurance Companies that have Sharia units:
a. Head of the Executive Supervisor of Non-Bank Financial Industry Financial Services Authority u.p. Director of Insurance Supervision and BPJS Kesehatan Sumitro Djojohadikusumo Building, 14th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710; and b. Head of the Executive Supervisor of Non-Bank Financial Industry Financial Services Authority u.p. Director of Sharia IKNB Sumitro Djojohadikusumo Building, 13th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710
For Sharia Insurance Companies and Sharia Reinsurance Companies:
Head of the Executive Supervisor of Non-Bank Financial Industry Financial Services Authority u.p. Director of Sharia IKNB Sumitro Djojohadikusumo Building, 13th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710
In the event of a change in the Financial Services Authority's office address for the submission of reports as referred to in Roman VII, VIII, and Roman IX, the Financial Services Authority will provide notification regarding the address change via letter or announcement.

XI. OTHER PROVISIONS

For Companies that have obtained a business license from the Financial Services Authority before the implementation of this Financial Services Authority Circular Letter, the submission of the Corporate Plan and Business Plan as referred to in Roman VII item 2, must be submitted for the first time no later than January 30, 2015.
Parties applying for a business license as a Company are required to submit the Corporate Plan and Business Plan together with the application.
Companies that have applied for a business license before the implementation of this Financial Services Authority Circular Letter and obtained a business license until June 30, 2015, are required to submit the Corporate Plan and Business Plan for the first time no later than October 31, 2015.
Companies that have applied for a business license before the implementation of this Financial Services Authority Circular Letter and obtained a business license after June 30, 2015, are required to submit the Corporate Plan and Business Plan for the first time no later than October 31, 2016.

XII. CLOSING
The provisions of this Financial Services Authority Circular Letter take effect on the date of determination. To ensure that everyone knows, it is ordered that this Financial Services Authority Circular Letter be announced by placing it in the State Gazette of the Republic of Indonesia. Determined in Jakarta on December 9, 2014 HEAD OF EXECUTIVE SUPERVISOR OF INSURANCE, PENSION FUNDS. FINANCING INSTITUTIONS, AND OTHER FINANCIAL SERVICE INSTITUTIONS FINANCIAL SERVICES AUTHORITY, Signed, FIRDAUS DJAELANI STATE GAZETTE OF THE REPUBLIC OF INDONESIA YEAR 2014 NUMBER Copy matches the original Legal Director 1 Legal Department, Signed, Tini Kustini

APPENDIX I
FINANCIAL SERVICES AUTHORITY CIRCULAR LETTER NUMBER 15/SEOJK.05/2014 REGARDING CORPORATE PLAN AND BUSINESS PLAN INSURANCE COMPANIES, SHARIA INSURANCE COMPANIES, REINSURANCE COMPANIES, AND SHARIA REINSURANCE COMPANIES

Form of Submission of Corporate Plan and/or Business Plan COMPANY LETTERHEAD Number :
Nature :
Attachment :
Subject :
To
/20.. ....................................................................., ............................ 20... Urgent 1 (one) file Submission of Corporate Plan and/or Business Plan PT XYZ Head of the Executive Supervisor of Non-Bank Financial Industry Financial Services Authority u.p. Director of Insurance Supervision and BPJS Kesehatan Soemitro Djojohadikusumo Building 14th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710
Hereby enclosed we submit the Corporate Plan for the fiscal year period........
and/or Business Plan PT XYZ for the fiscal year period
...........................................

COMPANY LETTERHEAD
Number :
Nature :
Attachment :
Subject :
To
/20.. ....................................................................., ............................ 20... Urgent 1 (one) file Submission of Corporate Plan and/or Business Plan PT XYZ Head of the Executive Supervisor of Non-Bank Financial Industry Financial Services Authority u.p. Director of Sharia IKNB Soemitro Djojohadikusumo Building 13th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710
Hereby enclosed we submit the Corporate Plan for the fiscal year period.........
and/or Business Plan PT XYZ for the fiscal year period
...........................................

and BPJS Kesehatan and Director of Sharia IKNB

Letter addressed to Director of Insurance Supervision and BPJS Kesehatan
COMPANY LETTERHEAD
Number :
Nature :
Attachment :
Subject :
To
/20.. ....................................................................., ............................ 20... Urgent 1 (one) file Submission of Corporate Plan and/or Business Plan PT XYZ Head of the Executive Supervisor of Non-Bank Financial Industry Financial Services Authority u.p. Director of Insurance Supervision and BPJS Kesehatan Soemitro Djojohadikusumo Building 14th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710
Hereby enclosed we submit the Corporate Plan for the fiscal year period.........
and/or Business Plan PT XYZ for the fiscal year period
...........................................
Letter addressed to Director of Sharia IKNB
COMPANY LETTERHEAD
Number :
Nature :
Attachment :
Subject :
To
/20.. ....................................................................., ............................ 20... Urgent 1 (one) file Submission of Corporate Plan and/or Business Plan PT XYZ Head of the Executive Supervisor of Non-Bank Financial Industry Financial Services Authority u.p. Director of Sharia IKNB Soemitro Djojohadikusumo Building 13th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710
Hereby enclosed we submit the Corporate Plan for the fiscal year period.........
and/or Business Plan PT XYZ for the fiscal year period
...........................................

Form of Adjustment Letter
Business Plan
COMPANY LETTERHEAD
Number :
Nature :
Attachment :
Subject :
To
/20.. ....................................................................., ............................ 20... Urgent 1 (one) file Submission of Business Plan Adjustment PT XYZ Head of the Executive Supervisor of Non-Bank Financial Industry Financial Services Authority u.p. Director of Insurance Supervision and BPJS Kesehatan Soemitro Djojohadikusumo Building 14th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710 Hereby enclosed we submit the Business Plan Adjustment PT XYZ for the fiscal year period Some adjustments we have made are related to:
a. (e.g.: adjustment of investment plan) b.
...........................................

COMPANY LETTERHEAD
Number :
Nature :
Attachment :
Subject :
To
/20.. ....................................................................., ............................ 20... Urgent 1 (one) file Submission of Business Plan Adjustment PT XYZ Head of the Executive Supervisor of Non-Bank Financial Industry Financial Services Authority u.p. Director of Sharia IKNB Soemitro Djojohadikusumo Building 13th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710 Hereby enclosed we submit the Business Plan Adjustment PT XYZ for the fiscal year period Some adjustments we have made are related to:
a. (e.g.: adjustment of investment plan)
b. .........
...........................................

and BPJS Kesehatan and Director of Sharia IKNB

Letter addressed to Director of Insurance Supervision and BPJS Kesehatan
COMPANY LETTERHEAD
Number :
Nature :
Attachment :
Subject :
To
/20.. ....................................................................., ............................ 20... Urgent 1 (one) file Submission of Business Plan Adjustment PT XYZ Head of the Executive Supervisor of Non-Bank Financial Industry Financial Services Authority u.p. Director of Insurance Supervision and BPJS Kesehatan Soemitro Djojohadikusumo Building 14th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710 Hereby enclosed we submit the Business Plan Adjustment PT XYZ for the fiscal year period Some adjustments we have made are related to:
a. (e.g.: adjustment of investment plan)
b. .........
...........................................
Letter addressed to Director of Sharia IKNB
COMPANY LETTERHEAD
Number :
Nature :
Attachment :
Subject :
To
/20.. ....................................................................., ............................ 20... Urgent 1 (one) file Submission of Business Plan Adjustment PT XYZ Head of the Executive Supervisor of Non-Bank Financial Industry Financial Services Authority u.p. Director of Sharia IKNB Soemitro Djojohadikusumo Building 13th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710 Hereby enclosed we submit the Business Plan Adjustment PT XYZ for the fiscal year period Some adjustments we have made are related to:
a. (e.g.: adjustment of investment plan)
b. .........
...........................................

Form of Change Letter
Business Plan
COMPANY LETTERHEAD
Number :
Nature :
Attachment :
Subject :
To
/20.. ....................................................................., ............................ 20... Urgent 1 (one) file Submission of Business Plan Change PT XYZ Head of the Executive Supervisor of Non-Bank Financial Industry Financial Services Authority u.p. Director of Insurance Supervision and BPJS Kesehatan Soemitro Djojohadikusumo Building 14th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710 Hereby enclosed we submit the Business Plan Change PT XYZ for the fiscal year period Some changes we have made are related to:
a. (e.g.: change of product development plan)
b. .........
...........................................

COMPANY LETTERHEAD
Number :
Nature :
Attachment :
Subject :
To
/20.. ....................................................................., ............................ 20... Urgent 1 (one) file Submission of Business Plan Change PT XYZ Head of the Executive Supervisor of Non-Bank Financial Industry Financial Services Authority u.p. Director of Sharia IKNB Soemitro Djojohadikusumo Building 13th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710 Hereby enclosed we submit the Business Plan Change PT XYZ for the fiscal year period Some changes we have made are related to:
a. (e.g.: change of product development plan)
b. .........
...........................................

and BPJS Kesehatan and Director of Sharia IKNB

Letter addressed to Director of Insurance Supervision and BPJS Kesehatan
COMPANY LETTERHEAD
Number :
Nature :
Attachment :
Subject :
To
/20.. ....................................................................., ............................ 20... Urgent 1 (one) file Submission of Business Plan Change PT XYZ Head of the Executive Supervisor of Non-Bank Financial Industry Financial Services Authority u.p. Director of Insurance Supervision and BPJS Kesehatan Soemitro Djojohadikusumo Building 14th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710 Hereby enclosed we submit the Business Plan Change PT XYZ for the fiscal year period Some changes we have made are related to:
a. (e.g.: change of product development plan)
b. .........
...........................................
Letter addressed to Director of Sharia IKNB
COMPANY LETTERHEAD
Number :
Nature :
Attachment :
Subject :
To
/20.. ....................................................................., ............................ 20... Urgent 1 (one) file Submission of Business Plan Change PT XYZ Head of the Executive Supervisor of Non-Bank Financial Industry Financial Services Authority u.p. Director of Sharia IKNB Soemitro Djojohadikusumo Building 13th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710 Hereby enclosed we submit the Business Plan Change PT XYZ for the fiscal year period Some changes we have made are related to:
a. (e.g.: change of product development plan)
b. .........
...........................................

Form of Adjustment Letter
Corporate Plan
COMPANY LETTERHEAD
Number :
Nature :
Attachment :
Subject :
To
/20.. ....................................................................., ............................ 20... Urgent 1 (one) file Submission of Corporate Plan Adjustment PT XYZ Head of the Executive Supervisor of Non-Bank Financial Industry Financial Services Authority u.p. Director of Insurance Supervision and BPJS Kesehatan Soemitro Djojohadikusumo Building 14th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710 Hereby enclosed we submit the Corporate Plan Adjustment PT XYZ for the fiscal year period Some adjustments we have made are related to:
a. (e.g.: adjustment of targets, strategies, and company work programs)
b. .........
...........................................

COMPANY LETTERHEAD
Number :
Nature :
Attachment :
Subject :
To
/20.. ....................................................................., ............................ 20... Urgent 1 (one) file Submission of Corporate Plan Adjustment PT XYZ Head of the Executive Supervisor of Non-Bank Financial Industry Financial Services Authority u.p. Director of Sharia IKNB Soemitro Djojohadikusumo Building 13th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710 Hereby enclosed we submit the Corporate Plan Adjustment PT XYZ for the fiscal year period Some adjustments we have made are related to:
a. (e.g.: adjustment of targets, strategies, and company work programs)
b. .........
...........................................

and BPJS Kesehatan and Director of Sharia IKNB

Letter addressed to Director of Insurance Supervision and BPJS Kesehatan
COMPANY LETTERHEAD
Number :
Nature :
Attachment :
Subject :
To
/20.. ....................................................................., ............................ 20... Urgent 1 (one) file Submission of Corporate Plan Adjustment PT XYZ Head of the Executive Supervisor of Non-Bank Financial Industry Financial Services Authority u.p. Director of Insurance Supervision and BPJS Kesehatan Soemitro Djojohadikusumo Building 14th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710 Hereby enclosed we submit the Corporate Plan Adjustment PT XYZ for the fiscal year period Some adjustments we have made are related to:
a. (e.g.: adjustment of targets, strategies, and company work programs)
b. .........
...........................................
Letter addressed to Director of Sharia IKNB
COMPANY LETTERHEAD
Number :
Nature :
Attachment :
Subject :
To
/20.. ....................................................................., ............................ 20... Urgent 1 (one) file Submission of Corporate Plan Adjustment PT XYZ Head of the Executive Supervisor of Non-Bank Financial Industry Financial Services Authority u.p. Director of Sharia IKNB Soemitro Djojohadikusumo Building 13th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710 Hereby enclosed we submit the Corporate Plan Adjustment PT XYZ for the fiscal year period Some adjustments we have made are related to:
a. (e.g.: adjustment of targets, strategies, and company work programs)
b. .........
...........................................

Form of Change Letter
Corporate Plan
COMPANY LETTERHEAD
Number :
Nature :
Attachment :
Subject :
To
/20.. ....................................................................., ............................ 20... Urgent 1 (one) file Submission of Corporate Plan Change PT XYZ Head of the Executive Supervisor of Non-Bank Financial Industry Financial Services Authority u.p. Director of Insurance Supervision and BPJS Kesehatan Soemitro Djojohadikusumo Building 14th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710 Hereby enclosed we submit the Corporate Plan Change PT XYZ for the fiscal year period Some changes we have made are related to:
a. (e.g.: change of assumptions used in preparing the company work plan)
b. ........
...........................................

COMPANY LETTERHEAD
Number :
Nature :
Attachment :
Subject :
To
/20.. ....................................................................., ............................ 20... Urgent 1 (one) file Submission of Corporate Plan Change PT XYZ Head of the Executive Supervisor of Non-Bank Financial Industry Financial Services Authority u.p. Director of Sharia IKNB Soemitro Djojohadikusumo Building 13th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710 Hereby enclosed we submit the Corporate Plan Change PT XYZ for the fiscal year period Some changes we have made are related to:
a. (e.g.: change of assumptions used in preparing the company work plan)
b. .......
...........................................

and BPJS Kesehatan and Director of Sharia IKNB

Letter addressed to Director of Insurance Supervision and BPJS Kesehatan
COMPANY LETTERHEAD
Number :
Nature :
Attachment :
Subject :
To
/20.. ....................................................................., ............................ 20... Urgent 1 (one) file Submission of Corporate Plan Change PT XYZ Head of the Executive Supervisor of Non-Bank Financial Industry Financial Services Authority u.p. Director of Insurance Supervision and BPJS Kesehatan Soemitro Djojohadikusumo Building 14th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710 Hereby enclosed we submit the Corporate Plan Change PT XYZ for the fiscal year period Some changes we have made are related to:
a. (e.g.: change of assumptions used in preparing the company work plan)
b. .......
...........................................
Letter addressed to the Director of Sharia Non-Bank Financial Industry

[Company Letterhead]
Number:
Nature:
Attachments:
Subject:

To
/20.. ....................................................................., ............................ 20... Immediately

1 (one) file

Submission of Changes to the Corporate Plan of PT XYZ

Executive Head of the Non-Bank Financial Industry Supervisor Financial Services Authority

Attention: Director of Sharia Non-Bank Financial Industry Soemitro Djojohadikusumo Building, 13th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710

Hereby we submit the Changes to the Corporate Plan of PT XYZ for the fiscal year period

Some changes we have made include:
a. (e.g., changes in assumptions used in preparing the company's work plan)
b. .......
...........................................

Format for the Letter of Submission of the Business Plan Realization Report and the Board of Commissioners' Supervision Results Report

[Company Letterhead]
Number:
Nature:
Attachments:
Subject:

To
/20.. ....................................................................., ............................ 20... Immediately

1 (one) file

Submission of the Business Plan Realization Report of PT XYZ

Executive Head of the Non-Bank Financial Industry Supervisor Financial Services Authority

Attention: Director of Insurance Supervision and BPJS Kesehatan Soemitro Djojohadikusumo Building, 14th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710

Hereby we submit the Business Plan Realization Report and the Board of Commissioners' Supervision Results Report of PT XYZ for the fiscal year period

This is our report, we thank you for your attention.
Board of Directors of PT XYZ
...........................................

[Company Letterhead]
Number:
Nature:
Attachments:
Subject:

To
/20.. ....................................................................., ............................ 20... Immediately

1 (one) file

Submission of the Business Plan Realization Report and the Board of Commissioners' Supervision Results Report of PT XYZ

Executive Head of the Non-Bank Financial Industry Supervisor Financial Services Authority

Attention: Director of Sharia Non-Bank Financial Industry Soemitro Djojohadikusumo Building, 13th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710

Hereby we submit the Business Plan Realization Report and the Board of Commissioners' Supervision Results Report of PT XYZ for the fiscal year period

This is our report, we thank you for your attention.
Board of Directors of PT XYZ
...........................................

and BPJS Kesehatan and the Director of Sharia Non-Bank Financial Industry

Letter addressed to the Director of Insurance Supervision and BPJS Kesehatan

[Company Letterhead]
Number:
Nature:
Attachments:
Subject:

To
/20.. ....................................................................., ............................ 20... Immediately

1 (one) file

Submission of the Business Plan Realization Report and the Board of Commissioners' Supervision Results Report of PT XYZ

Executive Head of the Non-Bank Financial Industry Supervisor Financial Services Authority

Attention: Director of Insurance Supervision and BPJS Kesehatan Soemitro Djojohadikusumo Building, 14th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710

Hereby we submit the Business Plan Realization Report and the Board of Commissioners' Supervision Results Report of PT XYZ for the fiscal year period

This is our report, we thank you for your attention.
Board of Directors of PT XYZ
...........................................

Letter addressed to the Director of Sharia Non-Bank Financial Industry

[Company Letterhead]
Number: /20.. ....................................................................., ................. 20... Nature: Immediately Attachments: 1 (one) file Subject: Submission of the Business Plan Realization Report and the Board of Commissioners' Supervision Results Report of PT XYZ

To
Executive Head of the Non-Bank Financial Industry Supervisor Financial Services Authority

Attention: Director of Sharia Non-Bank Financial Industry Soemitro Djojohadikusumo Building, 13th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710

Hereby we submit the Business Plan Realization Report and the Board of Commissioners' Supervision Results Report of PT XYZ for the fiscal year period

This is our report, we thank you for your attention.
Board of Directors of PT XYZ
...........................................

Established in Jakarta on the date of December 9, 2014

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

Signed,
FIRDAUS DJAELANI

Copy matches the original
Legal Director 1
Legal Department,

Signed. Signed.
Tini Kustini

APPENDIX II
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 15/SEOJK.05/2014 REGARDING CORPORATE PLAN AND BUSINESS PLAN OF INSURANCE COMPANIES, SHARIA INSURANCE COMPANIES, REINSURANCE COMPANIES, AND SHARIA REINSURANCE COMPANIES

CORPORATE PLAN
GENERAL INSURANCE COMPANY / REINSURANCE COMPANY / LIFE INSURANCE COMPANY 1
Year................................2
PT. XYZ

2 Corporate Plan period reported, e.g., year 2015 – 2017

Company Name :
Full Address :
Telephone and Fax :
Email :
Taxpayer Identification Number (NPWP) :
Business License No. & Date :
Shareholders :
Share Ownership
Shareholder Name
Rupiah
Percentage
Board of Directors and Board of Commissioners :
Board of Directors Name Position
Corporate Plan PIC (1 person)
,
PT. XYZ
Total
Board of Commissioners Name Position

OJK
Board of Directors

TABLE OF CONTENTS
Page
Company Profile
Table of Contents
Introduction
Executive Summary
CHAPTER I INTRODUCTION
1.1 Company History
1.2 Vision, Mission, and Values
1.3 Company Organizational Structure
CHAPTER II CURRENT POSITION OF INSURANCE COMPANY OR REINSURANCE COMPANY 1
2.1 Human Resources
2.2 IT Management
2.3 Products Marketed
2.4 Analysis Used in Preparing the Corporate Plan
2.5 Company Segmentation or Positioning Map
2.6 Company Market Share
CHAPTER III EVALUATION OF PREVIOUS CORPORATE PLAN IMPLEMENTATION 2
3.1 Comparison Between Corporate Plan and Business Plan Realization Each Year
3.2 Achievement of Objectives and Deviations Occurring
3.3 Implementation of Established Strategies and Policies
3.4 Challenges Faced and Problem-Solving Efforts
CHAPTER IV ASSUMPTIONS USED IN PREPARING THE CORPORATE PLAN 3
4.1 Macro Assumptions
4.2 Micro Assumptions
CHAPTER V OBJECTIVES, TARGETS, AND STRATEGIES FOR ACHIEVING THE CORPORATE PLAN 3
5.1 Objectives to be Achieved at the End of the Corporate Plan
5.2 Company Targets
5.3 Strategies Used by the Company
5.4 General and Functional Policies
5.5 Activity Programs
5.6 Matrix of Interconnection Between Targets, Strategies, Policies, and Activity Programs
5.7 Assumptions for Financial Projection Preparation
5.8 Cash Flow Projection Each Year for Five Years
5.9 Financial Position/Balance Sheet Projection Each Year for Five Years
5.10 Comprehensive Profit/Loss Projection Each Year for Five Years
5.11 Projection of MMBR Financial Health Ratio, Non-MMBR Financial Health Ratio, and Profitability Ratio
5.12 Other Matters Related to Company Activities

Note:
1 CHAPTER II describes the company's current position.
2 CHAPTER III describes the evaluation of the implementation of the previous corporate plan/long-term plan period. If the company is a new company, ignore the preparation of CHAPTER III. 3 CHAPTER IV and CHAPTER V describe the corporate plan period to be reported to the Financial Services Authority.

Introduction
The Introduction contains the background of the Corporate Plan preparation, the formulation of important aspects in the prepared Corporate Plan, and other matters considered important to convey. Important aspects in the Corporate Plan should only be summaries containing the outline and emphasizing the main points.

Executive Summary
The Executive Summary is the entry point to the Corporate Plan. This paragraph is merely a summary emphasizing the content of the submitted corporate plan.

CHAPTER I
INTRODUCTION
1.1 Company History
State when the company was founded, by whom, and for what purpose. How did the company develop after that? Have the company name and ownership changed since its founding? If your company is a new company, provide the background of the company's founding.

1.2 Vision, Mission, and Values
Vision is the picture of the company's condition in the future and represents the company's aspirations. Vision is a statement answering the question of the company's direction forward. Mission is the elaboration of the vision, where the mission elaborates a careful analysis of the desired benefits by existing policyholders and prospective policyholders. The mission also elaborates on the existing environmental and market conditions and the company's anticipation for the future. In realizing the vision and implementing the mission, the company relies on core values; elaborate on these values (if any).

1.3 Organizational Structure
Elaborate on the composition of the Board of Commissioners and Board of Directors and the work units under them in the company. Illustrate in the form of an organization chart.

CHAPTER II
CURRENT POSITION OF INSURANCE COMPANY OR REINSURANCE COMPANY
2.1 Human Resources
Show the number of management, company employees, experts used, foreign workers, and insurance agents currently available.

2.2 IT Management
Elaborate on the use of information technology used by the company to support business activities.

2.3 Products Marketed
Elaborate on a summary of products and services offered/sold. Example table No. Product Name General Description Product Number and Date of Recording Letter

2.4 Analysis Used in Preparing the Corporate Plan
Describe the analysis used when the company prepares the corporate plan, e.g., SWOT analysis, Balanced Scorecard, PEST, etc.

2.5 Company Segmentation or Positioning Map
Describe the company's position in the industry (upper, middle, and lower) specifically for business lines or products that are the company's focus.

2.6 Company Market Share
Describe the company's market share by comparing the company's premium revenue and industry revenue in each business line.

CHAPTER III
EVALUATION OF PREVIOUS CORPORATE PLAN IMPLEMENTATION
3.1 Comparison Between Corporate Plan and Business Plan Realization Each Year (Ignore if your company is a new company)
Elaborate in detail on the current corporate plan and its realization with the business plan each year. In this section, the company can view its performance during that period by comparing the corporate plan with the business plan realization. The example table below can be modified in more detail according to the company's needs.

Indicator
20XX-1 20XX-2 20XX-3 20XX-4 20XX-5
Corporate Plan
Realization
% Corporate Plan
Realization
% Corporate Plan
Realization
% Corporate Plan
Realization
% Corporate Plan
Realization
% Corporate Plan
Realization
%
(1) (2) (2/1) (1) (2) (2/1) (1) (2) (2/1) (1) (2) (2/1) (1) (2) (2/1) Premium Revenue Profit/Loss Return on Equity Return on Assets Solvency Ratio Liquidity Ratio Investment Adequacy Ratio Investment Income to Net Premium Ratio Claim Expense, Operating Expense, and Commission Ratio etc. (add other indicators as deemed necessary)

Note:

If the corporate plan submission is for the year 2015-2019, then 20XX-1 is 2014, 20XX-2 is 2013, etc.

3.2 Achievement of Objectives and Deviations Occurring
This section is a detailed picture of each indicator in the comparison table between the corporate plan and business plan, and if there are deviations in the comparison table, the reasons for the deviations are conveyed. Also elaborate on the company's objectives related to the achievement of sales, profits, and target market share and their realization; what about the deviations that occurred?

3.3 Implementation of Established Strategies and Policies
Explain the company's strategies and policies and elaborate on the implementation of the agreed and established company strategies and policies, e.g., regarding business lines, distribution channels, and production business sources that will be the company's focus.

3.4 Challenges Faced and Problem-Solving Efforts
Clearly state the challenges faced in implementing the established corporate plan and what the solutions are for problem-solving.

4.2 Micro Assumptions
This paragraph contains the elaboration of micro assumptions used in preparing the five-year corporate plan, e.g., investment yield levels, number of new coverages, lapse ratio, catastrophic losses, and factors affecting company operational activities originating from within the company.

CHAPTER V
OBJECTIVES, TARGETS, AND STRATEGIES FOR ACHIEVING THE CORPORATE PLAN
5.1 Objectives to be Achieved at the End of the Corporate Plan
Elaborate on the company's objectives to be achieved at the end of the corporate plan period, linked to the company's vision and mission.

5.2 Company Targets
This paragraph contains the company's targets during the five-year corporate plan period. Targets are made detailed and measurable, meaning they can measure the achievement of objectives.

5.3 Strategies Used by the Company
Strategies used by the company include corporate strategies according to the company's position, business strategies, and functional strategies for each field/unit of activity. Corporate strategy is more global than business and functional strategies. Business strategies emphasize improving the company's financial performance, while functional strategies focus more on strategies for each field/unit in the company, e.g., the marketing field/unit's strategy is cooperation with banks in product marketing.

5.4 General and Functional Policies
General and functional policies that provide flexibility boundaries and serve as management guidelines in implementing strategies or activity programs.

5.5 Activity Programs
Elaborate on the activity programs to be implemented each year for the next five years.

5.6 Matrix of Interconnection Between Targets, Strategies, Policies, and Activity Programs
A matrix of interconnection between targets, strategies, policies, and activity programs that describes the company's development direction in detail. An example matrix format can be seen below; if the company does not have a format, it can use the available format. Example:
Strategic Issue 1:
Human Resources Structure
Targets:

Increase productive age to 90.5%.
Increase experts from 10% (40 people) to 25% (100 people).
Realize an ideal HR composition structure.
Strategy:
HR Recomposition and Mapping
Policy:
HR Recomposition is based on competencies required by the company

No. Program 20XX 20XX+1 20XX+2 20XX+3 20XX+4 1 Conduct manpower planning 2 Job enrichment 3 Systematic and continuous employee mutation or rotation based on competence and company needs 4 Conduct recruitment according to competencies required by the company

Strategic Issue 2:
Capital
Targets:

Fulfillment of risk-based minimum capital
.....
.....
Strategy:
Policy:

..................................................................................
No. Program 20XX 20XX+1 20XX+2 20XX+3 20XX+4

Note:

If the corporate plan submission is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.

5.7 Assumptions in Financial Projection Preparation
Elaborate on the assumptions used in preparing financial projections.

5.8 Cash Flow Projection Each Year for Five Years
Elaborate on the cash flow projection each year for the next five years by filling in the table format below, then elaborate narratively on the accounts with gray rows. a. Cash Flow Projection for General Insurance Company/Reinsurance Company (in millions of Rupiah)

DESCRIPTION
Projection
Jan - Dec
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
BEGINNING CASH AND BANK BALANCE
CASH FLOWS FROM OPERATING ACTIVITIES
Cash Inflows a. Premium b. Co-insurance Claims
c. Reinsurance Claims
d. Commission e. Receivables f. Others
Total Cash Inflows -
Cash Outflows a. Reinsurance Premium b. Claims
c. Commission
d. Expenses e. Others
Total Cash Outflows -
TOTAL CASH FLOWS FROM OPERATING ACTIVITIES - CASH FLOWS FROM INVESTING ACTIVITIES Cash Inflows

DESCRIPTION
Projection
Jan - Dec
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* a. Investment Income Receipts b. Investment Withdrawals
c. Sale of Fixed Assets
d. Others
Total Cash Inflows -
Cash Outflows a. Investment Deposits b. Purchase of Fixed Assets
c. Others
Total Cash Outflows -
TOTAL CASH FLOWS FROM INVESTING ACTIVITIES - CASH FLOWS FROM FINANCING ACTIVITIES Cash Inflows a. Subordinated Loans b. Capital Deposits
c. Others
Total Cash Inflows -
Cash Outflows a. Dividend Payments b. Subordinated Loan Payments
c. Others
Total Cash Outflows -
TOTAL CASH FLOWS FROM FINANCING ACTIVITIES - ENDING CASH AND BANK BALANCE -

Note:

If the corporate plan submission is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
narrative elaboration of the gray rows above

b. Cash Flow Projection for Life Insurance Company (in millions of Rupiah)

Description
Projection
Jan - Dec
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
BEGINNING CASH AND BANK BALANCE
CASH FLOWS FROM OPERATING ACTIVITIES
Cash Inflows a. Premium b. Co-insurance Claims
c. Reinsurance Claims
d. Commission e. Receivables f. Others
Total Cash Inflows
Cash Outflows

Description
Projection
Jan - Dec
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* a. Reinsurance Premium b. Claims
c. Commission
d. Expenses e. Others
Total Cash Outflows
TOTAL CASH FLOWS FROM OPERATING ACTIVITIES CASH FLOWS FROM INVESTING ACTIVITIES Cash Inflows a. Investment Income Receipts b. Investment Withdrawals
c. Sale of Fixed Assets
d. Others
Total Cash Inflows
Cash Outflows a. Investment Deposits b. Purchase of Fixed Assets
c. Others
Total Cash Outflows
TOTAL CASH FLOWS FROM INVESTING ACTIVITIES CASH FLOWS FROM FINANCING ACTIVITIES Cash Inflows a. Subordinated Loans b. Capital Deposits - - - - -

Description
Projection
Jan - Dec
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
c. Others
Total Cash Inflows
Cash Outflows a. Dividend Payments b. Subordinated Loan Payments
c. Others Total
Cash Outflows
TOTAL CASH FLOWS FROM FINANCING ACTIVITIES ENDING CASH AND BANK BALANCE - - - -

Note:

If the corporate plan submission is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
narrative elaboration of the gray rows above

5.9 Financial Position/Balance Sheet Projection Each Year for Five Years
Elaborate on the balance sheet projection each year for the next five years by filling in the table format below, then elaborate narratively on the accounts with gray rows. a. Financial Position Projection for General Insurance Company/Reinsurance Company (in millions of Rupiah)

DESCRIPTION Projection as of Dec 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
ASSETS
Investments
Time Deposits and Certificates of Deposit - - Stocks - - Corporate Bonds and Corporate Sukuk - - Securities Issued by the RI State - - Securities Issued by Countries Other Than RI - - Securities Issued by Bank Indonesia - - Securities Issued by Multinational Institutions - - Mutual Funds - - Asset-Backed Securities Collective Investment Contracts - - Real Estate Investment Funds - - Direct Investments - - Buildings with Strata Rights or Land with Buildings for Investment - - Purchase of Receivables for Financing Companies and/or Banks - - Pure Gold - - Loans Secured by Mortgage Rights - - Other Investments - -

DESCRIPTION Projection as of Dec 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Total Investments - -
Non-Investments
Cash and Banks - -
Direct Written Premium Receivables - -
Co-insurance Claim Receivables - -
Reinsurance Receivables - -
Investment Receivables - -
Investment Income Receivables - -
Buildings with Strata Rights or Land with Buildings for Own Use

-
Other Fixed Assets -
Other Assets -
Total Non-Investments - -
TOTAL ASSETS - -
LIABILITIES AND EQUITY
Liabilities
Debts
Claim Payables - -
Co-insurance Payables - -
Reinsurance Payables - -
Commission Payables - -
Tax Payables - -
Accrued Expenses - -
Other Payables - -
Total Debts - -
Technical Reserves
Premium Reserves - -
Reserves for Unearned Premiums - -

DESCRIPTION Projection as of Dec 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Claims Reserves - -
Total Technical Reserves - -
Total Liabilities - -
Subordinated Loans - -
Equity
Paid-up Capital - -
Share Premium - -
Retained Earnings - -
Other Equity Components - -
Differences in Valuation Based on SAK and SAP Assets Not Included in AYD Total Equity - TOTAL LIABILITIES AND EQUITY -

Note:

If the corporate plan submission is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
If the descriptions below have no numbers related to SAP, they are entered manually in the ratio:

SAP Investment Balance
AYD
Total technical reserves
Claim payables
Obligations to policyholders

narrative elaboration of the gray rows above

b. Financial Position Projection for Life Insurance Company (in millions of Rupiah)

Description
Projection as of Dec 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
ASSETS
Investments
Time Deposits and Certificates of Deposit - - Stocks - - Corporate Bonds and Corporate Sukuk - - Securities Issued by the RI State - - Securities Issued by Countries Other Than RI - - Securities Issued by Bank Indonesia - -

Description
Projection as of Dec 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Securities Issued by Multinational Institutions - - Mutual Funds - - Asset-Backed Securities Collective Investment Contracts - - Real Estate Investment Funds - - Direct Investments - - Buildings with Strata Rights or Land with Buildings for Investment - - Purchase of Receivables for Financing Companies and/or Banks - - Pure Gold - - Loans Secured by Mortgage Rights - - Other Investments - - Total Investments - - Non-Investments Cash and Banks - - Direct Written Premium Receivables - - Co-insurance Claim Receivables - - Reinsurance Receivables - - Investment Receivables - - Investment Income Receivables - - Buildings with Strata Rights or Land with Buildings for Own Use - -

Description
Projection as of Dec 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Other Fixed Assets -
Other Assets -
Total Non-Investments - -
TOTAL ASSETS - -
LIABILITIES AND EQUITY
Liabilities
Debts
Claim Payables - -
Co-insurance Payables - -
Reinsurance Payables - -
Commission Payables - -
Tax Payables - -
Accrued Expenses - -
Other Payables - -
Total Debts - -
Technical Reserves
Premium Reserves - -
Reserves for Unearned Premiums - -
Claims Reserves - -
Total Technical Reserves - -
Total Liabilities - -
Subordinated Loans - -
Equity

Description
Projection as of Dec 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Paid-up Capital - -
Share Premium - -
Retained Earnings - -
Other Equity Components - -
Valuation Differences Based on IFRS and Insurance Accounting Standards Assets Not Included in AYD Total Equity - TOTAL LIABILITIES AND EQUITY - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
If the descriptions below do not have numbers related to SAP, they are entered manually in the ratio:

SAP Investment Balance
AYD
Total technical reserves
Claim liabilities
Obligations to policyholders
narrative/descriptive explanation of the gray rows above

5.10 Comprehensive Income/Loss Projection Every Year for Five Years
Detail the comprehensive income/loss projection for each year for the next five years by filling in the table format below, then provide a narrative explanation of the accounts with gray rows. a. Comprehensive Income/Loss Projection for General Insurance Companies/Reinsurance Companies (in millions of rupiah) DESCRIPTION Projection Jan-Dec 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* UNDERWRITING INCOME Gross Premium a. Direct Written Premium b. Indirect Written Premium
c. Commission Paid
Total Gross Premium -
Reinsurance Premium a. Reinsurance Premium Paid b. Reinsurance Commission Received Total Reinsurance Premium - Net Premium - Decrease (Increase) in Reserves Premium and CAPYBMP a. Decrease (Increase) in Premium Reserves b. Decrease (Increase) in CAPYBMP Decrease (Increase) in Reserves Premium and CAPYBMP - Total Net Premium Income - Other Net Underwriting Income UNDERWRITING INCOME - UNDERWRITING EXPENSES

DESCRIPTION
Projection
Jan-Dec
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Claim Expenses a. Gross Claims b. Reinsurance Claims
c. Increase (Decrease) in Claim Reserves
Total Net Claim Expenses -
Other Net Underwriting Expenses
TOTAL UNDERWRITING EXPENSES -
UNDERWRITING RESULT -
Investment Result
Operating Expenses:
a. Marketing Expenses b. General and Administrative Expenses:

Employee and Management Expenses
Education and Training Expenses
General and Administrative Expenses
Others
Total Operating Expenses -
INSURANCE OPERATING PROFIT (LOSS) -
Other (Expenses) Income
PROFIT (LOSS) BEFORE TAX -
Income Tax
PROFIT AFTER TAX -
COMPREHENSIVE INCOME
OTHER
TOTAL COMPREHENSIVE PROFIT (LOSS) -

DESCRIPTION
Projection
Jan-Dec
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
narrative/descriptive explanation of the gray rows above

b. Comprehensive Income/Loss Projection for Life Insurance Companies (in millions of rupiah) Description Projection Jan-Dec 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* UNDERWRITING INCOME a. Premium Income b. Reinsurance Premium
c. Decrease (Increase) in CAPYBMP
Total Net Premium Income a. Investment Result b. DPLC/Other Management Service Fees
c. Other Income
TOTAL INCOME
EXPENSES
Insurance Expenses a. Claims and Benefits (1) Claims and Benefits Paid (2) Reinsurance Claims (3) Increase (Decrease) in Premium Reserves (4) Increase (Decrease) in Claim Reserves Total Claims and Benefits Expenses b. Acquisition Costs (1) Commission Expenses - First Year (2) Commission Expenses - Subsequent Years (3) Overriding Commission Expenses (4) Other Expenses Total Acquisition Costs

Description
Projection
Jan-Dec
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Total Insurance Expenses
Operating Expenses:
a. Marketing Expenses b. General and Administrative Expenses:

Employee and Management Expenses
Education and Training Expenses
General and Administrative Expenses Others
Other (Expenses) Income
TOTAL EXPENSES
PROFIT (LOSS) BEFORE TAX
Income Tax
PROFIT AFTER TAX
OTHER COMPREHENSIVE INCOME
TOTAL COMPREHENSIVE PROFIT (LOSS)
Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
narrative/descriptive explanation of the gray rows above

5.11 Projection of Financial Health Ratios for Risk-Based Minimum Capital (MBBR) and Financial Health Ratios Other Than MBBR and Profitability Ratios
Detail the projection of the following ratios for a period of 1 to 5 years into the future. No. Ratio Projection Projection Year 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* A. MBBR FINANCIAL HEALTH RATIOS Solvency Achievement Ratio B. FINANCIAL HEALTH RATIOS OTHER THAN MBBR
i. Liquidity Ratio
ii. Investment Sufficiency Ratio with total technical reserves + retained claim payment liabilities & other liabilities
iii. Investment Return to Net Premium Income Ratio
iv. Claim Expenses, Operating Expenses, and Commission Ratio
C. PROFITABILITY RATIOS
i. Return on assets
ii. Return on equity
Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
narrative/descriptive explanation of the table above

5.12 Other Matters Related to Company Activities
This paragraph contains other matters related to company activities that are important to convey but are not covered in the corporate plan format, for example, the company's CSR activities. Determined in Jakarta on December 9, 2014 EXECUTIVE HEAD OF INSURANCE SUPERVISOR, PENSION FUND, FINANCING INSTITUTION, AND OTHER FINANCIAL SERVICES INSTITUTIONS FINANCIAL SERVICES AUTHORITY, Signed, FIRDAUS DJAELANI Copy matches the original Director of Law 1 Legal Department, Signed. Signed. Tini Kustini

APPENDIX III
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 15/SEOJK.05/2014 REGARDING CORPORATE PLANS AND BUSINESS PLANS OF INSURANCE COMPANIES, SHARIA INSURANCE COMPANIES, REINSURANCE COMPANIES, AND SHARIA REINSURANCE COMPANIES

CORPORATE PLAN
GENERAL INSURANCE/REINSURANCE/LIFE INSURANCE COMPANIES WITH SHARIA UNITS 1
Year.........2
PT. XYZ
2 Corporate Plan Period reported, e.g., year 2015 – 2019

Company Name
Full Address
Telephone and Fax
Email
Tax ID Number (NPWP)
:
:
:
:
:
License No. & Date :
Sharia Unit
a. Full Address :
b. Telephone and Fax :
c. E-mail :
d. NPWP :
e. License No. & Date :
f. Head of Sharia Unit :
Shareholders :
Share Ownership
Shareholder Name
Rupiah
Percentage
Board of Directors and Board of Commissioners :
Sharia Supervisory Board (DPS) :
,
PT. XYZ
Total
DPS Name Position
Corporate Plan PIC (1 person)

OJK
Board of Directors

TABLE OF CONTENTS
Page
Company Profile
Table of Contents
Part I Corporate Plan for Insurance or Reinsurance Companies
Introduction
Executive Summary
CHAPTER I INTRODUCTION
1.1 Company History
1.2 Vision, Mission, and Values
1.3 Company Organizational Structure
CHAPTER II CURRENT POSITION OF INSURANCE OR REINSURANCE COMPANIES 1
2.1 Human Resources
2.2 IT Management
2.3 Products Marketed
2.4 Analysis Used in Preparing the Corporate Plan
2.5 Company Segmentation or Positioning Map
2.6 Company Market Share
CHAPTER III EVALUATION OF PREVIOUS CORPORATE PLAN IMPLEMENTATION 2
3.1 Comparison Between Corporate Plan and Business Plan Realization Every Year
3.2 Achievement of Objectives and Deviations Occurred
3.3 Implementation of Established Strategies and Policies
3.4 Challenges Faced and Problem-Solving Efforts
CHAPTER IV ASSUMPTIONS USED IN PREPARING THE CORPORATE PLAN 3
4.1 Macro Assumptions
4.2 Micro Assumptions
CHAPTER V OBJECTIVES, TARGETS, AND STRATEGIES FOR ACHIEVING THE CORPORATE PLAN 3
5.1 Objectives to be Achieved at the End of the Corporate Plan
5.2 Company Targets
5.3 Strategies Used by the Company
5.4 General and Functional Policies
5.5 Activity Programs
5.6 Matrix of Linkages Between Targets, Strategies, Policies, and Activity Programs
5.7 Assumptions for Financial Projection Preparation
5.8 Cash Flow Projection Every Year for Five Years
5.9 Financial Position/Balance Sheet Projection Every Year for Five Years
5.10 Comprehensive Income/Loss Projection Every Year for Five Years
5.11 Projection of MBBR Financial Health Ratios and Financial Health Ratios Other Than MBBR and Profitability Ratios
5.12 Other Matters Related to Company Activities
Note:
1 CHAPTER II describes the company's current position.
2 CHAPTER III describes the evaluation of the implementation of the previous corporate plan/long-term plan of the company. If the company is a new company, then ignore the preparation of CHAPTER III. 3 CHAPTER IV and CHAPTER V describe the corporate plan period to be reported to

Part II Corporate Plan for Sharia Units
Introduction
Executive Summary
CHAPTER I INTRODUCTION
1.1 Company History
1.2 Vision, Mission, and Values
1.3 Company Organizational Structure
CHAPTER II CURRENT POSITION OF SHARIA UNITS 1
2.1 Human Resources
2.2 IT Management
2.3 Products Marketed
2.4 Analysis Used in Preparing the Corporate Plan
2.5 Sharia Unit Segmentation or Positioning Map
2.6 Sharia Unit Market Share
CHAPTER III EVALUATION OF PREVIOUS CORPORATE PLAN IMPLEMENTATION 2
3.1 Comparison Between Corporate Plan and Business Plan Realization Every Year
3.2 Achievement of Objectives and Deviations Occurred
3.3 Implementation of Established Strategies and Policies
3.4 Challenges Faced and Problem-Solving Efforts
CHAPTER IV ASSUMPTIONS USED IN PREPARING THE CORPORATE PLAN 3
4.1 Macro Assumptions
4.2 Micro Assumptions
CHAPTER V OBJECTIVES, TARGETS, AND STRATEGIES FOR ACHIEVING THE CORPORATE PLAN 3
5.1 Objectives to be Achieved at the End of the Corporate Plan
5.2 Sharia Unit Targets
5.3 Strategies Used by the Sharia Unit
5.4 General and Functional Policies
5.5 Activity Programs
5.6 Matrix of Linkages Between Targets, Strategies, Policies, and Activity Programs
5.7 Assumptions for Financial Projection Preparation
5.8 Cash Flow Projection Every Year for Five Years
5.9 Financial Position/Balance Sheet Projection Every Year for Five Years
5.10 Comprehensive Income/Loss Projection Every Year for Five Years;
5.11 Projection of MBBR Financial Health Ratios and Financial Health Ratios Other Than MBBR and Profitability Ratios
5.12 Other matters related to Sharia Unit activities
Note:
1 CHAPTER II describes the company's current position.
2 CHAPTER III describes the evaluation of the implementation of the previous corporate plan/long-term plan of the company. If the company is a new company, then ignore the preparation of CHAPTER III. 3 CHAPTER IV and CHAPTER V describe the corporate plan period to be reported to OJK

Part I
Corporate Plan for Insurance or Reinsurance Companies

Introduction
The introduction contains the background of the preparation of the Corporate Plan, the formulation of important aspects in the prepared Corporate Plan, and other matters considered important to convey. Important aspects in the Corporate Plan should only be summaries containing outlines and emphasize the main points. Executive Summary The executive summary is the entry point to the Corporate Plan. This paragraph is only a summary emphasizing the content of the corporate plan conveyed.

CHAPTER I
INTRODUCTION
1.1 Company History
State when the company was founded, by whom, and for what purpose. How did the company develop after that? Have the name and ownership of the company changed since it was founded? If your company is a new company, convey the background of the company's establishment.
1.2 Vision, Mission, and Values
Vision is the picture of the company's condition in the future and is the company's ideal. Vision is a statement to answer the question of the company's direction forward. Meanwhile, mission is the elaboration of the vision, where the mission elaborates a careful analysis of the benefits desired by existing policyholders as well as prospective policyholders. The mission also elaborates on the existing environmental and market conditions and the company's anticipation forward. In realizing the vision and implementing the mission, the company relies on core values; elaborate on those values (if any).

1.3 Organizational Structure Detail the composition of the Board of Commissioners and Board of Directors and the work units under them in the company. Depict in the form of an organization chart.

CHAPTER II
CURRENT POSITION OF INSURANCE OR REINSURANCE COMPANIES
2.1 Human Resources
Show the number of management, company employees, experts used, foreign workers, and insurance agents currently available.
2.2 IT Management
Detail the use of information technology used by the company to support business activities.

2.3 Products Marketed
Detail a summary of products and services offered/sold.
Example table
No. Product Name General Product Description Number and Date of Recording Letter
2.4 Analysis Used in Preparing the Corporate Plan Describe the analysis used when the company prepares the corporate plan, e.g., SWOT analysis, Balance Scorecard, PEST, etc.

2.5 Company Segmentation or Positioning Map
Describe the company's position in the industry (upper, middle, and lower) specifically for business lines or products that are the company's focus. .
2.6 Company Market Share
Describe the company's market share by comparing the company's premium income and industry income in each business line.

CHAPTER III
EVALUATION OF PREVIOUS CORPORATE PLAN IMPLEMENTATION
3.1 Comparison Between Corporate Plan and Business Plan Realization Every Year (Ignore if your company is a new company)
Detail the current corporate plan and how it is realized with the business plan every year. In this section, the company can see the company's performance in that period by comparing the corporate plan with the business plan realization. The example table below can be modified in more detail according to the company's needs. Indicator 20XX-1 20XX-2 20XX-3 20XX-4 20XX-5 Corporate Plan Realization % Corporate Plan Realization % Corporate Plan Realization % Corporate Plan Realization % Corporate Plan Realization % Corporate Plan Realization % Corporate Plan Realization % (1) (2) (2/1) (1) (2) (2/1) (1) (2) (2/1) (1) (2) (2/1) (1) (2) (2/1) Premium Income Profit/Loss Return on Equity Return on Assets Solvency Ratio Liquidity Ratio Investment Sufficiency Ratio Investment Return to Net Premium Income Ratio Claim Expenses, Operating Expenses, and Commission Ratio etc. (add other indicators as deemed necessary) Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX-1 is 2014, 20XX-2 is 2013, etc.

3.2 Achievement of Objectives and Deviations Occurred
This section is a detailed picture of each indicator in the comparison table between the corporate plan and business plan, and if there are deviations in the comparison table, the reasons for the deviations are conveyed. Also detail the company's objectives related to the achievement of sales, profits, market share to be achieved and their realization, how about the deviations that occurred?
3.3 Implementation of Established Strategies and Policies
Explain the company's strategies and policies and detail the implementation of the company's strategies and policies that have been agreed upon and established together, for example, regarding business lines and distribution channels and production business sources that will be the company's focus.

3.4 Challenges Faced and Problem-Solving Efforts
Clearly state the challenges faced in implementing the established corporate plan and what the solutions are for problem-solving.

CHAPTER IV
ASSUMPTIONS USED IN PREPARING THE CORPORATE PLAN
4.1 Macro Assumptions
This paragraph contains the elaboration of macro assumptions used in preparing the five-year corporate plan, for example, global economic conditions, national economic growth, inflation, exchange rates, etc.
4.2 Micro Assumptions
This paragraph contains the elaboration of micro assumptions used in preparing the corporate plan in the next five years, for example, investment return rates, number of new coverages, lapse ratio, catastrophic losses, and factors affecting company operational activities originating from within the company.

5.3 Strategies Used by the Company
Strategies used by the company include corporate strategies according to the company's position, business strategies, and functional strategies for each field/unit of activity. Corporate strategies are more global than business strategies and functional strategies. Business strategies emphasize improving the company's financial performance, while functional strategies are more focused on strategies for each field/unit in the company, for example, the marketing field/unit's strategy is cooperation with banks in product marketing.
5.4 General and Functional Policies
General and functional policies that provide flexibility boundaries and become management guidelines in implementing strategies or activity programs.

5.5 Activity Programs
Detail the activity programs to be implemented every year for the next five years.
5.6 Matrix of Linkages Between Targets, Strategies, Policies, and Activity Programs
A matrix of linkages between targets, strategies, policies, and activity programs that describes the detailed direction of company development. An example of the matrix format can be seen below; if the company does not yet have a format, it can use the available format. Example:
Strategic Issue 1:
HR Structure
Targets:

Increase productive age to 90.5%.
Increase experts from 10% (40 people) to 25% (100 people).
Realize an ideal HR composition structure.
Strategy:
HR Recomposition and Mapping
Policy:
HR Recomposition is based on competencies needed by the company No. Program 20XX 20XX+1 20XX+2 20XX+3 20XX+4 1 Doing manpower planning 2 Job enrichment 3 Systematic and continuous employee mutation or rotation based on competency and company needs 4 Conduct recruitment according to competencies needed by the company

Strategic Issue 2:
Capital
Targets:

Fulfillment of risk-based minimum capital
.....
.....
Strategy:
Policy:
................... .
No. Program 20XX 20XX+1 20XX+2 20XX+3 20XX+4 Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is
2015, 20XX+1 is 2016, etc.
5.7 Assumptions in Financial Projection Preparation
Detail the assumptions used in preparing financial projections.

5.8 Cash Flow Projection Every Year for Five Years
Detail the cash flow projection every year for the next five years by filling in the table format below, then provide a narrative explanation of the accounts with gray rows. a. Cash Flow Projection for General Insurance Companies/Reinsurance Companies (in millions of rupiah) DESCRIPTION Projection Jan - Dec 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* BEGINNING CASH AND BANK BALANCE CASH FLOWS FROM OPERATING ACTIVITIES Cash Inflows a. Premium b. Co-insurance Claims
c. Reinsurance Claims
d. Commission e. Receivables f. Others
Total Cash Inflows -
Cash Outflows a. Reinsurance Premium b. Claims
c. Commission
d. Expenses e. Others
Total Cash Outflows -
TOTAL CASH FLOWS FROM OPERATING ACTIVITIES - CASH FLOWS FROM INVESTMENT ACTIVITIES Cash Inflows

DESCRIPTION
Projection
Jan - Dec
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* a. Investment Return Receipts b. Investment Withdrawals
c. Sale of Fixed Assets
d. Others
Total Cash Inflows -
Cash Outflows a. Investment Placements b. Purchase of Fixed Assets
c. Others
Total Cash Outflows -
TOTAL CASH FLOWS FROM INVESTMENT ACTIVITIES - CASH FLOWS FROM FINANCING ACTIVITIES Cash Inflows a. Subordinated Loans b. Capital Deposits
c. Others
Total Cash Inflows -
Cash Outflows a. Dividend Payments b. Subordinated Loan Payments
c. Others
Total Cash Outflows -
TOTAL CASH FLOWS FROM FINANCING ACTIVITIES - ENDING CASH AND BANK BALANCE -

Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
narrative explanation of the gray rows above b. Cash Flow Projection for Life Insurance Companies (in millions of rupiah) Description Projection Jan-Dec 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* BEGINNING CASH AND BANK BALANCE CASH FLOWS FROM OPERATING ACTIVITIES Cash Inflows a. Premium b. Co-insurance Claims
c. Reinsurance Claims
d. Commission e. Receivables f. Others
Total Cash Inflows
Cash Outflows

Description
Projection
Jan-Dec
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* a. Reinsurance Premium b. Claims
c. Commission
d. Expenses e. Others
Total Cash Outflows
TOTAL CASH FLOWS FROM OPERATING ACTIVITIES CASH FLOWS FROM INVESTMENT ACTIVITIES Cash Inflows a. Investment Return Receipts b. Investment Withdrawals
c. Sale of Fixed Assets
d. Others
Total Cash Inflows
Cash Outflows a. Investment Placements b. Purchase of Fixed Assets
c. Others
Total Cash Outflows
TOTAL CASH FLOWS FROM INVESTMENT ACTIVITIES CASH FLOWS FROM FINANCING ACTIVITIES Cash Inflows a. Subordinated Loans b. Capital Deposits - - - - -

Description
Projection
Jan-Dec
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
c. Others
Total Cash Inflows
Cash Outflows a. Dividend Payments b. Subordinated Loan Payments
c. Others Total
Cash Outflows
TOTAL CASH FLOWS FROM FINANCING ACTIVITIES ENDING CASH AND BANK BALANCE - - - - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
narrative explanation of the gray rows above

5.9 Financial Position/Balance Sheet Projection Every Year for Five Years
Detail the balance sheet projection every year for the next five years by filling in the table format below, then provide a narrative explanation of the accounts with gray rows. a. Financial Position Projection for General Insurance Companies/Reinsurance Companies (in millions of rupiah) DESCRIPTION Projection as of Dec 31 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* ASSETS Investments Time Deposits and Certificates of Deposit - - Shares - - Corporate Bonds and Corporate Sukuk - - Securities Issued by the Republic of Indonesia - - Securities Issued by Countries Other Than Indonesia - - Securities Issued by Bank Indonesia - - Securities Issued by Multinational Institutions - - Mutual Funds - - Asset-Backed Collective Investment Contracts - - Real Estate Investment Funds - - Direct Investments - - Buildings with Strata Rights or Land with Buildings for Investment - - Purchase of Receivables for Financing Companies and/or Banks - - Pure Gold - - Loans Secured with Mortgage Rights - -

DESCRIPTION Projection as of Dec 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Other Investments - -
Total Investments - -
Non-Investments
Cash and Banks - -
Direct Written Premium Receivables - -
Co-insurance Claim Receivables - -
Reinsurance Receivables - -
Investment Receivables - -
Investment Return Receivables - -
Buildings with Strata Rights or Land with Buildings for Own Use

-
Other Fixed Assets -
Other Assets -
Total Non-Investments - -
TOTAL ASSETS - -
LIABILITIES AND EQUITY
Liabilities
Debts
Claim Payables - -
Co-insurance Payables - -
Reinsurance Payables - -
Commission Payables - -
Tax Payables - -
Accrued Expenses - -
Other Payables - -

DESCRIPTION Projection as of Dec 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Total Liabilities - -
Technical Reserves
Premium Reserve - -
Reserve for Premiums Not Yet Earned (CAPYBMP) - - Claim Reserve - - Total Technical Reserves - - Total Liabilities - - Subordinated Loans - - Equity Paid-in Capital - - Share Premium - - Retained Earnings - - Other Equity Components - - Valuation Differences Based on IFRS and SAP Assets Not Included in AYD Total Equity - TOTAL LIABILITIES AND EQUITY - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
If the descriptions below do not have figures related to SAP, they must be entered manually in the ratio:

SAP Investment Balance
AYD
Total technical reserves
Claim liabilities
Obligations to policyholders
Narrative explanation of the gray rows above b. Financial Position Projection for Life Insurance Companies (in millions of rupiah) Description Projection as of Dec 31 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* ASSETS Investments Time Deposits and Certificates of Deposit - - Stocks - - Corporate Bonds and Corporate Sukuk - - Securities Issued by the Republic of Indonesia - - Securities Issued by Countries Other than the Republic of Indonesia - - Securities Issued by Bank Indonesia - - Securities Issued by Multilateral Institutions - -

Description
Projection as of Dec 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Mutual Funds - -
Asset-Backed Securities Collective Investment Contracts - - Real Estate Investment Funds - - Direct Investments - - Buildings with Strata Rights or Land with Buildings for Investment - - Purchase of Receivables for Financing Companies and/or Banks - - Pure Gold - - Loans Secured by Mortgage Rights - - Other Investments - - Total Investments - - Non-Investments Cash and Bank - - Direct Premium Receivables - - Coinsurance Receivables - - Reinsurance Receivables - - Investment Receivables - - Investment Income Receivables - - Buildings with Strata Rights or Land with Buildings for Own Use - - Other Fixed Assets - Other Assets - Total Non-Investments - - TOTAL ASSETS - -

Description
Projection as of Dec 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
LIABILITIES AND EQUITY
Liabilities
Payables
Claim Payables - -
Coinsurance Payables - -
Reinsurance Payables - -
Commission Payables - -
Tax Payables - -
Accrued Expenses - -
Other Payables - -
Total Payables - -
Technical Reserves
Premium Reserve - -
Reserve for Premiums Not Yet Earned (CAPYBMP) - - Claim Reserve - - Total Technical Reserves - - Total Liabilities - - Subordinated Loans - - Equity Paid-in Capital - - Share Premium - - Retained Earnings - - Other Equity Components - -

Description
Projection as of Dec 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Valuation Differences Based on IFRS and SAP Assets Not Included in AYD Total Equity - TOTAL LIABILITIES AND EQUITY - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
If the descriptions below do not have figures related to SAP, they must be entered manually in the ratio:

SAP Investment Balance
AYD
Total technical reserves
Claim liabilities
Obligations to policyholders
Narrative/descriptive explanation of the gray rows above

5.10 Comprehensive Income/Loss Projection Every Year for Five Years
Detail the comprehensive income/loss projection for each year for the next five years by filling in the table format below, then narratively explain the accounts with gray rows. a. Comprehensive Income/Loss Projection for General Insurance/Reinsurance Companies (in millions of rupiah) DESCRIPTION Projection Jan-Dec 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* UNDERWRITING INCOME Gross Premiums a. Direct Premiums b. Indirect Premiums
c. Commissions Paid
Total Gross Premiums -
Reinsurance Premiums a. Reinsurance Premiums Paid b. Reinsurance Commissions Received Total Reinsurance Premiums - Net Premiums - Decrease (Increase) in Reserves Premiums and CAPYBMP a. Decrease (Increase) in Premium Reserves b. Decrease (Increase) in CAPYBMP Decrease (Increase) in Reserves Premiums and CAPYBMP - Total Net Premium Income - Other Net Underwriting Income UNDERWRITING INCOME -

DESCRIPTION
Projection
Jan-Dec
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
UNDERWRITING EXPENSES
Claim Expenses a. Gross Claims b. Reinsurance Claims
c. Increase (Decrease) in Claim Reserves
Total Net Claim Expenses -
Other Net Underwriting Expenses
TOTAL UNDERWRITING EXPENSES -
UNDERWRITING RESULT -
Investment Result
Operating Expenses:
a. Marketing Expenses b. General and Administrative Expenses:

Employee and Management Expenses
Education and Training Expenses
General and Administrative Expenses
Others
Total Operating Expenses -
INSURANCE OPERATING PROFIT (LOSS) -
Other (Expenses) Income
PROFIT (LOSS) BEFORE TAX -
Income Tax
PROFIT AFTER TAX -
COMPREHENSIVE INCOME

DESCRIPTION
Projection
Jan-Dec
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
OTHER
TOTAL COMPREHENSIVE PROFIT (LOSS) -
Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
Narrative/descriptive explanation of the gray rows above

(3) Increase (Decrease) in Premium Reserves (4) Increase (Decrease) in Claim Reserves Total Claims and Benefits Expenses b. Acquisition Costs (1) Commission Expenses

First Year
(2) Commission Expenses
Subsequent Years
(3) Commission Expenses
Overriding

Description
Projection
Jan-Dec
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
(4) Other Expenses
Total Acquisition Costs
Total Insurance Expenses
Operating Expenses:
a. Marketing Expenses b. General and Administrative Expenses:

Employee and Management Expenses
Education and Training Expenses
General and Administrative Expenses Others
Other (Expenses) Income
TOTAL EXPENSES
PROFIT (LOSS) BEFORE TAX
Income Tax
PROFIT AFTER TAX
OTHER COMPREHENSIVE INCOME
TOTAL COMPREHENSIVE PROFIT (LOSS)

Narrative/descriptive explanation of the gray rows above

5.11 Projection of Financial Health Ratios for Minimum Risk-Based Capital (MBR) and Other Than Minimum Risk-Based Capital, and Profitability Ratios
Detail the projection of the following ratios for a period of 1 to 5 years into the future. No. Ratio Projection Projection Year 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* A. MBR FINANCIAL HEALTH RATIOS Solvency Achievement Ratio B. FINANCIAL HEALTH RATIOS OTHER THAN MBR
i. Liquidity Ratio
ii. Investment Adequacy Ratio with Total Technical Reserves + Retained Claim Payment Liabilities + Other Liabilities
iii. Investment Result Balance Ratio with Net Premium Income
iv. Claim Expenses, Operating Expenses, and Commission Ratio
C. PROFITABILITY RATIOS
i. Return on Assets
ii. Return on Equity

Narrative/descriptive explanation of the table above
5.12 Other Matters Related to Company Activities
This paragraph contains other matters related to company activities that are important to convey but are not covered in the corporate plan format, e.g., company CSR activities.

Part II
Corporate Plan for Sharia Units

CHAPTER I
INTRODUCTION
1.1 History of Sharia Unit
State when the Sharia unit was established, by whom, and for what purpose. How did the Sharia unit develop thereafter? Has the capitalization of the Sharia unit changed since its establishment? If the Sharia unit is still new, explain the background of its establishment.
1.2 Vision, Mission, and Values
Vision is the picture of the Sharia unit's condition in the future and is the company's aspiration. Vision is a statement to answer the question of the direction of the Sharia unit going forward. Mission is the elaboration of the vision, where the mission elaborates a careful analysis of the benefits desired by current policyholders as well as prospective policyholders. The mission also elaborates the existing environmental and market conditions and the Sharia unit's anticipation going forward in realizing the vision and executing the mission. The Sharia unit bases itself on core values; elaborate on these values (if any).

1.3 Organizational Structure
Detail the composition of the Board of Commissioners and Board of Directors and the work units under them in the company, including the position of the Sharia unit in the company structure and the structure below the Sharia unit. Depict in the form of an organization chart.

CHAPTER II
CURRENT POSITION OF THE SHARIA UNIT
2.1 Human Resources
Explain the number of management, employees, experts used, foreign workers, and insurance agents supporting the Sharia unit's activities.
2.2 IT Management
Detail the use of information technology used to support the Sharia unit's business activities.
2.3 Products Marketed
Detail the summary of products and services offered/sold by the Sharia unit.

Example table
No. Product Name General Product Description Number and Date of Recording Letter
2.4 Analysis Used in Preparing the Corporate Plan
Describe the analysis used when the Sharia unit prepares the corporate plan, e.g., SWOT analysis, Balance Scorecard, PEST, etc.
2.5 Sharia Unit Segmentation or Positioning Map
Describe the position of the Sharia unit within the industry (upper, middle, and lower), specifically for products that are the focus of the Sharia unit.
2.6 Sharia Unit Market Share
Describe the Sharia unit's market share by comparing the Sharia unit's gross contribution with the insurance Sharia industry's gross contribution.

CHAPTER III
EVALUATION OF PREVIOUS CORPORATE PLAN IMPLEMENTATION
3.1 Comparison Between Corporate Plan and Business Plan Realization Every Year (Ignore if your Sharia unit is a new Sharia unit)
Detail the current corporate plan and its realization with the business plan every year. In this section, the Sharia unit can view the Sharia unit's performance in that period by comparing the corporate plan with the business plan realization. The table example below can be modified in more detail according to the Sharia unit's needs. Indicator 20XX-1 20XX-2 20XX-3 20XX-4 20XX-5 Corporate Plan Realization % Corporate Plan Realization % Corporate Plan Realization % Corporate Plan Realization % Corporate Plan Realization % (1) (2) (2/1) (1) (2) (2/1) (1) (2) (2/1) (1) (2) (2/1) (1) (2) (2/1) Gross Contribution Gross Contribution ÷ Acquisition Costs ' ILIT7 IbIrru’ Tabarru’ Contributions Underwriting Surplus Return on Investment DT Solvency Ratio Investment Balance Ratio plus Cash/Bank with Technical Provisions and Retained Claim Liabilities Company Funds Ujrah Profit/Loss Return on Equity Return on Assets Return on Investment Solvency Ratio Liquidity Ratio Available Wealth Ratio For Qardh Investment Result Company÷ Company Income Ujrah After Deducting Acquisition Costs ÷

Indicator
20XX-1 20XX-2 20XX-3 20XX-4 20XX-5
Corporate Plan Realization % Corporate Plan Realization % Corporate Plan Realization % Corporate Plan Realization % Corporate Plan Realization % (1) (2) (2/1) (1) (2) (2/1) (1) (2) (2/1) (1) (2) (2/1) (1) (2) (2/1) Gross Contribution Gross Contribution ÷ Acquisition Costs ' OCO 7 ObOUu’ Tabarru’ Contributions Underwriting Surplus Return on Investment DT Solvency Ratio Investment Balance Ratio plus Cash/Bank with Technical Provisions and Retained Claim Liabilities Company Funds Company Income Operating Expenses ÷ Ujrah Participant Investment Funds Contribution to Investment Accumulation of Participant Investment Funds Return on Investment etc. (add other indicators as deemed necessary) Note:
*
If the submission of the corporate plan is for the year 2015-2019, then 20XX-1 is 2014, 20XX-2 is 2013, etc.

3.2 Achievement of Objectives and Deviations Occurring
This section is a detailed picture of each indicator in the comparison table between the corporate plan and the business plan, and if there are deviations in the comparison table, the reasons for the deviations are conveyed. Also elaborate on the Sharia unit's objectives related to the achievement of sales, profits, and market share to be reached and their realization, how about the deviations that occurred?

3.3 Implementation of Established Strategies and Policies
Explain the company's strategies and policies and detail the implementation of the Sharia unit's strategies and policies that have been agreed upon and established together, e.g., related to business lines and distribution channels and production business sources that will be the focus of the Sharia unit.
3.4 Obstacles Faced and Problem-Solving Efforts
Clearly state the obstacles faced in implementing the established corporate plan and what the solutions are for problem-solving.

CHAPTER IV
ASSUMPTIONS USED IN PREPARING THE CORPORATE PLAN
4.1 Macro Assumptions
This paragraph contains the elaboration of macro assumptions used in preparing the five-year corporate plan, e.g., global economic conditions, national economic growth, inflation, exchange rates, etc.
4.2 Micro Assumptions
This paragraph contains the elaboration of micro assumptions used in preparing the five-year corporate plan, e.g., investment return rates, number of new coverages, lapse ratio, catastrophic losses, and factors affecting the Sharia unit's operational activities originating from within the Sharia unit.

CHAPTER V
OBJECTIVES, TARGETS, AND STRATEGIES FOR ACHIEVING THE CORPORATE PLAN
5.1 Objectives to Be Achieved at the End of the Corporate Plan
Elaborate on the Sharia unit's objectives to be achieved at the end of the corporate plan period related to the Sharia unit's vision and mission.
5.2 Sharia Unit Targets
This paragraph contains the Sharia unit's targets during the five-year corporate plan period. Targets are made in detail and measurable in terms of being able to measure the achievement of objectives.

5.3 Strategies Used by the Sharia Unit
The strategies used by the company include corporate strategies according to the company's position, business strategies, and functional strategies for each field/unit of activity. Corporate strategy is more global than business strategy and functional strategy. Business strategy emphasizes improving the company's financial performance, while functional strategy is more focused on strategies for each field/unit in the company, e.g., the marketing field/unit's strategy is cooperation with banks in product marketing.
5.4 General and Functional Policies
General and functional policies that provide flexibility boundaries and serve as management guidelines in executing strategies or program activities.

5.5 Activity Programs
Detail the activity programs to be implemented every year for the next five years.
5.6 Matrix of Linkages Between Targets, Strategies, Policies, and Activity Programs
A matrix of linkages between targets, strategies, policies, and activity programs that describes the Sharia unit's development direction in detail. Example matrix formats can be seen below; if the Sharia unit does not yet have a format, it can use the available format. Example format:
Strategic Issue 1:
HR Structure
Targets:

Increase productive age to 90.5%.
Increase experts from 10% (40 people) to 25% (100 people).
Realize an ideal HR composition structure.
Strategy:
HR Recomposition and Mapping
Policy:
HR Recomposition is based on competencies required by the company No Program 20XX 20XX+1 20XX+2 20XX+3 20XX+4 1 Perform manpower planning 2 Job enrichment 3 Systematic and continuous employee mutation or rotation based on competency and company needs

4 Perform recruitment according to the competencies required by the company Strategic Issue 2:
Capital
Targets:

Fulfill minimum capital for Sharia unit spin-off.
.....
.....
Strategy:
Policy:
................... .
No Program 20XX 20XX+1 20XX+2 20XX+3 20XX+4 2        Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is
2015, 20XX+1 is 2016, etc.
5.7 Assumptions in Financial Projection Preparation
Elaborate on the assumptions used in preparing financial projections.

5.8 Cash Flow Projection Every Year for Five Years
Detail the cash flow projection for each year for the next five years by filling in the table format below, then narratively explain the accounts with gray rows. a. Cash Flow Projection for General Insurance/Reinsurance Business in Sharia Units Company Fund Cash Flow Projection (in millions of rupiah) Description Projection January - December 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* Beginning Cash and Bank Balance - - - - - CASH FLOWS FROM OPERATING ACTIVITIES Cash Inflows a. Ujrah received - - - - - b. Others - - - - - Total Cash Inflows - - - - - Cash Outflows a. Commission - - - - - b. Marketing expenses - - - - -
c. Reinsurance ujrah payment - - - - -
d. Rent payment - - - - - e. Zakat payment - - - - - f. Tax payment - - - - - g. Others - - - - - Total Cash Outflows - - - - - Net Cash Flows From Operating Activities - - - - - CASH FLOWS FROM INVESTING ACTIVITIES Cash Inflows

Description
Projection
January - December
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* a. Company investment result receipts - - - - - b. Tabarru' fund surplus allocation receipts - - - - -
c. Tabarru' fund investment profit sharing receipts - - - - -
d. Investment withdrawal - - - - - e. Sale of fixed assets - - - - - f. Others - - - - - Total Cash Inflows - - - - - Cash Outflows a. Investment placement - - - - - b. Purchase of fixed assets - - - - -
c. Others - - - - -
Total Cash Outflows - - - - -
Net Cash Flows From Investing Activities - - - - - CASH FLOWS FROM FINANCING ACTIVITIES Cash Inflows a. Subordinated loans - - - - - b. Capital/capital work deposits - - - - -
c. Qardh receipts - - - - -
d. Others - - - - -
Total Cash Inflows - - - - -
Cash Outflows a. Subordinated loan repayment - - - - - b. Dividend payment - - - - -
c. Qardh - - - - -
d. Others - - - - -

Description
Projection
January - December
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Total Cash Outflows - - - - -
Net Cash Flows From Financing Activities - - - - - ENDING CASH AND BANK BALANCE - - - - - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
Narrative explanation of the gray rows above

Tabarru' Fund Cash Flow Projection (in millions of rupiah) Description Projection January - December 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* BEGINNING CASH AND BANK BALANCE CASH FLOWS FROM OPERATING ACTIVITIES Cash Inflows a. Participant contributions b. Reinsurance claims received
c. Reinsurance underwriting surplus distribution receipts
Total Cash Inflows -
Cash Outflows a. Insurance ujrah payment b. Reinsurance contributions paid
c. Claims paid
d. Others
Total Cash Outflows -
NET CASH FLOWS FROM OPERATING ACTIVITIES - CASH FLOWS FROM INVESTING ACTIVITIES Cash Inflows a. Tabarru' fund investment result receipts b. Tabarru' fund investment withdrawal
c. Sale of land and buildings
d. Others
Total Cash Inflows -
Cash Outflows a. Investment placement b. Underwriting surplus distribution payment to the company

Description
Projection
January - December
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
c. Underwriting surplus distribution payment to participants
d. Tabarru' fund investment profit sharing payment to the company e. Others Total Cash Outflows - NET CASH FLOWS FROM INVESTING ACTIVITIES - CASH FLOWS FROM FINANCING ACTIVITIES Cash Inflows a. Qardh b. Others Total Cash Inflows - Cash Outflows a. Qardh repayment b. Others Total Cash Outflows - NET CASH FLOWS FROM FINANCING ACTIVITIES - ENDING CASH AND BANK BALANCE - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.

Narrative explanation of the gray rows above b. Cash Flow Projection for Life Insurance Business in Sharia Units Company Fund Cash Flow Projection (in millions of rupiah) Description Projection January - December 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* Beginning Cash and Bank Balance - - - - - CASH FLOWS FROM OPERATING ACTIVITIES Cash Inflows a. Ujrah received - - - - - b. Others - - - - - Total Cash Inflows - - - - - Cash Outflows a. Commission - - - - - b. Marketing expenses - - - - -
c. Reinsurance ujrah payment - - - - -
d. Rent payment - - - - -

Description
Projection
January - December
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* e. Zakat payment - - - - - f. Tax payment - - - - - g. Others - - - - - Total Cash Outflows - - - - - Net Cash Flows From Operating Activities - - - - - CASH FLOWS FROM INVESTING ACTIVITIES Cash Inflows a. Company investment result receipts - - - - - b. Tabarru' fund surplus allocation receipts - - - - -
c. Tabarru' fund investment profit sharing receipts - - - - -
d. Investment withdrawal - - - - - e. Sale of fixed assets - - - - - f. Others - - - - - Total Cash Inflows - - - - - Cash Outflows a. Investment placement - - - - - b. Purchase of fixed assets - - - - -
c. Others - - - - -
Total Cash Outflows - - - - -
Net Cash Flows From Investing Activities - - - - -

Narrative explanation of the gray rows above CASH FLOWS FROM FINANCING ACTIVITIES Cash Inflows a. Subordinated loans - - - - - b. Capital/capital work deposits - - - - -
c. Qardh receipts - - - - -

Description
Projection
January - December
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* d. Others - - - - - Total Cash Inflows - - - - - Cash Outflows a. Subordinated loan repayment - - - - - b. Dividend payment - - - - -
c. Qardh - - - - -
d. Others - - - - -
Total Cash Outflows - - - - -
Net Cash Flows From Financing Activities - - - - - ENDING CASH AND BANK BALANCE - - - - - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.

c. Sale of land and buildings
d. Others
Total Cash Inflows -
Cash Outflows a. Investment placement

Description
Projection
January - December
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* b. Payment of underwriting surplus distribution to the company
c. Payment of underwriting surplus distribution to participants
d. Payment of investment profit sharing of tabarru' funds to the company e. Others Total Cash Outflow - TOTAL CASH FLOW FROM INVESTMENT ACTIVITIES - CASH FLOW FROM FINANCING ACTIVITIES Cash Inflow a. Qardh b. Others Total Cash Inflow - Cash Outflow a. Qardh payment b. Others Total Cash Outflow - TOTAL CASH FLOW FROM FINANCING ACTIVITIES - ENDING CASH AND BANK BALANCE - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.

5.9 Projection of Financial Position/Balance Sheet Every Year for Five Years
Detail the balance sheet projection every year for the next five years by filling in the table format below, then detail the accounts with gray rows narratively. a. Financial Position Projection for General Insurance Business/Reinsurance Business in Sharia Units Company Fund Financial Position Projection (in millions of rupiah) DESCRIPTION Projection as of December 31 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* ASSETS Investment Assets Deposits - - - - - Sharia stocks - - - - - Sharia sukuk or bonds - - - - - Sharia government securities - - - - - Sharia securities issued by Bank Indonesia - - - - - Sharia securities issued by entities other than the Republic of Indonesia - - - - - Sharia securities issued by multinational institutions - - - - - Sharia mutual funds - - - - - Sharia asset-backed securities - - - - - Financing through cooperation with other parties Sharia. - - - - - Pure gold - - - - -

narrative explanation of the gray rows above Direct participation - - - - - Buildings with strata rights or land with buildings for investment

Other investments - - - - -

DESCRIPTION
Projection as of December 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Total investment assets - - - - -
Non-investment Assets
Cash and bank - - - - -
Investment receivables - - - - -
Investment result receivables - - - - -
Ujrah receivables from participants - - - - - Tabarru' fund surplus allocation receivables - - - - - Tabarru' fund investment management profit sharing receivables - - - - - Qardh receivables - - - - - Buildings with strata rights or land with buildings for own use - - - - - Computer hardware - - - - - Other fixed assets - - - - - Other assets - - - - - Total non-investment assets - - - - - TOTAL ASSETS - - - - - LIABILITIES AND EQUITY Liabilities Commission payables - - - - - Reinsurance ujrah payables - - - - - Tax payables - - - - - Accrued expenses - - - - - Zakat payables - - - - - Other payables - - - - -

DESCRIPTION
Projection as of December 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Total liabilities - - - - -
Subordinated loans - - - - -
Company Equity
Paid-up capital - - - - -
Share premium - - - - -
Reserves - - - - -
Increase (decrease) in securities - - - - - Fixed asset valuation difference - - - - - Retained earnings - - - - - Total company equity - - - - - TOTAL LIABILITIES AND EQUITY - - - - - narrative explanation of the gray rows above Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.

Tabarru' Fund Financial Position Projection (in millions of rupiah) DESCRIPTION Projection as of December 31 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* ASSETS Investment Assets Deposits - - - - - Sharia stocks - - - - - Sharia sukuk or bonds - - - - - Sharia government securities - - - - - Sharia securities issued by Bank Indonesia - - - - - Sharia securities issued by entities other than NKRI - - - - - Sharia securities issued by Multinational Institutions - - - - - Sharia mutual funds - - - - - Sharia asset-backed securities - - - - - Financing through cooperation with other parties. - - - - - Pure gold - - - - - Other investments - - - - - Total Investments - - - - - Non-investment Assets Cash and bank - - - - - Contribution receivables - - - - - Reinsurance receivables - - - - - Investment receivables - - - - - Investment result receivables - - - - - Other assets - - - - -

DESCRIPTION
Projection as of December 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Total non-investment assets - - - - -
Total Assets - - - - -
LIABILITIES AND TABARRU' FUND EQUITY
Liabilities
Payables
Claim payables - - - - -
Reinsurance payables - - - - -
Ujrah payables to the company - - - - -
Surplus allocation payables to insured - - - - - Surplus allocation payables to the company - - - - - Tabarru' fund investment profit sharing payables to the company - - - - - Zakat payables - - - - - Other payables - - - - - Total Payables - - - - - Technical Provisions Contribution provisions - - - - - Provisions for contributions not yet recognized as income (PKYBMP) - - - - - Claim provisions - - - - - Total technical provisions - - - - - Qardh - - - - - Total liabilities - - - - - Tabarru' fund equity Accumulated tabarru' funds - - - - - Increase (decrease) in securities - - - - - Valuation difference based on SAK & SAP - - - - - Disallowed assets - - - - -

DESCRIPTION
Projection as of December 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Total Tabarru' Fund Equity - - - - -
TOTAL LIABILITIES AND TABARRU' FUND EQUITY - - - - - narrative explanation of the gray rows above Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.

b. Financial Position Projection for Life Insurance Companies in Sharia Units Company Fund Financial Position Projection (in millions of rupiah) DESCRIPTION Projection as of December 31 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* ASSETS Investment Assets Deposits - - - - - Sharia stocks - - - - - Sharia sukuk or bonds - - - - - Sharia government securities - - - - - Sharia securities issued by Bank Indonesia - - - - - Sharia securities issued by entities other than NKRI - - - - - Sharia securities issued by multinational institutions - - - - - Sharia mutual funds - - - - - Sharia asset-backed securities - - - - - Financing through cooperation with other parties Sharia. - - - - - Pure gold - - - - - Direct participation - - - - - Buildings with strata rights or land with buildings for investment

Other investments - - - - -
Total investment assets - - - - -
Non-investment Assets
Cash and bank - - - - -
Investment receivables - - - - -
Investment result receivables - - - - -
Ujrah receivables from participants - - - - -

DESCRIPTION
Projection as of December 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Tabarru' fund surplus allocation receivables - - - - - Tabarru' fund investment management profit sharing receivables - - - - - Qardh receivables - - - - - Buildings with strata rights or land with buildings for own use - - - - - Computer hardware - - - - - Other fixed assets - - - - - Other assets - - - - - Total non-investment assets - - - - - TOTAL ASSETS - - - - - LIABILITIES AND EQUITY Liabilities Commission payables - - - - - Reinsurance ujrah payables - - - - - Tax payables - - - - - Accrued expenses - - - - - Zakat payables - - - - - Other payables - - - - - Total liabilities - - - - - Subordinated loans - - - - - Company Equity Paid-up capital - - - - - Share premium - - - - - Reserves - - - - -

DESCRIPTION
Projection as of December 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Increase (decrease) in securities - - - - - Fixed asset valuation difference - - - - - Retained earnings - - - - - Total company equity - - - - - TOTAL LIABILITIES AND EQUITY - - - - - narrative explanation of the gray rows above Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.

DESCRIPTION
Projection as of December 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
LIABILITIES AND TABARRU' FUND EQUITY
Liabilities
Payables
Claim payables - - - - -
Reinsurance payables - - - - -
Ujrah payables to the company - - - - -
Surplus allocation payables to insured - - - - - Surplus allocation payables to the company - - - - - Tabarru' fund investment profit sharing payables to the company - - - - - Zakat payables - - - - - Other payables - - - - - Total Payables - - - - - Technical Provisions Contribution provisions - - - - - Provisions for contributions not yet recognized as income (PKYBMP) - - - - - Claim provisions - - - - - Total technical provisions - - - - - Qardh - - - - - Total liabilities - - - - - Tabarru' fund equity Accumulated tabarru' funds - - - - - Increase (decrease) in securities - - - - - Valuation difference based on SAK & SAP - - - - - Disallowed assets - - - - - Total Tabarru' Fund Equity - - - - - TOTAL LIABILITIES AND TABARRU' FUND EQUITY - - - - - narrative explanation of the gray rows above

Participant Investment Fund Financial Position Projection (in millions of rupiah) DESCRIPTION Projection as of December 31 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* ASSETS Investment Assets Deposits - - - - - Sharia Stocks - - - - - Sharia Sukuk or Bonds - - - - - Sharia Government Securities - - - - - Sharia Securities Issued by Bank Indonesia - - - - - Sharia Securities Issued by entities other than NKRI - - - - - Sharia Securities Issued by Multinational Institutions - - - - - Sharia Mutual Funds - - - - - Sharia Asset-backed Securities - - - - - Financing Through Cooperation With Other Parties. - - - - - Pure Gold - - - - - Other Investments - - - - - Total Investments - - - - - Non-Investment Cash and Bank - - - - - Investment Receivables - - - - - Investment Result Receivables - - - - - Other Assets - - - - - Total Non-Investment - - - - - TOTAL ASSETS - - - - - LIABILITIES Ujrah/Fund Management Fee Payables - - - - - Investment Profit Sharing Payables - - - - -

DESCRIPTION
Projection as of December 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Investment Fund Withdrawal Payables - - - - - Accumulated Participant Investment Funds - - - - - TOTAL LIABILITIES - - - - - narrative explanation of the gray rows above Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.

5.10 Projection of Comprehensive Income/Loss Every Year for Five Years
Detail the comprehensive income/loss projection every year for the next five years by filling in the table format below, then detail the accounts with gray rows narratively. a. Comprehensive Income/Loss and Underwriting Surplus Projection for General Insurance Business/Reinsurance Business in Sharia Units Company Fund Comprehensive Income/Loss Projection (in millions of rupiah) DESCRIPTION PROJECTION Jan-Dec 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* INCOME Ujrah received a. Ujrah received for risk management - - - - - b. Ujrah received for tabarru' fund investment management

Total Ujrah Received - - - - -
Commission Receipts - - - - -
Tabarru' fund investment management profit sharing - - - - - Tabarru' fund underwriting surplus allocation - - - - - Company investment management results - - - - - Other business income - - - - - Total income - - - - - BUSINESS EXPENSES Commissions paid - - - - - Reinsurance ujrah - - - - - Marketing expenses - - - - - General & administrative expenses - - - - - Other business expenses - - - - - Total Business Expenses - - - - -

DESCRIPTION
PROJECTION
Jan-Dec
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Business Profit (Loss) - - - - -
Other non-business results (expenses) net - - - - - PROFIT (LOSS) BEFORE ZAKAT AND TAX - - - - - Zakat - - - - - PROFIT (LOSS) BEFORE TAX - - - - - Income Tax - - - - - PROFIT (LOSS) AFTER TAX - - - - - Other Comprehensive Income - - - - - TOTAL COMPREHENSIVE PROFIT (LOSS) - - - - - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
narrative/descriptive explanation of the gray rows above

Tabarru' Fund Underwriting Surplus Projection (in millions of rupiah) DESCRIPTION PROJECTION Jan-Dec 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* UNDERWRITING INCOME Contributions from participants - - - - - Reinsurance contributions - - - - - Decrease (increase) in Contribution Provisions and KYBMP a. Decrease (increase) in contribution provisions - - - - - b. Decrease (increase) in KYBMP - - - - - Total Decrease (increase) in Contribution Provisions and KYBMP - - - - - Total net contribution income - - - - - Claim Expenses a. Gross claims - - - - - b. Reinsurance claims received - - - - -
c. Increase (decrease) in claim provisions - - - - -
Total claim expenses - - - - -
Adjuster costs - - - - -
Underwriting surplus (deficit) - - - - - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
narrative/descriptive explanation of the gray rows above

b. Comprehensive Income/Loss and Underwriting Surplus Projection for Life Insurance Companies in Sharia Units Company Fund Comprehensive Income/Loss Projection (in millions of rupiah) DESCRIPTION PROJECTION Jan-Dec 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* INCOME Ujrah received a. Ujrah for risk management - - - - - b. Ujrah for tabarru' fund investment management - - - - -
c. Ujrah for participant investment fund management
Total Ujrah Received - - - - -
Commission Receipts - - - - -
Tabarru' fund investment management profit sharing - - - - - Participant investment fund investment management profit sharing Tabarru' fund underwriting surplus allocation - - - - - Company investment management results - - - - - Other business income - - - - - Total income - - - - - BUSINESS EXPENSES Acquisition Costs a. Commission expenses - First year - - - - - b. Commission expenses - Subsequent years - - - - -
c. Commission expenses - Overriding - - - - -
d. Other acquisition expenses - - - - -
Total Acquisition Costs - - - - -
Reinsurance ujrah - - - - -
Marketing expenses - - - - -

DESCRIPTION
PROJECTION
Jan-Dec
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
General & administrative expenses - - - - - Other business expenses - - - - - Total Business Expenses - - - - - DPLC service fees/Other management services - - - - - Business Profit (Loss) - - - - - Other non-business results (expenses) net - - - - - PROFIT (LOSS) BEFORE ZAKAT AND TAX - - - - - Zakat - - - - - PROFIT (LOSS) BEFORE TAX - - - - - Income Tax - - - - - PROFIT (LOSS) AFTER TAX - - - - - Other Comprehensive Income - - - - - TOTAL COMPREHENSIVE PROFIT (LOSS) - - - - - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
narrative/descriptive explanation of the table above Tabarru' Fund Underwriting Surplus Projection (in millions of rupiah) DESCRIPTION PROJECTION Jan-Dec 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* UNDERWRITING INCOME Contributions from participants - - - - - Reinsurance contributions - - - - - Decrease (increase) in Contribution Provisions and KYBMP a. Decrease (increase) in contribution provisions - - - - - b. Decrease (increase) in KYBMP - - - - - Total Decrease (increase) in Contribution Provisions and KYBMP - - - - - Total net contribution income - - - - - Claim Expenses a. Gross claims - - - - - b. Reinsurance claims received - - - - -
c. Increase (decrease) in claim provisions - - - - -
Total claim expenses - - - - -
Underwriting surplus (deficit) - - - - - Note:
If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
narrative/descriptive explanation of the table above Participant Investment Fund Change Projection (in millions of rupiah) DESCRIPTION PROJECTION Jan-Dec 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* Participant investment funds at the beginning of the year - - - - - Additions to participant investment funds during the current period Additions to funds from participant contributions - - - - - Additions to funds from investment results - - - - - Total Additions to participant investment funds - - - - - Investment management costs and ujrah - - - - - Withdrawals of participant investment funds Withdrawal of participant investment funds that have matured - - - - -

DESCRIPTION
PROJECTION
Jan-Dec
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Withdrawal/redemption of participant investment funds before maturity - - - - - Total withdrawals of participant investment funds - - - - - Total participant investment funds at the end of the year - - - - - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
narrative/descriptive explanation of the gray rows above

5.11 Projection of Financial Health Ratios, Risk-Based Minimum Capital Ratio, Financial Health Ratios Other Than Risk-Based Minimum Capital, and Profitability Ratios
Detail the projection of the ratios below for a period of 1 to 5 years into the future. Financial Health of Insurance/Reinsurance Business in Sharia Units No. Projection Ratio Projection Year 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
I. TABARRU' FUND
A. TABARRU' FUND SOLVENCY RATIO
B. FINANCIAL HEALTH RATIO OTHER THAN
SOLVENCY
i. Liquidity Ratio
ii. Investment Sufficiency Ratio Plus Cash/Bank with total
technical provisions + claim payment liabilities for own retention
iii. Investment Return Ratio with Net Premium Income
iv. Claim Expense, Business Expense, and Commission Ratio
II. COMPANY FUND
A. QARDH AVAILABLE WEALTH RATIO
B. COMPANY FUND SOLVENCY RATIO
C. OTHER RATIOS

Return on assets
Return on equity
Company Investment Return ÷ Company Income
Ujrah After Deducting Acquisition Costs ÷ Company Income
Business Expenses ÷ Ujrah
Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
narrative/descriptive explanation of the table above
5.12 Other Matters Related to Sharia Unit Activities
Explain other matters related to Sharia unit activities that are important to convey but are not covered in the corporate plan format, for example, Sharia unit CSR activities. Determined in Jakarta on December 9, 2014 EXECUTIVE HEAD OF INSURANCE SUPERVISOR, PENSION FUND, FINANCING INSTITUTION, AND OTHER FINANCIAL SERVICES INSTITUTIONS FINANCIAL SERVICES AUTHORITY, Signed, FIRDAUS DJAELANI Copy matches the original Legal Director 1 Legal Department, Signed. Signed. Tini Kustini

APPENDIX IV
FINANCIAL SERVICES AUTHORITY CIRCULAR LETTER NUMBER 15/SEOJK.05/2014 CONCERNING CORPORATE PLAN AND BUSINESS PLAN OF INSURANCE COMPANIES, SHARIA INSURANCE COMPANIES, REINSURANCE COMPANIES, AND SHARIA REINSURANCE COMPANIES

CORPORATE PLAN
SHARIA GENERAL INSURANCE COMPANY/SHARIA REINSURANCE COMPANY/SHARIA LIFE INSURANCE COMPANY 1
Year...............................2
PT. XYZ
2 Corporate Plan period reported, e.g., year 2015 – 20

Company Name :
Full Address :
Telephone and Fax :
Email :
Tax ID Number (NPWP) :
License No. & Date :
Shareholders :
Share Ownership
Shareholder Name
Rupiah
Percentage
Board of Directors and Commissioners:
Sharia Supervisory Board (DPS) :
Name of DPS Position
Corporate Plan PIG (1 person)
,
PT. XYZ
Total

OJK
Board of Directors

TABLE OF CONTENTS
Page
Company Profile
Table of ContentsIntroduction
Executive Summary
CHAPTER I INTRODUCTION
1.1 Company History
1.2 Vision, Mission, and Values
1.3 Company Organizational Structure
CHAPTER II CURRENT POSITION OF SHARIA INSURANCE COMPANY OR SHARIA
REINSURANCE COMPANY 1
2.1 Human Resources
2.2 IT Management
2.3 Products Marketed
2.4 Analysis Used in Preparing Corporate Plan
2.5 Company Segmentation or Positioning Map
2.6 Company Market Share
CHAPTER III EVALUATION OF PREVIOUS CORPORATE PLAN IMPLEMENTATION
2
3.1 Comparison Between Corporate Plan and Business Plan Realization
Every Year
3.2 Achievement of Objectives and Deviations Occurring
3.3 Implementation of Established Strategies and Policies
3.4 Challenges Faced and Problem-Solving Efforts
CHAPTER IV ASSUMPTIONS USED IN PREPARING CORPORATE
PLAN 3
4.1 Macro Assumptions
4.2 Micro Assumptions
CHAPTER V OBJECTIVES, TARGETS, AND STRATEGIES FOR ACHIEVING CORPORATE
PLAN 3
5.1 Objectives to be Achieved at the End of the Corporate Plan
5.2 Company Targets
5.3 Strategies Used by the Company
5.4 General and Functional Policies
5.5 Activity Programs
5.6 Matrix of Linkages Between Targets, Strategies, Policies, and Activity Programs
5.7 Assumptions for Financial Projection Preparation
5.8 Cash Flow Projection Every Year for Five Years
5.9 Financial Position/Balance Sheet Projection Every Year for Five Years
5.10 Comprehensive Income/Loss Projection Every Year for Five Years
5.11 Financial Health Ratio and Profitability Ratio Projection
5.12 Other Matters Related to Company Activities
Note:
1 CHAPTER II describes the current position of the company. 2 CHAPTER III describes the evaluation of the implementation of the previous period's corporate plan/long-term plan of the company. If the company is a new company, then ignore the preparation of CHAPTER III. 3 CHAPTER IV and CHAPTER V describe the corporate plan period to be reported to

Introduction
The introduction contains the background of the preparation of the Corporate Plan, the formulation of important aspects in the prepared Corporate Plan, and other matters considered important to convey. Important aspects in the Corporate Plan should only be a summary containing an outline and emphasize the main points only. Executive Summary The executive summary is the entry point to the Corporate Plan. This paragraph is only a summary emphasizing the content of the corporate plan conveyed.

CHAPTER I
INTRODUCTION
1.1 Company History
State when the company was founded, by whom, and for what purpose. How has the company developed since then? Have the name and ownership of the company changed since it was founded. If your company is a new company, then convey the background of the company's establishment.
1.2 Vision, Mission, and Values
Vision is the picture of the company's condition in the future and is the company's dream. Vision is a statement to answer the question of the company's direction forward. Mission is the elaboration of the vision, where the mission elaborates a careful analysis of the benefits desired by existing policyholders as well as prospective policyholders. The mission also elaborates the existing environment and market conditions as well as the company's anticipation forward. In realizing the vision and implementing the mission, the company relies on core values, elaborate these values (if any).

1.3 Organizational Structure
Elaborate the composition of the Board of Commissioners and Board of Directors and work units below them in the company. Draw in the form of an organization chart.

CHAPTER II
CURRENT POSITION OF SHARIA INSURANCE COMPANIES OR SHARIA REINSURANCE COMPANIES
2.1 Human Resources
Describe the number of management, company employees, experts used, foreign workers, and existing insurance agents currently.
2.2 IT Management
Detail the use of information technology used to support the company's business activities.
2.3 Products Marketed
Detail a summary of products and services offered/sold by the company.

Example table
No Product Name General Product Description Number and Date of Recording Letter
2.4 Analysis Used in Preparing the Corporate Plan
Describe the analysis used when the company prepares the corporate plan, for example SWOT analysis, Balance Scorecard, PEST, etc.
2.5. Segmentation or Company Positioning Map
Describe the company's position in the industry (upper, middle, and lower), especially for products that are the company's focus.
2.6 Company Market Share
Describe the company's market share by comparing the company's gross contribution with the insurance industry's gross contribution.

CHAPTER III
EVALUATION OF THE IMPLEMENTATION OF THE PREVIOUS CORPORATE PLAN PERIOD
3.1 Comparison Between Corporate Plan and Realization of Business Plan Every Year (Ignore if your company is a new company)
Detail the current corporate plan and its realization with the business plan every year. In this section, the company can view the company's performance in that period by comparing the corporate plan with the realization of the business plan. The example table below can be modified in more detail according to the company's needs. Indicator 20XX-1 20XX-2 20XX-3 20XX-4 20XX-5 Corporate Plan Realization % Corporate Plan Realization % Corporate Plan Realization % Corporate Plan Realization % Corporate Plan Realization % (1) (2) (2/1) (1) (2) (2/1) (1) (2) (2/1) (1) (2) (2/1) (1) (2) (2/1) Gross Contribution Gross Contribution ÷ Acquisition Cost Tabarru' Fund Tabarru' Premium Underwriting Surplus Return on Investment DT Solvency Ratio Balance Ratio Investment plus Cash/Bank with Technical Provisions and Claims Payable Retention Company Funds Ujrah Profit/Loss Return on Equity Return on Assets Return on Investment Solvency Ratio Liquidity Ratio Available Wealth Ratio For Qardh Investment Results Company Funds ÷ Company Revenue Ujrah After Deducting Acquisition Costs ÷ Company Revenue

Indicator
20XX-1 20XX-2 20XX-3 20XX-4 20XX-5
Corporate Plan Realization % Corporate Plan Realization % Corporate Plan Realization % Corporate Plan Realization % Corporate Plan Realization % (1) (2) (2/1) (1) (2) (2/1) (1) (2) (2/1) (1) (2) (2/1) (1) (2) (2/1) Gross Contribution Gross Contribution ÷ Acquisition Cost Tabarru' Fund Tabarru' Premium Underwriting Surplus Return on Investment DT Solvency Ratio Balance Ratio Investment plus Cash/Bank with Technical Provisions and Claims Payable Retention Company Funds Business Expenses ÷ Ujrah Participant Investment Funds Contribution to Investment Accumulation of Participant Investment Funds Return on Investment etc. (add other indicators as deemed necessary) Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX-1 is 2014, 20XX-2 is 2013, etc.

3.2 Achievement of Objectives and Deviations That Occurred This section is a detailed picture of each indicator in the comparison table between the corporate plan and the business plan, and if there are deviations in the comparison table, the reasons for the deviations are explained. Also detail the company's objectives related to the achievement of sales, profits, and market share to be achieved and their realization, and what about the deviations that occurred?

3.3 Implementation of Established Strategies and Policies
Explain the company's strategies and policies and detail the implementation of the company's strategies and policies that have been agreed upon and established together, for example regarding business lines and distribution channels and sources of production business that will be the company's focus.
3.4 Obstacles Faced and Problem-Solving Efforts
Clearly state the obstacles faced in implementing the established corporate plan and what the solutions are for problem-solving.

CHAPTER IV
ASSUMPTIONS USED IN PREPARING THE CORPORATE PLAN
4.1 Macro Assumptions
This paragraph contains the elaboration of macro assumptions used in preparing the five-year corporate plan, for example global economic conditions, national economic growth, inflation, exchange rates, etc.
4.2 Micro Assumptions
This paragraph contains the elaboration of micro assumptions used in preparing the five-year corporate plan, for example investment return rates, number of new coverages, lapse ratio, catastrophic losses, and factors affecting the company's operational activities originating from within the company.

CHAPTER V
OBJECTIVES, TARGETS, AND STRATEGIES FOR ACHIEVING THE CORPORATE PLAN
5.1 Objectives to be Achieved at the End of the Corporate Plan
Detail the company's objectives to be achieved at the end of the corporate plan period related to the company's vision and mission.
5.2 Company Targets
This paragraph contains the company's targets during the five-year corporate plan period. Targets are made in detail and measurable in terms of being able to measure the achievement of objectives.
5.3 Strategies Used by the Company
The strategies used by the company include corporate strategies according to the company's position, business strategies, and functional strategies for each field/unit of activity. Corporate strategies are more global than business strategies and functional strategies. Business strategies emphasize improving the company's financial performance, while functional strategies focus more on strategies for each field/unit in the company, for example, the marketing field/unit's strategy is cooperation with banks in product marketing.

5.4 General and Functional Policies
General and functional policies that provide flexibility boundaries and become guidelines for management in implementing strategies or program activities.
5.5 Activity Programs
Detail the activity programs to be implemented every year for the next five years.
5.6 Matrix of Linkage Between Targets, Strategies, Policies, and Activity Programs
A matrix of linkage between targets, strategies, policies, and activity programs that describes the detailed development direction of the company. An example of the matrix format can be seen below; if the company does not yet have a format, it can use the available format.

Example format:
Strategic Issue 1:
HR Structure
Targets:

Increase productive age to 90.5%.
Increase experts from 10% (40 people) to 25% (100 people).
Realize an ideal HR composition structure.
Strategy:
HR Recomposition and Mapping
Policy:
HR Recomposition is based on the competencies required by the company No Program 20XX 20XX+1 20XX+2 20XX+3 20XX+4 1 Perform manpower planning 2 Job enrichment 3 Systematic and continuous employee mutation or rotation based on competence and company needs 4 Perform recruitment according to the competencies required by the company Strategic Issue 2:
Capital
Targets:
.......
.....
.....
Strategy:
Policy:
.....................
No Program 20XX 20XX+1 20XX+2 20XX+3 20XX+4 2 L Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.

5.7 Assumptions in Preparing Financial Projections
Detail the assumptions used in preparing financial projections.

5.8 Cash Flow Projections Every Year for Five Years
Detail the cash flow projections every year for the next five years by filling in the table format below, then detail the accounts with gray rows narratively. a. Cash Flow Projections for Sharia General Insurance Business / Sharia Reinsurance Business Company Funds Cash Flow Projections (in millions of rupiah) Description Projection January - December 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* Beginning Cash and Bank Balance - - - - - CASH FLOWS FROM OPERATING ACTIVITIES Cash Inflows a. Ujrah received - - - - - b. Others - - - - - Total Cash Inflows - - - - - Cash Outflows a. Commission - - - - - b. Marketing expenses - - - - -
c. Reinsurance ujrah payments - - - - -
d. Rent payments - - - - - e. Zakat payments - - - - - f. Tax payments - - - - - g. Others - - - - - Total Cash Outflows - - - - - Total Cash Flows from Operating Activities - - - - - CASH FLOWS FROM INVESTMENT ACTIVITIES Cash Inflows

Description
Projection
January - December
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* a. Company investment results received - - - - - b. Tabarru' fund surplus allocation received - - - - -
c. Tabarru' fund investment profit sharing received - - - - -
d. Investment withdrawal - - - - - e. Sale of fixed assets - - - - - f. Others - - - - - Total Cash Inflows - - - - - Cash Outflows a. Investment placement - - - - - b. Purchase of fixed assets - - - - -
c. Others - - - - -
Total Cash Outflows - - - - -
Total Cash Flows from Investment Activities - - - - - CASH FLOWS FROM FINANCING ACTIVITIES Cash Inflows a. Subordinated loans - - - - - b. Capital/capital work deposits - - - - -
c. Qardh received - - - - -
d. Others - - - - -
Total Cash Inflows - - - - -
Cash Outflows a. Subordinated loan payments - - - - - b. Dividend payments - - - - -
c. Qardh - - - - -
d. Others - - - - -

Description
Projection
January - December
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Total Cash Outflows - - - - -
Total Cash Flows from Financing Activities - - - - - ENDING CASH AND BANK BALANCE - - - - - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
narrative explanation of the gray rows above

Cash Flow Projections for Reinsurance Business (in millions of rupiah) Description Projection January - December 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* BEGINNING CASH AND BANK BALANCE CASH FLOWS FROM OPERATING ACTIVITIES Cash Inflows a. Participant contributions b. Reinsurance claims received
c. Reinsurance underwriting surplus distribution received
Total Cash Inflows -
Cash Outflows a. Insurance ujrah payments b. Reinsurance contributions paid
c. Claims paid
d. Others
Total Cash Outflows -
TOTAL CASH FLOWS FROM OPERATING ACTIVITIES - CASH FLOWS FROM INVESTMENT ACTIVITIES Cash Inflows a. Tabarru' fund investment results received b. Tabarru' fund investment withdrawal
c. Sale of land and buildings
d. Others
Total Cash Inflows -
Cash Outflows a. Investment placement b. Underwriting surplus distribution payments to the company

Description
Projection
January - December
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
c. Underwriting surplus distribution payments to participants
d. Tabarru' fund investment profit sharing payments to the company e. Others Total Cash Outflows - TOTAL CASH FLOWS FROM INVESTMENT ACTIVITIES - CASH FLOWS FROM FINANCING ACTIVITIES Cash Inflows a. Qardh b. Others Total Cash Inflows - Cash Outflows a. Qardh payments b. Others Total Cash Outflows - TOTAL CASH FLOWS FROM FINANCING ACTIVITIES - ENDING CASH AND BANK BALANCE - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.

narrative explanation of the gray rows above b. Cash Flow Projections for Sharia Life Insurance Business Company Funds Cash Flow Projections (in millions of rupiah) Description Projection January - December 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* Beginning Cash and Bank Balance - - - - - CASH FLOWS FROM OPERATING ACTIVITIES Cash Inflows a. Ujrah received - - - - - b. Others - - - - - Total Cash Inflows - - - - - Cash Outflows a. Commission - - - - - b. Marketing expenses - - - - -
c. Reinsurance ujrah payments - - - - -
d. Rent payments - - - - -

Description
Projection
January - December
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* e. Zakat payments - - - - - f. Tax payments - - - - - g. Others - - - - - Total Cash Outflows - - - - - Total Cash Flows from Operating Activities - - - - - CASH FLOWS FROM INVESTMENT ACTIVITIES Cash Inflows a. Company investment results received - - - - - b. Tabarru' fund surplus allocation received - - - - -
c. Tabarru' fund investment profit sharing received - - - - -
d. Investment withdrawal - - - - - e. Sale of fixed assets - - - - - f. Others - - - - - Total Cash Inflows - - - - - Cash Outflows a. Investment placement - - - - - b. Purchase of fixed assets - - - - -
c. Others - - - - -
Total Cash Outflows - - - - -
Total Cash Flows from Investment Activities - - - - -

CASH FLOWS FROM FINANCING ACTIVITIES
Cash Inflows a. Subordinated loans

b. Capital/capital work deposits

c. Qardh received

Description
Projection
January - December
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* d. Others - - - - - Total Cash Inflows - - - - - Cash Outflows a. Subordinated loan payments - - - - - b. Dividend payments - - - - -
c. Qardh - - - - -
d. Others - - - - -
Total Cash Outflows - - - - -
Total Cash Flows from Financing Activities - - - - - ENDING CASH AND BANK BALANCE - - - - - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.

Tabarru' Fund Cash Flow Projections (in millions of rupiah) Description Projection January - December 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* BEGINNING CASH AND BANK BALANCE CASH FLOWS FROM OPERATING ACTIVITIES Cash Inflows a. Participant contributions b. Reinsurance claims received
c. Reinsurance underwriting surplus distribution received
Total Cash Inflows -
Cash Outflows a. Insurance ujrah payments b. Reinsurance contributions paid
c. Claims paid
d. Others
Total Cash Outflows -
TOTAL CASH FLOWS FROM OPERATING ACTIVITIES - CASH FLOWS FROM INVESTMENT ACTIVITIES Cash Inflows a. Tabarru' fund investment results received b. Tabarru' fund investment withdrawal

narrative explanation of the gray rows above
c. Sale of land and buildings
d. Others
Total Cash Inflows -
Cash Outflows a. Investment placement

Description
Projection
January - December
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* b. Underwriting surplus distribution payments to the company
c. Underwriting surplus distribution payments to participants
d. Tabarru' fund investment profit sharing payments to the company e. Others Total Cash Outflows - TOTAL CASH FLOWS FROM INVESTMENT ACTIVITIES - CASH FLOWS FROM FINANCING ACTIVITIES Cash Inflows a. Qardh b. Others Total Cash Inflows - Cash Outflows a. Qardh payments b. Others Total Cash Outflows - TOTAL CASH FLOWS FROM FINANCING ACTIVITIES - ENDING CASH AND BANK BALANCE - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.

5.9 Financial Position/Balance Sheet Projections Every Year for Five Years
Detail the balance sheet projections every year for the next five years by filling in the table format below, then detail the accounts with gray rows narratively. a. Financial Position Projections for Sharia General Insurance Business / Sharia Reinsurance Business Company Funds Financial Position Projections (in millions of rupiah) DESCRIPTION Projection as of December 31 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* ASSETS Investment Assets Deposits - - - - - Sharia stocks - - - - - Sharia sukuk or bonds - - - - - Sharia government securities - - - - - Sharia securities issued by Bank Indonesia - - - - - Sharia securities issued by entities other than the Republic of Indonesia - - - - - Sharia securities issued by multinational institutions - - - - - Sharia mutual funds - - - - - Sharia asset-backed securities - - - - - Financing through cooperation with other parties Sharia. - - - - - Pure gold - - - - -

Direct participation

Buildings with strata rights or land with buildings for investment - - - - - Other investments - - - - -

DESCRIPTION
Projection as of December 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Total investment assets - - - - -
Non-Investment Assets
Cash and bank - - - - -
Investment receivables - - - - -
Investment results receivables - - - - - Ujrah receivables from participants - - - - - Tabarru' fund surplus allocation receivables - - - - - Tabarru' fund investment management profit sharing receivables - - - - - Qardh receivables - - - - - Buildings with strata rights or land with buildings for own use - - - - - Computer hardware - - - - - Other fixed assets - - - - - Other assets - - - - - Total non-investment assets - - - - - TOTAL ASSETS - - - - - LIABILITIES AND EQUITY Liabilities Commission payables - - - - - Reinsurance ujrah payables - - - - - Tax payables - - - - - Accrued expenses - - - - - Zakat payables - - - - - Other payables - - - - -

DESCRIPTION
Projection as of December 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Total liabilities - - - - -
Subordinated loans - - - - -
Company Equity
Paid-in capital - - - - -
Share premium - - - - -
Reserves - - - - -
Increase (decrease) in securities - - - - - Difference in fixed asset valuation - - - - - Retained earnings - - - - - Total company equity - - - - - TOTAL LIABILITIES AND EQUITY - - - - - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
narrative explanation of the gray rows above

Financial Position Projections for Reinsurance Business (in millions of rupiah) DESCRIPTION Projection as of December 31 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* ASSETS Investment Assets Deposits - - - - - Sharia stocks - - - - - Sharia sukuk or bonds - - - - - Sharia government securities - - - - - Sharia securities issued by Bank Indonesia - - - - - Sharia securities issued by entities other than NKRI - - - - - Sharia securities issued by Multinational Institutions - - - - - Sharia mutual funds - - - - - Sharia asset-backed securities - - - - - Financing through cooperation with other parties. - - - - - Pure gold - - - - - Other investments - - - - - Total Investments - - - - - Non-Investment Assets Cash and bank - - - - - Contribution receivables - - - - - Reinsurance receivables - - - - - Investment receivables - - - - - Investment results receivables - - - - - Other assets - - - - -

DESCRIPTION
Projection as of December 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Total non-investment assets - - - - -
Total Assets - - - - -
LIABILITIES AND TABARRU' FUND EQUITY
Liabilities
Payables
Claims payables - - - - -
Reinsurance payables - - - - -
Ujrah payables to the company - - - - -
Surplus allocation payables to insured - - - - - Surplus allocation payables to the company - - - - - Tabarru' fund investment profit sharing payables to the company - - - - - Zakat payables - - - - - Other payables - - - - - Total Payables - - - - - Technical Provisions Contribution provisions - - - - - Provisions for contributions not yet earned (PKYBMP) - - - - - Claims provisions - - - - - Total technical provisions - - - - - Qardh - - - - - Total liabilities - - - - - Tabarru' fund equity Accumulated tabarru' funds - - - - - Increase (decrease) in securities - - - - - Difference in valuation based on SAK & SAP - - - - - Disallowed assets - - - - -

DESCRIPTION
Projection as of December 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Total equity (Tabarru' Fund) - - - - -
TOTAL LIABILITIES AND TABARRU' FUND EQUITY - - - - - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
narrative explanation of the gray rows above

b. Financial Position Projections for Sharia Life Insurance Companies Company Funds Financial Position Projections (in millions of rupiah) DESCRIPTION Projection as of December 31 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* ASSETS Investment Assets Deposits - - - - - Sharia stocks - - - - - Sharia sukuk or bonds - - - - - Sharia government securities - - - - - Sharia securities issued by Bank Indonesia - - - - - Sharia securities issued by entities other than NKRI - - - - - Sharia securities issued by multinational institutions - - - - - Sharia mutual funds - - - - - Sharia asset-backed securities - - - - - Financing through cooperation with other parties Sharia. - - - - - Pure gold - - - - - Direct participation - - - - - Buildings with strata rights or land with buildings for investment

Other investments - - - - -
Total investment assets - - - - -
Non-Investment Assets
Cash and bank - - - - -
Investment receivables - - - - -
Investment results receivables - - - - - Ujrah receivables from participants - - - - - Tabarru' fund surplus allocation receivables - - - - -

DESCRIPTION
Projection as of December 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Tabarru' fund investment management profit sharing receivables - - - - - Qardh receivables - - - - - Buildings with strata rights or land with buildings for own use - - - - - Computer hardware - - - - - Other fixed assets - - - - - Other assets - - - - - Total non-investment assets - - - - - TOTAL ASSETS - - - - - LIABILITIES AND EQUITY Liabilities Commission payables - - - - - Reinsurance ujrah payables - - - - - Tax payables - - - - - Accrued expenses - - - - - Zakat payables - - - - - Other payables - - - - - Total liabilities - - - - - Subordinated loans - - - - - Company Equity Paid-in capital - - - - - Share premium - - - - - Reserves - - - - - Increase (decrease) in securities - - - - -

DESCRIPTION
Projection as of December 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Difference in fixed asset valuation - - - - - Retained earnings - - - - - Total company equity - - - - - TOTAL LIABILITIES AND EQUITY - - - - - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
narrative explanation of the gray rows above

Tabarru' Fund Financial Position Projections (in millions of rupiah) DESCRIPTION Projection as of December 31 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* ASSETS Investment Assets Deposits - - - - - Sharia stocks - - - - - Sharia sukuk or bonds - - - - - Sharia government securities - - - - - Sharia securities issued by Bank Indonesia - - - - - Sharia securities issued by entities other than NKRI - - - - - Sharia securities issued by Multinational Institutions - - - - - Sharia mutual funds - - - - - Sharia asset-backed securities - - - - - Financing through cooperation with other parties. - - - - - Pure gold - - - - - Other investments - - - - - Total Investments - - - - - Non-Investment Assets Cash and bank - - - - - Contribution receivables - - - - - Reinsurance receivables - - - - - Investment receivables - - - - - Investment results receivables - - - - - Other assets - - - - - Total non-investment assets - - - - - Total Assets - - - - - LIABILITIES AND TABARRU' FUND EQUITY Liabilities

DESCRIPTION
Projection as of December 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Liabilities
Claims Payable - - - - -
Reinsurance Payable - - - - -
Ujrah Payable to Company - - - - -
Surplus Allocation Payable to Insured - - - - - Surplus Allocation Payable to Company - - - - - Investment Profit Sharing Payable for Tabarru' Funds to Company - - - - - Zakat Payable - - - - - Other Payables - - - - - Total Liabilities - - - - - Technical Provisions Contribution Provision - - - - - Provision for Contribution Not Yet Earned (PKYBMP) - - - - - Claims Provision - - - - - Total Technical Provisions - - - - - Qardh - - - - - Total Liabilities - - - - - GIVIIED1111’ Equity Accumulated Tabarru' Funds - - - - - Increase (Decrease) in Securities - - - - - Valuation Difference Based on SAK & SAP - - - - - Disallowed Assets - - - - - Total GIVItIED1111’ Equity - - - - - TOTAL LIABILITIES AND TABARRU' FUND EQUITY - - - - - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.

Narrative explanation of the gray rows above Projection of Participant Investment Fund Financial Position (in millions of rupiah) DESCRIPTION Projection as of December 31 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* ASSETS Investment Assets Time Deposits - - - - - Sharia Stocks - - - - - Sharia Sukuk or Bonds - - - - - Sharia Government Securities - - - - - Sharia Securities Issued by Bank Indonesia - - - - - Sharia Securities Issued by Entities Other Than NKRI - - - - - Sharia Securities Issued by Multinational Institutions - - - - - Sharia Mutual Funds - - - - - Sharia Asset-Backed Securities - - - - - Financing Through Cooperation with Other Parties. - - - - -

DESCRIPTION
Projection as of December 31
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
Pure Gold - - - - -
Other Investments - - - - -
Total Investments - - - - -
Non-Investment
Cash and Bank - - - - -
Investment Receivables - - - - -
Investment Income Receivables - - - - -
Other Assets - - - - -
Total Non-Investment - - - - -
TOTAL ASSETS - - - - -
LIABILITIES
Ujrah/Investment Management Fee Payable - - - - - Investment Profit Sharing Payable - - - - - Investment Fund Withdrawal Payable - - - - - Accumulated Participant Investment Funds - - - - - TOTAL LIABILITIES - - - - - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
narrative explanation of the gray rows above

5.10 Profit/Loss Projection Each Year for Five Years
Detail the profit/loss projection for each year for the next five years by filling in the table format below, then detail the accounts with gray rows narratively. a. Comprehensive Profit/Loss Projection and Underwriting Surplus for General Sharia Insurance Business / Sharia Reinsurance Business Comprehensive Profit/Loss Projection of Company Funds (in millions of rupiah) DESCRIPTION PROJECTION Jan-Dec 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* INCOME Ujrah Received a. Ujrah received for risk management - - - - - b. Ujrah received for management of tabarru' investment funds

Total Ujrah Received - - - - -
Commission Received - - - - -
Profit sharing for management of tabarru' investment funds - - - - - Allocation of underwriting surplus of tabarru' funds - - - - - Company investment management results - - - - - Other business income - - - - - Total Income - - - - - BUSINESS EXPENSES Commissions Paid - - - - - Reinsurance Ujrah - - - - - Marketing Expenses - - - - - General & Administrative Expenses - - - - - Other Business Expenses - - - - - Total Business Expenses - - - - -

narrative/descriptive explanation of the gray rows above DESCRIPTION PROJECTION Jan-Dec 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* Business Profit (Loss) - - - - - Other Non-Business Results (Expenses) Net - - - - - PROFIT (LOSS) BEFORE ZAKAT AND TAX - - - - - Zakat - - - - - PROFIT (LOSS) BEFORE TAX - - - - - Income Tax - - - - - PROFIT (LOSS) AFTER TAX - - - - - Other Comprehensive Income - - - - - TOTAL COMPREHENSIVE PROFIT (LOSS) - - - - - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.

narrative/descriptive explanation of the gray rows above Projection of Underwriting Income/Expense in (millions of rupiah) DESCRIPTION PROJECTION Jan-Dec 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* UNDERWRITING INCOME Participant Contributions - - - - - Reinsurance Contributions - - - - - Decrease (Increase) in Contribution Provision and KYBMP a. Decrease (Increase) in contribution provision - - - - - b. Decrease (Increase) in KYBMP - - - - - Total Decrease (Increase) in Contribution Provision and KYBMP - - - - - Total Net Contribution Income - - - - - Claims Expenses a. Gross Claims - - - - - b. Reinsurance Claims Received - - - - -
c. Increase (Decrease) in Claims Provision - - - - -
Total Claims Expenses - - - - -
Adjuster Costs - - - - -
Underwriting Surplus (Deficit) - - - - - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.

b. Comprehensive Profit/Loss Projection and Underwriting Surplus for Sharia Life Insurance Business Comprehensive Profit/Loss Projection of Company Funds (in millions of rupiah) DESCRIPTION PROJECTION Jan-Dec 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* INCOME Ujrah Received a. Ujrah for risk management - - - - - b. Ujrah for management of tabarru' investment funds - - - - -
c. Ujrah for management of participant investment funds
Total Ujrah Received - - - - -
Commission Received - - - - -
Profit sharing for management of tabarru' investment funds - - - - - Profit sharing for management of participant investment funds Allocation of underwriting surplus of tabarru' funds - - - - - Company investment management results - - - - - Other business income - - - - - Total Income - - - - - BUSINESS EXPENSES Acquisition Costs a. Commission Expense - First Year - - - - - b. Commission Expense - Subsequent Years - - - - -
c. Commission Expense - Overriding - - - - -
d. Other Acquisition Expenses - - - - -
Total Acquisition Costs - - - - -
Reinsurance Ujrah - - - - -
Marketing Expenses - - - - -

narrative explanation of the table above DESCRIPTION PROJECTION Jan-Dec 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* General & Administrative Expenses - - - - - Other Business Expenses - - - - - Total Business Expenses - - - - - DPLC/Other Management Service Fees - - - - - Business Profit (Loss) - - - - - Other Non-Business Results (Expenses) Net - - - - - PROFIT (LOSS) BEFORE ZAKAT AND TAX - - - - - Zakat - - - - - PROFIT (LOSS) BEFORE TAX - - - - - Income Tax - - - - - PROFIT (LOSS) AFTER TAX - - - - - Other Comprehensive Income - - - - - TOTAL COMPREHENSIVE PROFIT (LOSS) - - - - - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.

narrative explanation of the table above Projection of Underwriting Income/Expense in (millions of rupiah) DESCRIPTION PROJECTION Jan-Dec 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* UNDERWRITING INCOME Participant Contributions - - - - - Reinsurance Contributions - - - - - Decrease (Increase) in Contribution Provision and KYBMP a. Decrease (Increase) in contribution provision - - - - - b. Decrease (Increase) in KYBMP - - - - - Total Decrease (Increase) in Contribution Provision and KYBMP - - - - - Total Net Contribution Income - - - - - Claims Expenses a. Gross Claims - - - - - b. Reinsurance Claims Received - - - - -
c. Increase (Decrease) in Claims Provision - - - - -
Total Claims Expenses - - - - -
Underwriting Surplus (Deficit) - - - - - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.

Projection of Changes in Participant Investment Funds (in millions of rupiah) DESCRIPTION PROJECTION Jan-Dec 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* Participant Investment Funds at Beginning of Year - - - - - Additions to Participant Investment Funds in Current Period Additions from Participant Contributions - - - - - Additions from Investment Results - - - - - Total Additions to Participant Investment Funds - - - - - Investment Management Costs and Ujrah - - - - - Withdrawals of Participant Investment Funds Withdrawals of Participant Investment Funds that have Matured - - - - - Withdrawals/Redemptions of Participant Investment Funds before Maturity - - - - - Total Withdrawals of Participant Investment Funds - - - - - Total Participant Investment Funds at End of Year - - - - - Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.
narrative/descriptive explanation of the gray rows above

5.11 Projection of Financial Health Ratios Based on Minimum Risk-Based Capital, Other Than Minimum Risk-Based Capital Financial Health Ratios, and Profitability Ratios
Detail the projection of the following ratios for a period of 1 to 5 years into the future. Financial Health of Sharia Insurance Business / Sharia Reinsurance Business No. Ratio Projection Projection Year 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
I. TABARRU' FUNDS
A. TABARRU' FUND SOLVENCY RATIO
B. FINANCIAL HEALTH RATIO OTHER THAN
SOLVENCY
i. Liquidity Ratio
ii. Investment Sufficiency Ratio Plus Cash/Bank with the amount
of technical provisions + own retention claims payment liabilities
iii. Investment Return Ratio with Net Premium Income
iv. Claims Expense, Business Expense, and Commission Ratio
II. COMPANY FUNDS
A. RATIO OF WEALTH AVAILABLE FOR QARDH
B. COMPANY FUND SOLVENCY RATIO
C. OTHER RATIOS

Return on assets
Return on equity
Company Investment Results ÷ Company Income
Ujrah After Deducting Acquisition Costs ÷ Company Income
Business Expenses ÷ Ujrah
Note:

If the submission of the corporate plan is for the year 2015-2019, then 20XX is 2015, 20XX+1 is 2016, etc.

narrative/descriptive explanation of the table above
5.12 Other Matters Related to Company Activities
Explain other matters related to company activities that are important to convey but are not covered in the corporate plan format, for example, the company's CSR activities. Determined in Jakarta on December 9, 2014 EXECUTIVE HEAD OF INSURANCE SUPERVISOR, PENSION FUND, FINANCING INSTITUTION, AND OTHER FINANCIAL SERVICE INSTITUTIONS FINANCIAL SERVICES AUTHORITY, Signed, FIRDAUS DJAELANI Copy matches the original Legal Director 1 Legal Department, Signed. Signed. Tini Kustini

APPENDIX V
FINANCIAL SERVICES AUTHORITY CIRCULAR LETTER NUMBER 15/SEOJK.05/2014 CONCERNING CORPORATE PLAN AND BUSINESS PLAN OF INSURANCE COMPANIES, SHARIA INSURANCE COMPANIES, REINSURANCE COMPANIES, AND SHARIA REINSURANCE COMPANIES

BUSINESS PLAN
GENERAL INSURANCE COMPANY / REINSURANCE COMPANY / LIFE INSURANCE COMPANY 1
Year................................2
PT. XYZ
2 Business Plan Period Reported, e.g., year 2015 – 2017

Company Name :
Full Address :
Telephone and Fax :
Email :
Tax ID Number (NPWP) :
License No. & Date :
Shareholders :
Share Ownership
Shareholder Name
Rupiah
Percentage
Board of Directors and Commissioners:
,
PT. XYZ
Total
Business Plan PIC (1 person)

Board of Directors

TABLE OF CONTENTS
Page
Company Profile
Table of ContentsExecutive Summary
CHAPTER I MANAGEMENT POLICY AND STRATEGY
1.1 Analysis of Company Position in Business Competition
1.2 Management Policy
1.3 Risk Management and Compliance Policy
1.4 Business Development Strategy
1.5 Human Resources (HR) Development Strategy
CHAPTER II IMPLEMENTATION OF RISK MANAGEMENT AND COMPLIANCE
2.1 Implementation of Risk Management
2.2 Implementation of Good Corporate Governance
CHAPTER III CURRENT COMPANY PERFORMANCE
3.1 Premium Income
3.2 Investment Results
3.3 Profit and Capital
CHAPTER IV FINANCIAL STATEMENT PROJECTIONS AND ASSUMPTIONS USED
4.1 Balance Sheet Projection
4.2 Comprehensive Profit/Loss Projection
4.3 Cash Flow Projection
4.4 Ratio Projections
4.5 Assumptions Used
CHAPTER V INSURANCE COMPANY / REINSURANCE COMPANY PLAN
5.1 Capital Plan
5.2 Investment Plan
5.3 Reinsurance Plan
5.4 Product Development and Marketing Plan
5.5 Organization and HR Development Plan
5.6 Information Technology System Development Plan
5.8 Other Information

EXECUTIVE SUMMARY
The executive summary must include at least:
a. vision, mission, strategic values (corporate value) and company organizational structure; Explanation of the company's organizational structure in general; b. company policy direction containing information regarding the direction and policy of business development to be carried out by the company in the short term of 1 (one) year ahead and the medium term of 3 (three) years ahead;
c. key financial indicators including company performance as of the end of September
in the year of Business Plan preparation and projections of capital, solvency level, investment sufficiency ratio, and other financial ratios as well as risk level assessment, specifically asset and liability risk, insurance risk, and operational risk; and d. short-term activity targets of the company for the next 1 (one) year and medium-term activity targets of the company for the next 3 (three) years.

CHAPTER I
MANAGEMENT POLICY AND STRATEGY
1.1 Analysis of Company Position in Facing Business Competition
Analysis of the company's position in facing business competition containing analysis conducted at the industry level as well as against groups of companies with similar characteristics.
1.2 Management Policy
Management policy containing general information on company policy established by management in developing the company's business in the future.

1.3 Risk Management and Compliance Policy
Risk management and compliance policy containing information regarding steps in implementing risk management based on evaluation of the company's risk profile and improvement efforts to be taken as well as explanation of policy in carrying out the compliance function.
1.4 Business Development Strategy
Business development strategy containing information on strategic steps to achieve the company's established business objectives, including explanation of organizational and information technology development strategy, and strategy to anticipate changes in external conditions.

1.5 HR Development Strategy
HR development strategy and remuneration policy that must at least contain information regarding general policy governing the provision of salary, allowances, incentives, and other financial facilities to members of the Board of Commissioners, members of the Board of Directors, and employees.

CHAPTER II
IMPLEMENTATION OF RISK MANAGEMENT AND COMPLIANCE
2.1 Implementation of Risk Management
Implementation of risk management, including risk profile assessment for all risks identified by the Company.
2.2 Implementation of Good Corporate Governance
Briefly detail the implementation of good corporate governance principles as regulated in the POJK Regarding Good Corporate Governance for Insurance Companies.

CHAPTER III
CURRENT COMPANY PERFORMANCE
3.1 Premium IncomeDetail the company's current premium income both qualitatively and quantitatively.
3.2 Investment ResultsDetail the investment results obtained by the company currently both qualitatively and
quantitatively.
3.3 Profit and Capital
Detail the company's current profit and capital both qualitatively and quantitatively.

CHAPTER IV
FINANCIAL STATEMENT PROJECTIONS AND ASSUMPTIONS USED
4.1 Balance Sheet Projection (Non-Consolidated)
Fill in the format below and detail the contents of the table below narratively/descriptively. a. Balance Sheet Projection for General Insurance Company/Reinsurance Company (in millions of rupiah) DESCRIPTION Actual as of Sept 30 20XX-1* Projection as of Dec 31 20XX-1* Projection Year 1 Projection as of Dec 31 20XX+1* Projection as of Dec 31 20XX+2* Projection as of Mar 31 20XX* Projection as of Jun 30 20XX* Projection as of Sept 30 20XX * Projection as of Dec 31 20XX * ASSETS Investment Time Deposits and Certificates of Deposit - - - - Stocks

Corporate Bonds and
Corporate Sukuk - - - -
Securities Issued by the State of RI - - - - Securities Issued by Countries Other Than RI

Securities Issued by
Bank Indonesia

DESCRIPTION
Actual as of Sept 30
20XX-1*
Projection as of Dec 31
20XX-1*
Projection
Year 1
Projection as of Dec 31
20XX+1*
Projection as of Dec 31
20XX+2*
Projection as of Mar 31
20XX*
Projection as of Jun 30
20XX*
Projection as of Sept 30
20XX *
Projection as of Dec 31
20XX *
Securities Issued by
Multinational Institutions

Mutual Funds - - - -
Collective Investment Contracts
Asset-Backed Securities - - - -
Real Estate Investment Funds - - - -
Direct Investments - - - -
Buildings with Strata Rights or Land with Buildings for Investment

Purchase of Receivables for
Financing Companies and/or Banks

Pure Gold - - - -
Loans Secured with Mortgage Rights - - - - Other Investments - - - - Total Investments - - - - Non-Investment Cash and Bank

Direct Written Premium Receivables - - - - Coinsurance Claims Receivables

Investment Receivables

Investment Income Receivables - - - -
Buildings with Strata Rights or Land with Buildings for Own Use

Other Fixed Assets - -
Other Assets - -
Total Non-Investment - - - -
TOTAL ASSETS - - - -
LIABILITIES AND
EQUITY
Liabilities
Payables
Claims Payable - - - -
Coinsurance Payable - - - -
Reinsurance Payable - - - -
Commission Payable - - - -
Tax Payable - - - -
Accrued Expenses

Claims Reserve - - - -
Total Technical Reserves - - - -
Total Liabilities - - - -
Subordinated Loans

Equity
Paid-up Capital - - - -
Share Premium - - - -
Retained Earnings - - - -
Other Equity Components - - - -
Valuation Difference Based on
SAK and SAP -
Assets Not Included in
AYD -
Total Equity - - - - - -
TOTAL LIABILITIES
AND EQUITY - - - - - -

Note:
*If the submission of the business plan is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc. If the descriptions below do not have numbers related to SAP, they are entered manually in the ratio:
 SAP Investment Balance
 AYD
 Total technical reserves
 Claims Payable
 Liabilities to policyholders narrative/descriptive explanation of the table above

b. Balance Sheet Projection for Life Insurance Company (in millions of rupiah) Description Actual as of Sept 30 Projection as of Dec 31 Year 1 Projection as of Dec 31 20XX+1* Projection as of Dec 31 20XX+2* 20XX-1* 20XX-1* Projection as of Mar 31 20XX* Projection as of Jun 30 20XX* Projection as of Sept 30 20XX* Projection as of Dec 31 20XX* ASSETS Investment Time Deposits and Certificates of Deposit - - - - Stocks - - - - Corporate Bonds and Corporate Sukuk - - - - Securities Issued by the State of RI - - - - Securities Issued by Countries Other Than RI

Securities Issued by
Bank Indonesia

Securities Issued by
Multinational Institutions

Mutual Funds - - - -
Collective Investment Contracts
Asset-Backed Securities - - - -
Real Estate Investment Funds - - - -
Direct Investments - - - -

Purchase of Receivables for
Financing Companies and/or Banks

Pure Gold - - - -
Loans Secured with Mortgage Rights - - - - Other Investments - - - - Total Investments - - - - Non-Investment Cash and Bank - - - - Direct Written Premium Receivables - - - - Coinsurance Claims Receivables - - - - Reinsurance Receivables - - - - Investment Receivables - - - - Investment Income Receivables - - - - Buildings with Strata Rights or Land with Buildings for Own Use

Other Fixed Assets - -
Other Assets - -

Description
Actual as of Sept 30
Projection as of Dec 31
Year 1
Projection as of Dec 31
20XX+1*
Projection as of Dec 31
20XX+2*
20XX-1* 20XX-1*
Projection as of Mar 31
20XX*
Projection as of Jun 30
20XX*
Projection as of Sept 30
20XX*
Projection as of Dec 31
20XX*
Total Non-Investment - - - -
TOTAL ASSETS - - - -
LIABILITIES AND
EQUITY
Liabilities
Payables
Claims Payable - - - -
Coinsurance Payable - - - -
Reinsurance Payable - - - -
Commission Payable - - - -
Tax Payable - - - -
Accrued Expenses - - - -
Other Payables - - - -
Total Payables - - - -
Technical Reserves
Premium Reserve - - - -
Reserve for Premiums
Not Yet Earned

Claims Reserve - - - -
Total Technical Reserves - - - -
Total Liabilities - - - -
Subordinated Loans - - - -

Description
Actual as of Sept 30
Projection as of Dec 31
Year 1
Projection as of Dec 31
20XX+1*
Projection as of Dec 31
20XX+2*
20XX-1* 20XX-1*
Projection as of Mar 31
20XX*
Projection as of Jun 30
20XX*
Projection as of Sept 30
20XX*
Projection as of Dec 31
20XX*
Equity
Paid-up Capital - - - -
Share Premium - - - -
Retained Earnings - - - -
Other Equity Components - - - -
Valuation Difference Based on
SAK and SAP -
Assets Not Included in
AYD -
Total Equity - - -
TOTAL LIABILITIES
AND EQUITY - - -
Note:
*If the submission of the business plan is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc. If the descriptions below do not have numbers related to SAP, they are entered manually in the ratio:
 SAP Investment Balance
 AYD
 Total technical reserves
 Claims Payable
 Liabilities to policyholders narrative/descriptive explanation of the table above

4.2 Comprehensive Profit/Loss Projection (For Periods Ending On)
Fill in the format below and detail the contents of the table below narratively/descriptively. a. Comprehensive Profit/Loss Projection for General Insurance Company/Reinsurance Company (in millions of rupiah) DESCRIPTION Actual Jan - Sept Projection Jan-Dec Year 1 Jan-Dec 20XX+1* Jan-Dec 20XX-1* Jan-Dec 20XX-1* Jan-Dec 20XX+2* Jan-Mar 20XX* Jan-Jun 20XX* Jan - Sept 20XX* Jan-Dec 20XX* UNDERWRITING INCOME Gross Premium a. Direct Written Premium b. Indirect Written Premium
c. Commission Paid
Total Gross Premium - -
Reinsurance Premium a. Reinsurance Premium Paid b. Reinsurance Commission Received Total Reinsurance Premium - - Net Premium - - Decrease (Increase) Premium Reserve and CAPYBMP a. Decrease (Increase) in Premium Reserve b. Decrease (Increase) in CAPYBMP Decrease (Increase) - -

DESCRIPTION
Actual
Jan - Sept
Projection
Jan-Dec
Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1*
Jan-Dec
20XX-1*
Jan-Dec
20XX+2*
Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX*
Premium Reserve and
CAPYBMP
Total Net Premium Income - -
Other Underwriting Income
Net
UNDERWRITING
INCOME - -
UNDERWRITING
EXPENSES
Claims Expenses a. Gross Claims b. Reinsurance Claims
c. Increase (Decrease) in Claims
Reserve
Total Net Claims Expenses - -
Other Underwriting Expenses Net
TOTAL UNDERWRITING
EXPENSES - -
UNDERWRITING
RESULT - -
Investment Results
Business Expenses:
a. Marketing Expenses b. General and Administrative Expenses:

Employee and Officer Expenses
Education and
Training Expenses

DESCRIPTION
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1* 20XX-1* 20XX+2* Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX*

General and Administrative Expenses
Other
Total Operating Expenses - -
OPERATING PROFIT (LOSS)
INSURANCE - -
Other Income (Expense)
PROFIT (LOSS) BEFORE
TAX - -
Income Tax
PROFIT AFTER TAX - -
OTHER COMPREHENSIVE INCOME
TOTAL COMPREHENSIVE PROFIT (LOSS) - -
Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.
narrative/descriptive explanation of the table above

b. Comprehensive Income Statement Projection for Life Insurance Companies (in millions of rupiah) Description Actual Projection Jan - Sept Jan-Dec Year 1 Jan-Dec 20XX+1* Jan-Dec 20XX-1* 20XX-1* 20XX+2* Jan-Mar 20XX* Jan-Jun 20XX* Jan - Sept 20XX* Jan-Dec 20XX* UNDERWRITING INCOME a. Premium Income b. Reinsurance Premium
c. Decrease (Increase) in CAPYBMP
Net Premium Income Total a. Investment Income - b. DPLC Service Fees/Other Management Fees
c. Other Income
TOTAL INCOME
EXPENSES
Insurance Expenses a. Claims and Benefits (1) Claims and Benefits Paid (2) Reinsurance Claims - (3) Increase (Decrease) Premium Reserves - (4) Increase (Decrease) Claim Reserves Total Claims and Benefits Expenses -

Description
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1* 20XX-1* 20XX+2* Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX* b. Acquisition Costs
(1) Commission Expenses - First Year
(2) Commission Expenses - Subsequent
Years
(3) Overriding Commission Expenses
(4) Other Expenses
Total Acquisition Costs -
Total Insurance Expenses
Operating Expenses:

a. Marketing Expenses
b. General and Administrative Expenses:
Employee and Management Expenses
Education and Training Expenses
General and Administrative
Other Expenses
Other Income (Expense)
TOTAL EXPENSES
PROFIT (LOSS) BEFORE TAX
Income Tax

PROFIT AFTER TAX

INCOME

Description
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1* 20XX-1* 20XX+2* Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX*
OTHER COMPREHENSIVE
TOTAL COMPREHENSIVE PROFIT (LOSS) -
Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.
narrative/descriptive explanation of the table above

4.3 Cash Flow Projection
Fill in the format below and provide a narrative/descriptive explanation of the content of the table below. a. Cash Flow Projection for General Insurance Companies/Reinsurance Companies (in millions of rupiah) DESCRIPTION Actual Projection Jan - Sept Jan-Dec Year 1 Jan-Dec 20XX+1* Jan-Dec 20XX-1* 20XX-1* 20XX+2* Jan-Mar 20XX* Jan-Jun 20XX* Jan - Sept 20XX* Jan-Dec 20XX* BEGINNING CASH AND BANK BALANCE CASH FLOWS FROM OPERATING ACTIVITIES Cash Inflows a. Premium b. Co-insurance Claims
c. Reinsurance Claims
d. Commission e. Receivables f. Others
Total Cash Inflows -
Cash Outflows a. Reinsurance Premium b. Claims
c. Commission
d. Expenses e. Others
Total Cash Outflows -
TOTAL CASH FLOWS FROM
OPERATING ACTIVITIES -

DESCRIPTION
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1* 20XX-1* 20XX+2* Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX*
CASH FLOWS FROM INVESTMENT
ACTIVITIES
Cash Inflows a. Investment Income Receipts b. Investment Withdrawals
c. Sale of Fixed Assets
d. Others
Total Cash Inflows -
Cash Outflows a. Investment Deposits b. Purchase of Fixed Assets
c. Others
Total Cash Outflows -
TOTAL CASH FLOWS FROM
INVESTMENT ACTIVITIES -
CASH FLOWS FROM FINANCING
ACTIVITIES
Cash Inflows a. Subordinated Loans b. Capital Deposits
c. Others
Total Cash Inflows -
Cash Outflows a. Dividend Payments b. Subordinated Loan Payments

DESCRIPTION
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1* 20XX-1* 20XX+2* Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX*
c. Others
Total Cash Outflows

TOTAL CASH FLOWS FROM
FINANCING ACTIVITIES -
ENDING CASH AND BANK BALANCE -
Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.
narrative/descriptive explanation of the table above

b. Cash Flow Projection for Life Insurance Companies (in millions of rupiah) Description Actual Projection Jan - Sept Jan-Dec Year 1 Jan-Dec 20XX+1* Jan-Dec 20XX-1* 20XX-1* 20XX+2* Jan-Mar 20XX* Jan-Jun 20XX* Jan - Sept 20XX* Jan-Dec 20XX* BEGINNING CASH AND BANK BALANCE CASH FLOWS FROM OPERATING ACTIVITIES Cash Inflows a. Premium b. Co-insurance Claims
c. Reinsurance Claims
d. Commission e. Receivables f. Others
Total Cash Inflows
Cash Outflows a. Reinsurance Premium b. Claims
c. Commission
d. Expenses e. Others
Total Cash Outflows
TOTAL CASH FLOWS FROM
OPERATING ACTIVITIES
CASH FLOWS FROM INVESTMENT
ACTIVITIES
Cash Inflows

Description
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1* 20XX-1* 20XX+2* Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX* a. Investment Income Receipts b. Investment Withdrawals
c. Sale of Fixed Assets
d. Others
Total Cash Inflows
Cash Outflows a. Investment Deposits b. Purchase of Fixed Assets
c. Others
Total Cash Outflows
TOTAL CASH FLOWS FROM
INVESTMENT ACTIVITIES
CASH FLOWS FROM FINANCING
ACTIVITIES
Cash Inflows a. Subordinated Loans b. Capital Deposits
c. Others
Total Cash Inflows
Cash Outflows a. Dividend Payments b. Subordinated Loan Payments
c. Others
Total Cash Outflows

Description
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1* 20XX-1* 20XX+2* Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX*
TOTAL CASH FLOWS FROM
FINANCING ACTIVITIES
ENDING CASH AND BANK BALANCE

Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.
narrative/descriptive explanation of the table above

4.4 Ratio Projections
Ratio projections must at least contain projections of core financial ratios and other specific items that can provide information for assessing capital conditions, solvency, liquidity, investment, and liabilities. a. Ratio Projections and Other Specific Items for General Insurance Companies/Reinsurance Companies (in millions of rupiah) (ratios in percentage) DESCRIPTION Actual Projection Projection as of Sept 30 as of Dec 31 Year 1 as of Dec 31 20XX+1* as of Dec 31 20XX+2* 20XX-1* 20XX-1* as of Mar 31 20XX* as of Jun 30 20XX* as of Sept 30 20XX* as of Dec 31 20XX* A. FINANCIAL HEALTH RATIO MMBR Solvency Ratio Permitted Assets Liabilities (excluding Subordinated Loans) Total Solvency Ratio (a) Minimum Risk-Based Capital (MMRC) Total MMRC (b) Excess (Deficiency) of Solvency Ratio Limit Solvency Achievement Ratio (a:b) B. FINANCIAL HEALTH RATIO OTHER THAN MMBR
i. Liquidity Ratio
a. Current Assets b. Current Liabilities
c. Ratio (a : b)

DESCRIPTION
Actual Projection Projection as of Sept 30 as of Dec 31 Year 1 as of Dec 31 20XX+1* as of Dec 31 20XX+2* 20XX-1* 20XX-1* as of Mar 31 20XX* as of Jun 30 20XX* as of Sept 30 20XX* as of Dec 31 20XX*
ii. Investment Sufficiency Ratio
a. Investments + Cash & Bank (See
SAP Balance Sheet) b. Own Retention Technical Reserves
c. Own Retention Claim Liabilities +
Other Liabilities to Policyholders d. Ratio (a : (b + c))
iii. Investment Income to Net Premium
Income Balance Ratio a. Investment Income b. Net Premium Income
c. Ratio (a : b)
iv. Claim Expense, Operating Expense,
and Commission Ratio a. Net Claim Expense b. Operating Expenses
c. Net Commission
d. Net Premium Income e. Ratio a : d (Ratio I) f. Ratio b : d (Ratio II) g. Ratio c : d (Ratio III) h. Ratio I + Ratio II + Ratio III C. EDUCATION AND TRAINING RATIO
i. Employee, Board of Directors, and
Commissioners' Costs

DESCRIPTION
Actual Projection Projection as of Sept 30 as of Dec 31 Year 1 as of Dec 31 20XX+1* as of Dec 31 20XX+2* 20XX-1* 20XX-1* as of Mar 31 20XX* as of Jun 30 20XX* as of Sept 30 20XX* as of Dec 31 20XX*
ii. Education and Training (Diklat)
Costs a. Employee Diklat b. Board of Directors Diklat
c. Board of Commissioners Diklat
iii. Total Diklat Costs (a + b + c)
iv. Ratio of Diklat Costs to Employee,
Board of Directors, and Commissioners
Costs (iii : i)

Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.
If there are accounts that must be filled in from cumulative calculations, e.g., from the income statement, they must be filled in with cumulative values. narrative/descriptive explanation of the table above

b. Ratio Projections and Other Specific Items for Life Insurance Companies (in millions of rupiah) (ratios in percentage) Description Actual Projection as of Sept 30 as of Dec 31 Year 1 as of Dec 31 20XX+1* as of Dec 31 20XX+2* 20XX-1* 20XX-1* as of Mar 31 20XX* as of Jun 30 20XX* as of Sept 30 20XX* as of Dec 31 20XX* A. FINANCIAL HEALTH RATIO MMBR Solvency Ratio Permitted Assets Liabilities (excluding Subordinated Loans) Total Solvency Ratio (a) Minimum Risk-Based Capital (MMRC) Total MMRC (b) Excess (Deficiency) of Solvency Ratio Limit Solvency Achievement Ratio (a:b) B. FINANCIAL HEALTH RATIO OTHER THAN MMBR
i. Liquidity Ratio
a. Current Assets b. Current Liabilities

Description
Actual Projection as of Sept
30 as of Dec 31 Year 1 as of Dec 31
20XX+1* as of Dec 31
20XX+2*
20XX-1* 20XX-1* as of Mar 31
20XX* as of Jun 30
20XX* as of Sept 30
20XX* as of Dec 31
20XX*
c. Ratio (a : b)
ii. Investment Sufficiency Ratio
a. Investments + Cash & Bank (See
SAP Balance Sheet) b. Own Retention Technical Reserves
c. Own Retention Claim Liabilities +
Other Liabilities to Policyholders d. Ratio (a : (b + c))
iii. Investment Income to Net Premium
Income Balance Ratio a. Investment Income b. Net Premium Income
c. Ratio (a : b)
iv. Claim Expense, Operating Expense,
and Commission Ratio a. Net Claim Expense b. Operating Expenses
c. Net Commission
d. Net Premium Income e. Ratio a : d (Ratio I) f. Ratio b : d (Ratio II) g. Ratio c : d (Ratio III) h. Ratio I + Ratio II + Ratio III C. EDUCATION AND

Description
Actual Projection as of Sept
30 as of Dec 31 Year 1 as of Dec 31
20XX+1* as of Dec 31
20XX+2*
20XX-1* 20XX-1* as of Mar 31
20XX* as of Jun 30
20XX* as of Sept 30
20XX* as of Dec 31
20XX*
TRAINING
i. Employee, Board of Directors, and
Commissioners' Costs
ii. Education and Training (Diklat)
Costs a. Employee Diklat b. Board of Directors Diklat
c. Board of Commissioners Diklat
iii. Total Diklat Costs (a + b + c)
iv. Ratio of Diklat Costs to
Employee, Board of Directors, and Commissioners Costs (iii : i)

Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.
If there are accounts that must be filled in from cumulative calculations, e.g., from the income statement, they must be filled in with cumulative values. narrative/descriptive explanation of the table above
4.5 Assumptions Used
Assumptions use optimistic, normal, and pessimistic assumptions. These assumptions cover both micro and macro assumptions. The example table below applies to general insurance companies/life insurance companies/reinsurance companies. (in millions of rupiah) No. Assumption Actual Projection Jan - Sept Jan-Dec Year 1 Jan-Dec 20XX+1 Jan-Dec 20XX-1 20XX-12 20XX+2 Jan-Mar 20XX Jan-Jun 20XX Jan - Sept 20XX Jan-Dec2 20XX ACTUAL DATA 1 Rupiah exchange rate 4 2 Inflation rate 5 Catastrophe losses (in rupiah) 6 4 Investment yield rate 7 5 Amount of new coverage

No. Assumption
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+12
Jan-Dec
20XX+22 20XX-1
20XX-12
Jan-Mar
20XX 2
Jan-Jun
20XX 2
Jan - Sept
20XX 2
Jan-Dec
20XX 2
(in premium rupiah) 8
Policy lapse rate (policies lapsed/total policies at start of period) 9 Claim rate (gross claims/gross premiums) 8 and onwards (other relevant assumptions) OPTIMISTIC ASSUMPTION 1 Rupiah exchange rate 2 Inflation rate 3 Catastrophe losses 4 Investment yield rate Amount of new coverage (in premium rupiah) 6 Policy lapse rate 7 Claim rate 8 and onwards (other relevant assumptions) NORMAL ASSUMPTION 1 Rupiah exchange rate 2 Inflation 3 Catastrophe losses 4 Investment yield rate Amount of new coverage (in premium rupiah) Policy lapse rate (policies lapsed/total policies at

No. Assumption
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+12
Jan-Dec
20XX+22 20XX-1
20XX-12
Jan-Mar
20XX 2
Jan-Jun
20XX 2
Jan - Sept
20XX 2
Jan-Dec
20XX 2 start of period)
7 Claim rate
8 and onwards (other relevant assumptions) PESSIMISTIC ASSUMPTION 1 Rupiah exchange rate 2 Inflation 3 Catastrophe losses 4 Investment yield rate Amount of new coverage premiums 6 Policy lapse rate 7 Claim rate 8 and onwards (other relevant assumptions) Note:
1 Columns or rows colored gray are not filled in.
2 If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc. If quarterly assumptions are not available, annual assumptions may be used. 4 The reported BI exchange rate value is the BI mid-rate on the date of the quarterly report, e.g., for the quarterly report for January - March, the exchange rate used is the BI rate as of March 31. 5 Inflation rate per month, data can be obtained from data issued by BPS. 6 Data can be obtained from claims and claim reserves. 7 Guidelines for calculating investment yield rates are explained based on SAK calculations. 8 Projections are adjusted to the amount of new coverage added during that period. 9 Policy lapse rate = policies lapsed/total policies at start of period. 10 For items 1, 2, and 7, use Jan-Sept period data (accumulated).

CHAPTER V
INSURANCE/REINSURANCE COMPANY PLAN
5.1 Capital Plan
The capital plan must at least include plans for capital changes, including plans for capital additions from existing shareholders or new shareholders, plans for capital additions through the capital market, and other capital addition plans. Companies may use the table format below if they do not have a standard format. The example table below applies to general insurance companies/life insurance companies/reinsurance companies, and can be modified as needed. (in millions of rupiah) Description Actual Projection as of Sept 30 as of Dec 31 Year 1 as of Dec 31 20XX+1 as of Dec 31 20XX+2 20XX-1 20XX-1 as of Mar 31 20XX as of Jun 30 20XX as of Sept 30 20XX as of Dec 31 20XX CAPITAL POSITION Shareholders 1.--------------- (filled with nominal)
2. --------------
3. --------------
4. --------------
Total Paid-in Capital
IPO (Initial Public Offering) -
Go Public
Issuance of new shares
Others (such as subordinated loans)

Description
Actual Projection as of Sept 30 as of Dec 31 Year 1 as of Dec 31 20XX+1 as of Dec 31 20XX+2 20XX-1 20XX-1 as of Mar 31 20XX as of Jun 30 20XX as of Sept 30 20XX as of Dec 31 20XX - Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.
narrative/descriptive explanation of the table above

5.2 Investment Plan
Annual investment plans must at least include:
a. plans for the composition of investment types; b. estimated investment yield rates for each investment type; and
c. considerations underlying the plan for the composition of investment types.

5.3 Reinsurance Plan
The reinsurance plan must at least include:
a. details of maximum own retention for each risk or event after reinsurance placement, according to business class/line of business; b. details of primary reinsurers including name, address, and country of origin of the reinsurer;
c. description of own retention including proportional automatic reinsurance support and/or non-proportional automatic reinsurance support; and
d. significant proportion of the program covered by one reinsurer or reinsurers affiliated with one insurance business group, additional information about the reasons for selecting the said reinsurer, including details of guarantees provided and financial health.

5.4 Product Development and Insurance Product Marketing Plan for Insurance Companies or Reinsurance Program Development Plan for Reinsurance Companies
a. Insurance product development plans for Insurance Companies must at least contain:
i. lines of business to be developed for the next 1 (one) year;
ii. product development studies considering the following data:

community needs or demand for similar insurance products;
marketing trends of similar insurance products by other insurance companies;
availability of company resources to market similar insurance products;
risk and loss profiles suitable for the insurance product to be marketed and the target market segment;
cost profiles suitable for the product to be marketed;
current investment portfolio performance of the company;
investment portfolios suitable for the insurance product to be marketed;
capitalization; and
risks that may arise for the company and their mitigation.

iii. plan for issuing new products
No.
New
Product Name 1
Line of
Business
Type of
Coverage 2
Risks
Covered
Benefits
Provided
Coverage
Period
Marketing
Method
Target
Market
Plan Time for Issuance or
Implementation
Purpose/Benefit Risks that
May
Arise 3 For the Company For Policyholders and onwards .. 1 If 2 Type 3 Explanation/Description coverage has been determined, filled with individual, groups can be attached or in individual, and groups separate sheets.

b. Insurance product marketing plans must at least contain:
i. distribution channels used and cooperation with third parties
ii. cooperation with third parties
No. Name of Third Party Affiliation/non-affiliation Business Field Product Name General Description Product Model/Form/Type Cooperation Duration Cooperation Marketing

No. Name of Third Party Affiliation/non-affiliation Business Field Product Name General Description Product Model/Form/Type Cooperation Duration Cooperation Marketing and onwards..
c. Reinsurance Program Development Plan for Reinsurance Companies must at least contain:
i. lines of business to be developed for the next 1 (one) year;
ii. reinsurance program development studies considering the following data:

needs or demand of other companies for similar reinsurance programs;
marketing trends of similar reinsurance programs by other Reinsurance Companies;
availability of Reinsurance Company resources to market similar reinsurance programs;
risk and loss profiles suitable for the reinsurance program to be marketed and the target market segment;
cost profiles suitable for the reinsurance program to be marketed;
current investment portfolio performance of the Reinsurance Company;
investment portfolios suitable for the reinsurance program to be marketed;
capitalization; and
risks that may arise for the Reinsurance Company and their mitigation.

d. Human Resource Development Plan Related to Insurance Product Development Explain the human resource development plan related to the product development plan in the company.

5.5 Organizational and Human Resource Development Plan
The organizational and human resource development plan must at least include:
i. organizational development plan containing plans for the formation/change of work units and/or committees adjusted to the size and complexity of the company's business;
ii. human resource development plan containing:

plans for the number of human resources needed;
plans for human resource education and training needs and education/training cost/budget plans in accordance with applicable regulations;
iii. plans for the utilization of foreign labor and outsourcing, including plans for the use of labor outside permanent labor, both foreign and local labor, including the number and fields of work assignment.
Note:
For point i, the format is free. If the company does not yet have a format for points ii and iii, the company can use the format attached below. HUMAN RESOURCE NEEDS PLAN No Total number of HR as of Sept 30 20XX-1* Number of HR per Job Level Recruitment to be Implemented as of Dec 31 20XX-1* as of Mar 31 20X X* as of Jun 30 20X X* as of Sept 30 20XX* as of Dec 31 20XX* as of Dec 31 20XX+1* as of Dec 31 20XX+2*

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the
year 2014 (current year), 20XX is the year 2015, etc.

HUMAN RESOURCE EDUCATION AND TRAINING NEEDS PLAN AND EDUCATION/TRAINING COSTS/BUDGET No. Material Diklat 1 Method Diklat 2 Estimated Time Diklat 3 Duration Diklat 4 Place Name Speaker/ Institution Diklat Total Number Participants Number of Participants per Job Level Diklat Cost 1 e.g., risk management, marketing, etc... filled with in-house training or out-house 2 training filled with the month of training implementation, e.g., month 3 March 2015 4 filled with the duration of diklat, e.g.: 3 days

FOREIGN LABOR UTILIZATION PLAN 1
No.
Field of Task and Position
Number Name of Foreign Worker Foreign Worker Citizenship Term of Office Name of Accompanying Staff Plan for Knowledge Transfer Position Job Title Scope of Work/Job Description Start Date End Date 1 Commissioners 2 Board of Directors Office Management Office Management Outside Office Branch Experts/ Consultants Other Positions 2

No.
Field of Task and Position
Number Name of Foreign Worker Foreign Worker Citizenship Term of Office Name of Accompanying Staff Plan for Knowledge Transfer Position Job Title Scope of Work/Job Description Start Date End Date
Reasons for using Foreign Workers and reasons for not/not yet using Indonesian Labor: ..................................................
a...............................................................................................................................................................................................
b ..............................................................................................................................................................................................
and onwards............................................................................................................................................................................................
1 filled with NIL if the company has no plans to utilize Foreign Workers if any in accordance with OJK approval

PLAN FOR TERMINATING THE UTILIZATION OF FOREIGN WORKERS CURRENTLY HOLDING/WORKING IN THE COMPANY 1 PT.XYZ No. Foreign Workers Term of Office Knowledge Transfer Program Final Result Knowledge Transfer Program 2 Name Citizenship Job Title Field of Task/ Job Description Start Date End Date Reasons for terminating Foreign Worker utilization
a ..................................................................................................................................................................
b..................................................................................................................................................................
and onwards...............................................................................................................................................................
Note:
1 filled with NIL if the company has no plans to terminate Foreign Workers. 2 filled with:

the position or job description will be filled/continued by another foreign worker.
the position or job description can already be filled by an Indonesian citizen.
other relevant reasons

5.6 IT System Development Plan
The IT system development plan must at least meet the following requirements:

can provide current and accurate information regarding the insurance portfolio as well as risk and loss profiles;
can support reporting to the Financial Services Authority;

The development plan and/or changes to the office network must at least include plans for opening and merging offices outside the head office.

OFFICE NETWORK DEVELOPMENT AND/OR CHANGES PLAN

No	OFFICE TYPE	IMPLEMENTATION TIME 1	ESTIMATED INVESTMENT/COST LOCATION 2	NOTES 3
A. OFFICE OPENING
Office with authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
Office without authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
B. STATUS CHANGE
Office with authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
Office without authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
C. MERGER
Office with authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
a. Between offices with authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
b. Between offices without authority to accept or reject insurance closures, sign policies, determine to pay or reject claims, etc.
D. ADDRESS RELOCATION
E. CLOSURE

Notes:

Filled with the month of the planned implementation time.
For locations in the DKI Jakarta region, at least mention the name of the DKI Jakarta province. For locations outside the DKI Jakarta region, at least include the name of the Regency/City.
- Detailed notes can be attached in a separate sheet

Specifically for offices with authority to accept or reject insurance closures, sign policies, determine to pay or reject claims, the experts who will fill those offices must be informed.

5.8 Other Information
Other information must at least include information that needs to be conveyed because it affects the company's business activities, which is not mentioned in the scope of the Business Plan. Examples:

merger, acquisition, and consolidation plans;
insurance portfolio transfer plans;
plans to change the insurance business field;
plans to change business activities not based on Sharia principles to be based on Sharia principles.

Copy matches the original
Legal Director 1
Legal Department,
Signed. Signed.
Tini Kustini

APPENDIX VI
FINANCIAL SERVICES AUTHORITY CIRCULAR LETTER NUMBER 15/SEOJK.05/2014 REGARDING CORPORATE PLAN AND BUSINESS PLAN INSURANCE COMPANIES, SHARIA INSURANCE COMPANIES, REINSURANCE COMPANIES, AND SHARIA REINSURANCE COMPANIES

BUSINESS PLAN
GENERAL INSURANCE COMPANY / REINSURANCE COMPANY / LIFE INSURANCE COMPANY THAT HAS A SHARIA UNIT 1
Year............................... 2
PT. XYZ
(Sharia unit address)

2 Business Plan period reported, e.g., year 2015 – 2017

Company Name
Full Address
Telephone and Fax
Email
Taxpayer Identification Number (NPWP)
:
:
:
:
:
Business License No. & Date :
Sharia Unit
a. Full Address :
b. Telephone and Fax :
c. E-mail :
d. NPWP :
e. Business License No. & Date :
f. Sharia Unit Head :
Shareholders :
Share Ownership
Shareholder Name
Rupiah
Percentage
Board of Directors and Commissioners:
Sharia Supervisory Board (DPS) :
, PT. XYZ
Total
DPS Name Position
Business Plan PIC (1 person)

Board of Directors

TABLE OF CONTENTS
Page
Company Profile
Table of Contents
Part I Business Plan for Insurance Company or Reinsurance Company
Executive Summary
CHAPTER I MANAGEMENT POLICY AND STRATEGY
1.1 Analysis of Company Position in Business Competition
1.2 Management Policy
1.3 Risk Management and Compliance Policy
1.4 Business Development Strategy
1.5 Human Resources (HR) Development Strategy
CHAPTER II IMPLEMENTATION OF RISK MANAGEMENT AND COMPLIANCE
2.1 Implementation of Risk Management
2.2 Implementation of Good Corporate Governance
CHAPTER III CURRENT COMPANY PERFORMANCE
3.1 Premium Income
3.2 Investment Results
3.3 Profit and Capital
CHAPTER IV FINANCIAL STATEMENT PROJECTIONS AND ASSUMPTIONS USED
4.1 Financial Position Projection
4.2 Comprehensive Income/Loss Projection
4.3 Cash Flow Projection
4.4 Ratio Projections
4.5 Assumptions Used
CHAPTER V INSURANCE/REINSURANCE COMPANY PLAN
5.1 Capital Plan
5.2 Investment Plan
5.3 Reinsurance Plan
5.4 Product Development and Product Marketing Plan
5.5 Organization and HR Development Plan
5.6 IT System Development Plan
5.7 Office Network Development and/or Change Plan
5.8 Other Information
Part II Business Plan for Sharia Unit
Executive Summary
CHAPTER I MANAGEMENT POLICY AND STRATEGY
1.1 Analysis of Sharia Unit Position in Business Competition
1.2 Management Policy
1.3 Risk Management and Compliance Policy
1.4 Business Development Strategy
1.5 HR Development Strategy
CHAPTER II IMPLEMENTATION OF RISK MANAGEMENT AND COMPLIANCE
2.1 Implementation of Risk Management
2.2 Implementation of Good Corporate Governance
2.3 Implementation of Compliance with Sharia Principles
CHAPTER III CURRENT SHARIA UNIT PERFORMANCE
3.1 Contribution
3.2 Investment Results
3.3 Profit and Capital
CHAPTER IV FINANCIAL STATEMENT PROJECTIONS AND ASSUMPTIONS USED
4.1 Financial Position Projection
4.2 Comprehensive Income/Loss Projection
4.3 Cash Flow Projection
4.4 Ratio Projections
4.5 Assumptions Used
CHAPTER V SHARIA UNIT PLAN
5.1 Capital Plan
5.2 Investment Plan
5.3 Reinsurance Plan
5.4 Product Development and Product Marketing Plan
5.5 Organization and HR Development Plan
5.6 IT System Development Plan
5.7 Office Network Development and/or Change Plan
5.8 Other Information

Part I
Business Plan for Insurance/Reinsurance Company

EXECUTIVE SUMMARY
The executive summary must at least include:
a. vision, mission, strategic values (corporate value), and company organizational structure; Explanation of the company's organizational structure in general; b. company policy direction containing information regarding the direction and policy of business development to be carried out by the company in the short term 1 (one) year ahead and medium term 3 (three) years ahead;
c. key financial indicators including company performance as of the end of September in the year the Business Plan was prepared and projections of capital, solvency level, investment adequacy ratio, and other financial ratios as well as risk level assessment, specifically asset and liability risk, insurance risk, and operational risk; and
d. short-term activity targets of the company for the next 1 (one) year and medium-term activity targets of the company for the next 3 (three) years.

1.3 Risk Management and Compliance Policy
Risk management and compliance policy containing information on steps to implement risk management prepared based on evaluation of the company's risk profile and improvement efforts to be taken, as well as explanation regarding policy in carrying out the compliance function.
1.4 Business Development Strategy
Business development strategy containing information on strategic steps to achieve the company's established business objectives, including explanation regarding organization and information technology development strategy, and strategy to anticipate external condition changes.
1.5 HR Development Strategy
Human resources development strategy and remuneration policy that must at least contain information on general policy regulating the provision of salaries, allowances, incentives, and other financial facilities to members of the Board of Commissioners, members of the Board of Directors, and employees.

CHAPTER II
IMPLEMENTATION OF RISK MANAGEMENT AND COMPLIANCE
2.1 Implementation of Risk Management
Implementation of risk management, including risk profile assessment for all risks identified by the company.
2.2 Implementation of Good Corporate Governance
Briefly describe the implementation of good corporate governance principles as regulated in the POJK Regarding Good Corporate Governance for Insurance Companies.

CHAPTER III
CURRENT COMPANY PERFORMANCE
3.1 Premium Income
Describe the company's current premium income both qualitatively and quantitatively.
3.2 Investment Results
Describe the investment results obtained by the company currently both qualitatively and quantitatively.
3.3 Profit and Capital
Describe the company's current profit and capital both qualitatively and quantitatively.

CHAPTER IV
FINANCIAL STATEMENT PROJECTIONS AND ASSUMPTIONS USED
4.1 Financial Position Projection (Non-Consolidated)
Fill in the format below and describe the content of the table below narratively/descriptively. a. Financial Position Projection for General Insurance Company/Reinsurance Company (in millions of Rupiah)

DESCRIPTION	Actual as of Sept 30, 20XX-1*	Projection as of Dec 31, 20XX-1*	Projection Year 1	Projection as of Dec 31, 20XX+1*	Projection as of Dec 31, 20XX+2*	Projection as of Mar 31, 20XX*	Projection as of Jun 30, 20XX*	Projection as of Sept 30, 20XX*
ASSETS
Investments
Time Deposits and Deposit Certificates	-	-	-	-
Stocks	-	-	-	-
Corporate Bonds and Corporate Sukuk	-	-	-	-
Securities Issued by the Indonesian State	-	-	-	-
Securities Issued by States Other Than Indonesia	-	-	-	-
Securities Issued by Bank Indonesia	-	-	-	-
Securities Issued by Multinational Institutions	-	-	-	-
Mutual Funds	-	-	-	-
Asset-Backed Collective Investment Contracts	-	-	-	-
Real Estate Investment Funds	-	-	-	-
Direct Investments	-	-	-	-
Buildings with Strata Title or Land with Buildings for Investment	-	-	-	-
Purchase of Receivables for Financing Companies and/or Banks	-	-	-	-
Pure Gold	-	-	-	-
Loans Secured by Mortgage Rights	-	-	-	-
Other Investments	-	-	-	-
Total Investments	-	-	-	-
Non-Investments
Cash and Banks	-	-	-	-
Direct Written Premium Receivables	-	-	-	-
Co-insurance Claim Receivables	-	-	-	-
Reinsurance Receivables	-	-	-	-
Investment Receivables	-	-	-	-
Investment Income Receivables	-	-	-	-
Buildings with Strata Title or Land with Buildings for Own Use	-	-	-	-
Other Fixed Assets	-	-
Other Assets	-	-
Total Non-Investments	-	-	-	-
TOTAL ASSETS	-	-	-	-
LIABILITIES AND EQUITY
Liabilities
Payables
Claim Payables	-	-	-	-
Co-insurance Payables	-	-	-	-
Reinsurance Payables	-	-	-	-
Commission Payables	-	-	-	-
Tax Payables	-	-	-	-
Accrued Expenses	-	-	-	-
Other Payables	-	-	-	-
Total Payables	-	-	-	-
Technical Reserves
Premium Reserves	-	-	-	-
Reserves for Premiums Not Yet Earned Income	-	-	-	-
Claim Reserves	-	-	-	-
Total Technical Reserves	-	-	-	-
Total Liabilities	-	-	-	-
Subordinated Loans	-	-	-	-
Equity
Paid-in Capital	-	-	-	-
Share Premium	-	-	-	-
Retained Earnings	-	-	-	-
Other Equity Components	-	-	-	-
Valuation Difference Based on IFRS and SAP	-
Assets Not Included in AYD	-
Total Equity	-	-	-	-	-	-	-	-
TOTAL LIABILITIES AND EQUITY	-	-	-	-	-	-	-	-

Note:
*If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc. If the descriptions below do not have numbers related to SAP, they are entered manually in the ratio:

SAP Investment Balance
AYD
Total technical reserves
Claim payables
Obligations to policyholders
describe the table above narratively/descriptively

b. Financial Position Projection for Life Insurance Company (in millions of Rupiah)

Description	Actual as of Sept 30, 20XX-1*	Projection as of Dec 31, 20XX-1*	Projection Year 1	Projection as of Dec 31, 20XX+1*	Projection as of Dec 31, 20XX+2*	Projection as of Mar 31, 20XX*	Projection as of Jun 30, 20XX*	Projection as of Sept 30, 20XX*
ASSETS
Investments
Time Deposits and Deposit Certificates	-	-	-	-
Stocks	-	-	-	-
Corporate Bonds and Corporate Sukuk	-	-	-	-
Securities Issued by the Indonesian State	-	-	-	-
Securities Issued by States Other Than Indonesia	-	-	-	-
Securities Issued by Bank Indonesia	-	-	-	-
Securities Issued by Multinational Institutions	-	-	-	-
Mutual Funds	-	-	-	-
Asset-Backed Collective Investment Contracts	-	-	-	-
Real Estate Investment Funds	-	-	-	-
Direct Investments	-	-	-	-
Buildings with Strata Title or Land with Buildings for Investment	-	-	-	-
Purchase of Receivables for Financing Companies and/or Banks	-	-	-	-
Pure Gold	-	-	-	-
Loans Secured by Mortgage Rights	-	-	-	-
Other Investments	-	-	-	-
Total Investments	-	-	-	-
Non-Investments
Cash and Banks	-	-	-	-
Direct Written Premium Receivables	-	-	-	-
Co-insurance Claim Receivables	-	-	-	-
Reinsurance Receivables	-	-	-	-
Investment Receivables	-	-	-	-
Investment Income Receivables	-	-	-	-
Buildings with Strata Title or Land with Buildings for Own Use	-	-	-	-
Other Fixed Assets	-	-
Other Assets	-	-
Total Non-Investments	-	-	-	-
TOTAL ASSETS	-	-	-	-
LIABILITIES AND EQUITY
Liabilities
Payables
Claim Payables	-	-	-	-
Co-insurance Payables	-	-	-	-
Reinsurance Payables	-	-	-	-
Commission Payables	-	-	-	-
Tax Payables	-	-	-	-
Accrued Expenses	-	-	-	-
Other Payables	-	-	-	-
Total Payables	-	-	-	-
Technical Reserves
Premium Reserves	-	-	-	-
Reserves for Premiums Not Yet Earned Income	-	-	-	-
Claim Reserves	-	-	-	-
Total Technical Reserves	-	-	-	-
Total Liabilities	-	-	-	-
Subordinated Loans	-	-	-	-
Equity
Paid-in Capital	-	-	-	-
Share Premium	-	-	-	-
Retained Earnings	-	-	-	-
Other Equity Components	-	-	-	-
Valuation Difference Based on IFRS and SAP	-
Assets Not Included in AYD	-
Total Equity	-	-	-	-	-	-	-	-
TOTAL LIABILITIES AND EQUITY	-	-	-	-	-	-	-	-

SAP Investment Balance
AYD
Total technical reserves
Claim payables
Obligations to policyholders
describe the table above narratively/descriptively

4.2 Comprehensive Income/Loss Projection (For Periods Ending On)
Fill in the format below and describe the content of the table below narratively/descriptively. a. Comprehensive Income/Loss Projection for General Insurance Company/Reinsurance Company (in millions of Rupiah)

DESCRIPTION	Actual Jan - Sept 20XX-1*	Projection Jan-Dec 20XX-1*	Projection Year 1 Jan-Dec	Projection Jan-Dec 20XX+1*	Projection Jan-Dec 20XX+2*	Projection Jan-Mar 20XX*	Projection Jan-Jun 20XX*	Projection Jan-Sept 20XX*	Projection Jan-Dec 20XX*
UNDERWRITING INCOME
Gross Premium
a. Direct Written Premium
b. Indirect Written Premium
c. Commission Paid
Total Gross Premium	-	-	-	-	-	-	-	-	-
Reinsurance Premium
a. Reinsurance Premium Paid
b. Reinsurance Commission Received
Total Reinsurance Premium	-	-	-	-	-	-	-	-	-
Net Premium	-	-	-	-	-	-	-	-	-
Decrease (Increase) in Premium Reserves and CAPYBMP
a. Decrease (Increase) in Premium Reserves
b. Decrease (Increase) in CAPYBMP
Decrease (Increase) in Premium Reserves and CAPYBMP	-	-	-	-	-	-	-	-	-
Total Net Premium Income	-	-	-	-	-	-	-	-	-
Other Net Underwriting Income
UNDERWRITING INCOME	-	-	-	-	-	-	-	-	-
UNDERWRITING EXPENSES
Claim Expenses
a. Gross Claims
b. Reinsurance Claims
c. Increase (Decrease) in Claim Reserves
Total Net Claim Expenses	-	-	-	-	-	-	-	-	-
Other Net Underwriting Expenses
TOTAL UNDERWRITING EXPENSES	-	-	-	-	-	-	-	-	-
UNDERWRITING RESULT	-	-	-	-	-	-	-	-	-
Investment Result
Business Expenses:
a. Marketing Expenses
b. General and Administrative Expenses:
- Employee and Management Expenses
- Education and Training Expenses
- Other General and Administrative Expenses
Total Business Expenses	-	-	-	-	-	-	-	-	-
INSURANCE BUSINESS PROFIT (LOSS)	-	-	-	-	-	-	-	-	-
Other Income (Expenses)
PROFIT (LOSS) BEFORE TAX	-	-	-	-	-	-	-	-	-
Income Tax
PROFIT AFTER TAX	-	-	-	-	-	-	-	-	-
OTHER COMPREHENSIVE INCOME
TOTAL COMPREHENSIVE PROFIT (LOSS)	-	-	-	-	-	-	-	-	-

Note:
*If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc. describe the table above narratively/descriptively

b. Comprehensive Income/Loss Projection for Life Insurance Company (in millions of Rupiah)

Description	Actual Jan - Sept 20XX-1*	Projection Jan-Dec 20XX-1*	Projection Year 1 Jan-Dec	Projection Jan-Dec 20XX+1*	Projection Jan-Dec 20XX+2*	Projection Jan-Mar 20XX*	Projection Jan-Jun 20XX*	Projection Jan-Sept 20XX*	Projection Jan-Dec 20XX*
UNDERWRITING INCOME
a. Premium Income
b. Reinsurance Premium
c. Decrease (Increase) in CAPYBMP
Total Net Premium Income
a. Investment Result	-
b. DPLK/Other Management Service Fees
c. Other Income
TOTAL INCOME
EXPENSES
Insurance Expenses
a. Claims and Benefits
(1) Claims and Benefits Paid
(2) Reinsurance Claims	-
(3) Increase (Decrease) in Premium Reserves	-
(4) Increase (Decrease) in Claim Reserves	-
Total Claims and Benefits Expenses	-
b. Acquisition Costs
(1) Commission Expenses - First Year
(2) Commission Expenses - Renewal Year
(3) Overriding Commission Expenses
(4) Other Expenses
Total Acquisition Costs	-
Total Insurance Expenses
Business Expenses:
- a. Marketing Expenses	-
- b. General and Administrative Expenses:
- Employee and Management Expenses
- Education and Training Expenses
- Other General and Administrative Expenses
Other Income (Expenses)
TOTAL EXPENSES
PROFIT (LOSS) BEFORE TAX
Income Tax	-
PROFIT AFTER TAX	-
OTHER COMPREHENSIVE INCOME
TOTAL COMPREHENSIVE PROFIT (LOSS)	-

Note:
*If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc. describe the table above narratively/descriptively

4.3 Cash Flow Projection
Fill in the format below and describe the content of the table below narratively/descriptively. a. Cash Flow Projection for General Insurance Company/Reinsurance Company (in millions of Rupiah)

DESCRIPTION	Actual Jan - Sept 20XX-1*	Projection Jan-Dec 20XX-1*	Projection Year 1 Jan-Dec	Projection Jan-Dec 20XX+1*	Projection Jan-Dec 20XX+2*	Projection Jan-Mar 20XX*	Projection Jan-Jun 20XX*	Projection Jan-Sept 20XX*	Projection Jan-Dec 20XX*
CASH AND BANK BALANCE AT BEGINNING
CASH FLOWS FROM OPERATING ACTIVITIES
Cash Inflows
a. Premium
b. Co-insurance Claims
c. Reinsurance Claims
d. Commission
e. Receivables
f. Others
Total Cash Inflows	-
Cash Outflows
a. Reinsurance Premium
b. Claims
c. Commission
d. Expenses
e. Others
Total Cash Outflows	-
TOTAL CASH FLOWS FROM OPERATING ACTIVITIES	-
CASH FLOWS FROM INVESTING ACTIVITIES
Cash Inflows
a. Investment Income Receipts
b. Investment Withdrawals
c. Sale of Fixed Assets
d. Others
Total Cash Inflows	-
Cash Outflows
a. Investment Placements
b. Purchase of Fixed Assets
c. Others
Total Cash Outflows	-
TOTAL CASH FLOWS FROM INVESTING ACTIVITIES	-
CASH FLOWS FROM FINANCING ACTIVITIES
Cash Inflows
a. Subordinated Loans
b. Capital Deposits
c. Others
Total Cash Inflows	-
Cash Outflows
a. Dividend Payments
b. Subordinated Loan Payments
c. Others
Total Cash Outflows	-
TOTAL CASH FLOWS FROM FINANCING ACTIVITIES	-
CASH AND BANK BALANCE AT END	-

Note:
*If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc. describe the table above narratively/descriptively

b. Cash Flow Projection for Life Insurance Company (in millions of Rupiah)

Description	Actual Jan - Sept 20XX-1*	Projection Jan-Dec 20XX-1*	Projection Year 1 Jan-Dec	Projection Jan-Dec 20XX+1*	Projection Jan-Dec 20XX+2*	Projection Jan-Mar 20XX*	Projection Jan-Jun 20XX*	Projection Jan-Sept 20XX*	Projection Jan-Dec 20XX*
CASH AND BANK BALANCE AT BEGINNING
CASH FLOWS FROM OPERATING ACTIVITIES
Cash Inflows
a. Premium
b. Co-insurance Claims
c. Reinsurance Claims
d. Commission
e. Receivables
f. Others
Total Cash Inflows
Cash Outflows
a. Reinsurance Premium
b. Claims
c. Commission
d. Expenses
e. Others
Total Cash Outflows
TOTAL CASH FLOWS FROM OPERATING ACTIVITIES
CASH FLOWS FROM INVESTING ACTIVITIES
Cash Inflows	-
a. Investment Income Receipts
b. Investment Withdrawals
c. Sale of Fixed Assets
d. Others
Total Cash Inflows
Cash Outflows
a. Investment Placements
b. Purchase of Fixed Assets
c. Others
Total Cash Outflows
TOTAL CASH FLOWS FROM INVESTING ACTIVITIES
CASH FLOWS FROM FINANCING ACTIVITIES
Cash Inflows
a. Subordinated Loans
b. Capital Deposits
c. Others
Total Cash Inflows
Cash Outflows
a. Dividend Payments
b. Subordinated Loan Payments
c. Others
Total Cash Outflows	-	-	-	-	-	-	-	-	-

Description
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1* 20XX-1* 20XX+2* Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX*
TOTAL CASH FLOWS FROM
FINANCING ACTIVITIES
CASH AND BANK BALANCE END

Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.
narrative/descriptive explanation of the table above

4.4 Projection of Ratios
The projection of ratios must at least contain projections of core financial ratios and certain other items that can provide information for the assessment of capital adequacy, solvency, liquidity, investment, and liabilities. a. Projection of Ratios and Certain Other Items for General Insurance Companies/Reinsurance Companies (in millions of rupiah) (ratios in percentage) DESCRIPTION Actual Projection Projection as of Sept 31 as of Dec 31 Year 1 as of Dec 31 20XX+1* as of Dec 31 20XX+2* 20XX-1* 20XX-1* as of Mar 31 20XX* as of Jun 30 20XX* as of Sept 30 20XX* as of Dec 31 20XX* A. FINANCIAL HEALTH RATIO MMBR Solvency Level Permitted Assets Liabilities (except Subordinated Loans) Total Solvency Level (a) Minimum Risk-Based Capital (MMRC) Total MMRC (b) Excess (Deficiency) of Solvency Level Limit Solvency Achievement Ratio (a:b) B. FINANCIAL HEALTH RATIO OTHER THAN MMBR
i. Liquidity Ratio
a. Current Assets b. Current Liabilities
c. Ratio (a : b)

DESCRIPTION
Actual Projection Projection as of Sept 31 as of Dec 31 Year 1 as of Dec 31 20XX+1* as of Dec 31 20XX+2* 20XX-1* 20XX-1* as of Mar 31 20XX* as of Jun 30 20XX* as of Sept 30 20XX* as of Dec 31 20XX* i iInvestment Sufficiency Ratio a. Investment + Cash & Bank (See SAP Balance Sheet) b. Technical Reserves Own Retention c. Own Retention Claim Payables + Other Payables to Policyholders d. Ratio (a :(b + c) i.Ratio of Investment Returns to Net Premium Income a. Investment Returns b. Net Premium Income
c. Ratio (a : b) iv.Expense Ratio
Claims, Operating Expenses, and Commission a. Net Claims Expense b. Operating Expenses
c. Net Commission
d. Net Premium Income e. Ratio a : d (ratio I) f. Ratio b : d (ratio II) g. Ratio c : d (ratio III) h. Ratio I + Ratio II + Ratio III C. EDUCATION AND TRAINING RATIOS i. Costs Employees, Board of Directors, and Board of Commissioners

DESCRIPTION
Actual Projection Projection as of Sept 31 as of Dec 31 Year 1 as of Dec 31 20XX+1* as of Dec 31 20XX+2* 20XX-1* 20XX-1* as of Mar 31 20XX* as of Jun 30 20XX* as of Sept 30 20XX* as of Dec 31 20XX* ii.Education and Training Costs (Training) a. Employee Training b. Board of Directors Training
c. Board of Commissioners Training
iii. Total Training Costs (a + b + c)
iv. Ratio of Training Costs to Costs of
Employees, Board of Directors, and Board of Commissioners (iii : i)

Note:
*If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc. If there are accounts that must be filled from cumulative calculations, e.g., from the income statement, then they are filled with cumulative values. narrative/descriptive explanation of the table above b. Projection of Ratios and Certain Other Items for Life Insurance Companies

(in millions of rupiah)
(ratios in percentage)
Description
Actual Projection as of Sept
31 as of Dec 31 Year 1 as of Dec 31
20XX+1* as of Dec 31
20XX+2*
20XX-1* 20XX-1* as of Mar 31
20XX* as of Jun 30
20XX* as of Sept 30
20XX*
As of Dec 31
20XX*
A. FINANCIAL HEALTH RATIO
MMBR
Solvency Level
Permitted Assets
Liabilities (except Subordinated
Loans)
Total Solvency Level (a)
Minimum Risk-Based Capital
(MMRC)
Total MMRC (b)
Excess (Deficiency) of Solvency Level
Limit
Solvency Achievement Ratio
(a:b)
B. FINANCIAL HEALTH RATIO
OTHER THAN MMBR
i. 'Liquidity Ratio
a. Current Assets b. Current Liabilities
c. Ratio (a : b)

Description
Actual Projection as of Sept
31 as of Dec 31 Year 1 as of Dec 31
20XX+1* as of Dec 31
20XX+2*
20XX-1* 20XX-1* as of Mar 31
20XX* as of Jun 30
20XX* as of Sept 30
20XX*
As of Dec 31
20XX* ii.Investment Sufficiency Ratio a. Investment + Cash & Bank (See SAP Balance Sheet) b. Technical Reserves Own Retention
c. Own Retention Claim Payables +
Other Payables to Policyholders d. Ratio (a : (b + c)) iii.Ratio of Investment Returns to Net Premium Income a. Investment Returns b. Net Premium Income
c. Ratio (a : b)
iv.Ratio of Claims Expense, Operating
Expense, and Commission a. Net Claims Expense b. Operating Expenses
c. Net Commission
d. Net Premium Income e. Ratio a : d (ratio I) f.Ratio b : d (ratio II) g. Ratio c : d (ratio III) h. Ratio I + Ratio II + Ratio III C. EDUCATION AND TRAINING RATIOS

Description
Actual Projection as of Sept
31 as of Dec 31 Year 1 as of Dec 31
20XX+1* as of Dec 31
20XX+2*
20XX-1* 20XX-1* as of Mar 31
20XX* as of Jun 30
20XX* as of Sept 30
20XX*
As of Dec 31
20XX*
i. Costs of Employees, Board of Directors, and Board of Commissioners
ii.Education and Training Costs (Training) a. Training Employees b. Board of Directors Training
c. Board of Commissioners Training
iii. Total Training Costs (a + b + c)
iv. Ratio of Training Costs to Costs of Employees, Board of Directors, and Board of Commissioners (iii : i)

Note:
*If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.

If there are accounts that must be filled from cumulative calculations, e.g., from the income statement, then they are filled with cumulative values. narrative/descriptive explanation of the table above

4.5 Assumptions Used
Assumptions use optimistic, normal, and pessimistic assumptions. These assumptions cover both micro and macro assumptions. The example table below applies to general insurance companies/life insurance companies/reinsurance companies. (in millions of rupiah) No. Assumption Actual Projection Jan - Sept Jan-Dec Year 1 Jan-Dec 20XX+1 2 Jan-Dec 20XX+2 2 20XX-1 20XX-12 Jan-Mar 20XX 2 Jan-Jun 20XX 2 Jan - Sept 20XX 2 Jan-Dec 20XX 2 ACTUAL DATA 1 Rupiah exchange rate 4 2 Inflation rate 5 Catastrophic losses (in rupiah) 6 4 Investment return rate 7 Total new coverage (in premium rupiah) 8 Policy lapse rate ( policies lapsed/total policies at start of period) 9 Claim rate (gross claims/gross premiums) 8 etc. (other relevant assumptions) OPTIMISTIC ASSUMPTION 1 Rupiah exchange rate 2 Inflation rate 3 Catastrophic losses 4 Investment return rate Total new coverage (in premium rupiah) 6 Policy lapse rate

No. Assumption
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+1 2
Jan-Dec
20XX+2 2
20XX-1
20XX-12
Jan-Mar
20XX 2
Jan-Jun
20XX 2
Jan - Sept
20XX 2
Jan-Dec
20XX 2
7 Claim rate
8 etc. (other relevant assumptions)
NORMAL
ASSUMPTION
1 Rupiah exchange rate
2 Inflation
3 Catastrophic losses
4 Investment return rate
Total new coverage
(in premium rupiah)
Policy lapse rate ( policies lapsed/total policies at start of period) 7 Claim rate 8 etc. (other relevant assumptions) PESIMISTIC ASSUMPTION 1 Rupiah exchange rate 2 Inflation 3 Catastrophic losses 4 Investment return rate Total premium new coverage 6 Policy lapse rate 7 Claim rate 8 etc. (other relevant assumptions)

Note:
1 Columns or rows colored gray are not filled.
2 If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc. If quarterly assumptions are not available, annual assumptions can be used. 4The reported BI exchange rate value is the BI mid-rate on the date of the quarterly report, e.g., for the quarterly report for January - March, the exchange rate used is the BI rate on March 31. 5 Inflation rate per month, data can be obtained from data issued by BPS. 6 Data can be obtained from claims and claim reserves. 7 The calculation guidelines for investment return rates are explained based on SAK calculations. 8 The projection is adjusted to the increase in new coverage during that period. 9 Policy lapse rate = policies lapsed/total policies at start of period. 10 For figures 1, 2, and 7, use Jan-Sept period data (accumulated).

CHAPTER V
INSURANCE/REINSURANCE COMPANY PLAN
5.1 Capital Plan
a. The capital plan must at least include plans for capital changes including plans for capital additions from existing shareholders or new shareholders, plans for capital additions through the capital market, and other capital addition plans. Companies can use the table format below if they do not have a standard format. The example table below applies to general insurance companies/life insurance companies/reinsurance companies, and can be modified as needed. (in millions of rupiah) Description Actual Projection as of Sept 30 as of Dec 31 Year 1 as of Dec 31 20XX+1 as of Dec 31 20XX+2 20XX-1 20XX-1 as of Mar 31 20XX as of Jun 30 20XX as of Sept 30 20XX as of Dec 31 20XX CAPITAL POSITION Shareholders 1.--------------- (filled with nominal) 2.--------------- 3.--------------- 4.--------------- Total Paid-in Capital IPO (Initial Public Offering) - Go Public Issuance of new shares Others (such as subordinated loans)

Description
Actual Projection as of Sept 30 as of Dec 31 Year 1 as of Dec 31 20XX+1 as of Dec 31 20XX+2 20XX-1 20XX-1 as of Mar 31 20XX as of Jun 30 20XX as of Sept 30 20XX as of Dec 31 20XX - Note:
*If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc. narrative/descriptive explanation of the table above
5.2 Investment Plan
The annual investment plan must at least include:
a. plan for the composition of investment types; b. estimated investment return rate for each type of investment; and
c. considerations underlying the plan for the composition of investment types.

5.3 Reinsurance Plan
The reinsurance plan must at least include:
a. details of maximum own retention for each risk or event after reinsurance is placed, according to business class/business line; b. details of the main reinsurer including name, address, country of origin of the reinsurer;
c. description of own retention including proportional automatic reinsurance support and/or non-proportional automatic reinsurance support; and
d. significant proportion of the program covered by one reinsurer or reinsurers affiliated with one insurance business group, additional information about the reasons for choosing the said reinsurer, including details of guarantees provided and financial health.

5.4 Product Development and Insurance Product Marketing Plan for Insurance Companies or Reinsurance Program Development Plan for Reinsurance Companies
a. The insurance product development plan for Insurance Companies must at least contain:
i. business lines to be developed for a period of 1 (one) year ahead;
ii.product development study considering the following data:

needs or public demand for similar insurance products;
marketing trends of similar insurance products by other insurance companies;
availability of company resources to market similar insurance products;
risk and loss profiles suitable for the insurance product to be marketed and the target market segment;
cost profiles suitable for the product to be marketed;
current investment portfolio performance of the company;
investment portfolios suitable for the insurance product to be marketed;
capital adequacy; and
risks that may arise for the company and their mitigation.

iii. plan for issuing new products
No
New
Product Name 1
Business
Line
Type of
Coverage
Risks
Covered
Benefits
Provided
Coverage
Period
Marketing
Method
Target
Market
Plan Time for Issuance or
Implementation
Purpose/Benefit
Risks that
May
Arise 3
For Shariah
Unit
For Policyholders etc
1 If
Type
Coverage has been set, fill in with more detail for individuals, collections or individuals, and collections can be attached in separate sheets.

b. The insurance product marketing plan must at least contain:
i. distribution channels used and cooperation with third parties
ii. cooperation with third parties
No. Name of Third Party Affiliation/non-affiliation Business Field Product Name General Description Product Model/Form/Type Cooperation Duration Cooperation Marketing

c. The Reinsurance Program Development Plan for Reinsurance Companies must at least contain:
i. business lines to be developed for a period of 1 (one) year ahead;
ii.reinsurance program development study considering the following data:

needs or demand of other companies for similar reinsurance programs;
marketing trends of similar reinsurance programs by other Reinsurance Companies;
availability of Reinsurance Company resources to market similar reinsurance programs;
risk and loss profiles suitable for the reinsurance program to be marketed and the target market segment;
cost profiles suitable for the reinsurance program to be marketed;
current investment portfolio performance of the Reinsurance Company;
investment portfolios suitable for the reinsurance program to be marketed;
capital adequacy; and
risks that may arise for the Reinsurance Company and their mitigation.
etc..

d. HR Development Plan Related to Insurance Product Development The HR development plan related to the product development plan in the company is explained.
5.5 Organizational and HR Development Plan
The organizational and HR development plan must at least include:

i. organizational development plan containing plans for the formation/change of work units and/or committees adjusted to the size and complexity of the company's business;
ii. HR development plan containing:

plan for the number of HR needs;
plan for HR education and training needs and education/training cost/budget plans in accordance with applicable regulations;
iii. plan for the utilization of foreign labor and outsourcing including plans for the use of labor outside permanent labor, both foreign and local labor, including the number and fields of assignment.
Note:
For point i, the format is free. If the company does not yet have a format for points ii and iii, the company can use the format attached below. HR NEEDS PLAN No Total HR as of Sept 30 20XX-1* HR Number per Job Level Recruitment to be Implemented as of Dec 31 20XX-1* as of Mar 31 20XX* as of Jun 30 20XX* as of Sept 30 20XX* as of Dec 31 20XX* as of Dec 31 20XX+1* as of Dec 31 20XX+2* *If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc. HR EDUCATION AND TRAINING NEEDS PLAN AND EDUCATION/TRAINING COSTS/BUDGET

No
Training
Material 1
Training
Method 2
Estimated
Training
Time 3
Training
Duration 4
Location
Name
Speaker/
Training
Institution
Total
Number of Participants
Number of Participants per Job Level
Training
Cost
1 e.g.: risk management, marketing, etc... filled with in-house training or out-house 2 training filled with the month of training implementation, e.g.: March 3 2015 4 filled with the duration of training, e.g.: 3 days FOREIGN LABOR UTILIZATION PLAN 1

No
Field of Assignment and Position
Number Name of Foreign Worker Foreign Worker Citizenship Term of Office Name of Accompanying Staff Knowledge Transfer Plan Position Job Title Scope of Work/Job Description Start Date End Date 1 Commissioners 2 Board of Directors Office Managers Office Managers Outside Branch Offices Experts/ Consultants Other Positions 2
Reasons for using Foreign Workers and reasons for not/not yet using Indonesian Workers: ..................................................
a...............................................................................................................................................................................................
b ..............................................................................................................................................................................................

No
Field of Assignment and Position
Number Name of Foreign Worker Foreign Worker Citizenship Term of Office Name of Accompanying Staff Knowledge Transfer Plan Position Job Title Scope of Work/Job Description Start Date End Date
etc ......................................................................................................................................................................................
1filled with NIHIL if the company has no plan to utilize Foreign Workers 2 if any in accordance with OJK approval PLAN FOR TERMINATION OF UTILIZATION OF FOREIGN WORKERS CURRENTLY HOLDING/WORKING IN THE COMPANY 1 PT.XYZ No Foreign Workers Term of Office Knowledge Transfer Program Final Result Knowledge Transfer Program Name Citizenship Job Title Field of Assignment/ Job Description Start Date End Date Reason for termination of Foreign Worker utilization
a..................................................................................................................................................................

No
Foreign Workers Term of Office
Knowledge
Transfer Program
Final Result
Knowledge
Transfer Program 2
Name Citizenship Job Title
Field of Assignment/
Job Description
Start Date End Date
b...................................................................................................................................................................
etc ................................................................................................................................................................
Note:
1 filled with NIHIL if the company has no plan to terminate Foreign Workers. 2 filled with:

the job title or job description will be filled/continued by another foreign worker.
the job title or job description can already be filled by an Indonesian citizen.
other relevant reasons
5.6 Information Technology System Development Plan
The information technology system development plan must at least meet the following requirements:
can provide current and accurate information regarding the coverage portfolio as well as risk and loss profiles;
can support reporting to the Financial Services Authority;

Plans for the development and/or change of office networks must at least include plans for the opening and merging of offices outside the head office. OFFICE NETWORK DEVELOPMENT AND/OR CHANGE PLAN No TYPE OF OFFICE IMPLEMENTATION TIME 1 ESTIMATED INVESTMENT/COST LOCATION 2 NOTES 3 A. OFFICE OPENING Offices with the authority to accept or reject insurance coverage, sign policies, settle or reject claims Offices without the authority to accept or reject insurance coverage, sign policies, settle or reject claims B. STATUS CHANGE Offices with the authority to accept or reject insurance coverage, sign policies, settle or reject claims Offices without the authority to accept or reject insurance coverage, sign policies, settle or reject claims C. MERGER Offices with the authority to accept or reject insurance coverage, sign policies,

No TYPE OF OFFICE IMPLEMENTATION TIME 1 ESTIMATED INVESTMENT/COST LOCATION 2 NOTES 3 settle or reject claims a. Between offices with the authority to accept or reject insurance coverage, sign policies, settle or reject claims b. Between offices without the authority to accept or reject insurance coverage, sign policies, settle or reject claims etc. C. ADDRESS TRANSFER D. CLOSURE

5.8 Other Information
Other information must at least include information that needs to be submitted because it affects the company's business activities, which is not mentioned in the scope of the Business Plan above. Example:

merger, acquisition, and consolidation plans;
plan for the transfer of coverage portfolio;
plan for changing the insurance business field;
Note:
1 Filled with the month of the planned implementation time. 2 For locations in the DKI Jakarta region, at least mention the name of the DKI Jakarta province. For locations outside the DKI Jakarta region, at least include the name of the Regency/City. 3 - Detailed notes can be attached in a separate sheet

Specifically for offices with the authority to accept or reject insurance coverage, sign policies, settle or reject claims,
the expert personnel who will fill the office is informed

plan for changing business activities not based on Shariah principles to based on Shariah principles.

Part II
Corporate Plan for Shariah Units

EXECUTIVE SUMMARY
The executive summary must at least include:
a. vision, mission, and strategic values (corporate value) and the organizational structure of the Shariah unit; Explanation regarding the general organizational structure of the Shariah unit; b. Shariah unit policy direction containing information regarding the direction and policy of business development to be carried out by the Shariah unit in the short term of 1 (one) year ahead and the medium term of 3 (three) years ahead;
c. key financial indicators including at least the performance of the Shariah unit as of September 30
of the year the Business Plan was prepared and projections of capital adequacy, solvency level, investment sufficiency ratio, and other financial ratios as well as risk level assessment, specifically asset and liability risk, insurance risk, and operational risk; and a. short-term activity targets of the Shariah unit for the next 1 (one) year and medium-term activity targets of the Shariah unit for the next 3 (three) years.

CHAPTER I
MANAGEMENT POLICY AND STRATEGY
1.1 Analysis of the Shariah Unit's Position in Facing Business Competition
Analysis of the Shariah unit's position in facing business competition containing analysis conducted at the industry level as well as against the Shariah unit group having similar characteristics.
1.2 Management Policy
Management policy containing general information on the Shariah unit's policy set by management in developing the Shariah unit's business in the future.

1.3 Risk Management and Compliance Policy
Risk management and compliance policy containing information regarding steps in implementing risk management based on an evaluation of the Shariah unit's risk profile and improvement efforts to be taken as well as an explanation regarding the policy in carrying out the compliance function.
1.5 Business Development Strategy
Business development strategy containing information on strategic steps to achieve the business objectives set for the Shariah unit, including an explanation regarding organizational and information technology development strategy, and strategy for anticipating changes in external conditions.

1.5 HR Development Strategy
Human resource development strategy and remuneration policy (remuneration policy) which must at least contain information regarding general policies regulating regarding the provision of salaries, allowances, incentives, and other financial facilities to members of the Board of Commissioners, members of the Board of Directors, and employees including to the Shariah Supervisory Board.

CHAPTER II
RISK MANAGEMENT AND COMPLIANCE IMPLEMENTATION
2.2 Risk Management Implementation
Implementation of risk management, including risk profile assessment for all risks identified by the Sharia unit.
2.2 Implementation of Good Corporate Governance
Briefly describe the implementation of good corporate governance principles as regulated in the POJK Regarding Good Corporate Governance for Insurance Companies.
2.3 Implementation of Sharia Principle Compliance
Explain the implementation of compliance with Sharia principles in the Sharia unit.

CHAPTER III
CURRENT PERFORMANCE OF THE SHARIA UNIT
3.1 Contribution
Describe the current contribution of the Sharia unit both qualitatively and quantitatively.
3.2 Investment Results
Describe the investment results obtained by the Sharia unit currently both qualitatively and quantitatively.
3.3 Profit and Capitalization
Describe the profit and capitalization of the Sharia unit currently both qualitatively and quantitatively.

CHAPTER IV
FINANCIAL STATEMENT PROJECTIONS AND ASSUMPTIONS USED
4.1 Financial Position Projections (Non-Consolidated)
Fill in the format below and describe the content of the table below narratively/descriptively. a. Financial Position Projections for General Insurance Business / Reinsurance Business in Sharia Units Financial Position Projection of Company Funds (in millions of rupiah)

DESCRIPTION	Actual as of 30 Sept 20XX-1*	Projection as of 31 Dec 20XX-1*	Projection Year 1	Projection as of 31 Dec 20XX+1*	Projection as of 31 Dec 20XX+2*	Projection as of 31 Mar 20XX*	Projection as of 30 Jun 20XX*	Projection as of 30 Sept 20XX*	Projection as of 31 Dec 20XX*
ASSETS
Investment Assets
Deposits	-	-	-	-	-	-	-	-	-
Sharia Stocks	-	-	-	-	-	-	-	-	-
Sharia Sukuk or Bonds	-	-	-	-	-	-	-	-	-
Sharia Government Securities	-	-	-	-	-	-	-	-	-
Sharia Securities issued by Bank Indonesia	-	-	-	-	-	-	-	-	-
Sharia Securities issued by entities other than the Republic of Indonesia	-	-	-	-	-	-	-	-	-
Sharia Securities issued by multinational institutions	-	-	-	-	-	-	-	-	-
Sharia Mutual Funds	-	-	-	-	-	-	-	-	-
Sharia Asset-Backed Securities	-	-	-	-	-	-	-	-	-
Sharia Financing through cooperation with other parties	-	-	-	-	-	-	-	-	-
Pure Gold	-	-	-	-	-	-	-	-	-
Direct Participation	-	-	-	-	-	-	-	-	-
Buildings with strata rights or land with buildings for investment	-	-	-	-	-	-	-	-	-
Other Investments	-	-	-	-	-	-	-	-	-
Total Investment Assets	-	-	-	-	-	-	-	-	-
Non-Investment Assets
Cash and Bank	-	-	-	-	-	-	-	-	-
Investment Receivables	-	-	-	-	-	-	-	-	-
Investment Result Receivables	-	-	-	-	-	-	-	-	-
Ujrah Receivables from Participants	-	-	-	-	-	-	-	-	-
Surplus Allocation Receivables from Tabarru' Funds	-	-	-	-	-	-	-	-	-
Investment Management Profit-Sharing Receivables from Tabarru' Funds	-	-	-	-	-	-	-	-	-
Qardh Receivables	-	-	-	-	-	-	-	-	-
Buildings with strata rights or land with buildings for own use	-	-	-	-	-	-	-	-	-
Computer Hardware	-	-	-	-	-	-	-	-	-
Other Fixed Assets	-	-	-	-	-	-	-	-	-
Other Assets	-	-	-	-	-	-	-	-	-
Total Non-Investment Assets	-	-	-	-	-	-	-	-	-
TOTAL ASSETS	-	-	-	-	-	-	-	-	-
LIABILITIES AND EQUITY
Liabilities
Commission Payables	-	-	-	-	-	-	-	-	-
Reinsurance Ujrah Payables	-	-	-	-	-	-	-	-	-
Tax Payables	-	-	-	-	-	-	-	-	-
Accrued Expenses	-	-	-	-	-	-	-	-	-
Zakat Payables	-	-	-	-	-	-	-	-	-
Other Payables	-	-	-	-	-	-	-	-	-
Total Liabilities	-	-	-	-	-	-	-	-	-
Subordinated Loans	-	-	-	-	-	-	-	-	-
Sharia Unit Equity
Paid-in Capital	-	-	-	-	-	-	-	-	-
Share Premium	-	-	-	-	-	-	-	-	-
Reserves	-	-	-	-	-	-	-	-	-
Increase (Decrease) in Securities	-	-	-	-	-	-	-	-	-
Difference in Valuation of Fixed Assets	-	-	-	-	-	-	-	-	-
Retained Earnings	-	-	-	-	-	-	-	-	-
Total Sharia Unit Equity	-	-	-	-	-	-	-	-	-
TOTAL LIABILITIES AND SHARIA UNIT EQUITY	-	-	-	-	-	-	-	-	-

Narrative/descriptive explanation of the table above Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.

Financial Position Projection of Tabarru' Funds (in millions of rupiah)

DESCRIPTION	Actual as of 30 Sept 20XX-1*	Projection as of 31 Dec 20XX-1*	Projection Year 1	Projection as of 31 Dec 20XX+1*	Projection as of 31 Dec 20XX+2*	Projection as of 31 Mar 20XX*	Projection as of 30 Jun 20XX*	Projection as of 30 Sept 20XX*	Projection as of 31 Dec 20XX*
ASSETS
Investment Assets
Deposits	-	-	-	-	-	-	-	-	-
Sharia Stocks	-	-	-	-	-	-	-	-	-
Sharia Sukuk or Bonds	-	-	-	-	-	-	-	-	-
Sharia Government Securities	-	-	-	-	-	-	-	-	-
Sharia Securities issued by Bank Indonesia	-	-	-	-	-	-	-	-	-
Sharia Securities issued by entities other than the Republic of Indonesia	-	-	-	-	-	-	-	-	-
Sharia Securities issued by Multinational Institutions	-	-	-	-	-	-	-	-	-
Sharia Mutual Funds	-	-	-	-	-	-	-	-	-
Sharia Asset-Backed Securities	-	-	-	-	-	-	-	-	-
Financing through cooperation with other parties	-	-	-	-	-	-	-	-	-
Pure Gold	-	-	-	-	-	-	-	-	-
Other Investments	-	-	-	-	-	-	-	-	-
Total Investments	-	-	-	-	-	-	-	-	-
Non-Investment Assets	-	-	-	-	-	-	-	-	-
Cash and Bank	-	-	-	-	-	-	-	-	-
Contribution Receivables	-	-	-	-	-	-	-	-	-
Reinsurance Receivables	-	-	-	-	-	-	-	-	-
Investment Receivables	-	-	-	-	-	-	-	-	-
Investment Result Receivables	-	-	-	-	-	-	-	-	-
Other Assets	-	-	-	-	-	-	-	-	-
Total Non-Investment Assets	-	-	-	-	-	-	-	-	-
Total Assets	-	-	-	-	-	-	-	-	-
LIABILITIES AND TABARRU' FUND EQUITY
Liabilities
Payables
Claim Payables	-	-	-	-	-	-	-	-	-
Reinsurance Payables	-	-	-	-	-	-	-	-	-
Ujrah Payables to Sharia Unit	-	-	-	-	-	-	-	-	-
Surplus Allocation Payables to Insured	-	-	-	-	-	-	-	-	-
Surplus Allocation Payables to Sharia Unit	-	-	-	-	-	-	-	-	-
Investment Profit-Sharing Payables from Tabarru' Funds to Sharia Unit	-	-	-	-	-	-	-	-	-
Zakat Payables	-	-	-	-	-	-	-	-	-
Other Payables	-	-	-	-	-	-	-	-	-
Total Payables	-	-	-	-	-	-	-	-	-
Technical Provisions	-	-	-	-	-	-	-	-	-
Contribution Provisions	-	-	-	-	-	-	-	-	-
Provisions for Contributions Not Yet Recognized as Income (KYBMP)	-	-	-	-	-	-	-	-	-
Claim Provisions	-	-	-	-	-	-	-	-	-
Total Technical Provisions	-	-	-	-	-	-	-	-	-
Qardh	-	-	-	-	-	-	-	-	-
Total Liabilities	-	-	-	-	-	-	-	-	-
Tabarru' Fund Equity
Accumulated Tabarru' Funds	-	-	-	-	-	-	-	-	-
Increase (Decrease) in Securities	-	-	-	-	-	-	-	-	-
Valuation Differences based on SAK & SAP	-	-	-	-	-	-	-	-	-
Disallowed Assets	-	-	-	-	-	-	-	-	-
Total Tabarru' Fund Equity	-	-	-	-	-	-	-	-	-
TOTAL LIABILITIES AND TABARRU' FUND EQUITY	-	-	-	-	-	-	-	-	-

Narrative/descriptive explanation of the table above Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.

b. Financial Position Projections for Life Insurance Business in Sharia Units Financial Position Projection of Company Funds (in millions of rupiah)

DESCRIPTION	Actual as of 30 Sept 20XX-1*	Projection as of 31 Dec 20XX-1*	Projection Year 1	Projection as of 31 Dec 20XX+1*	Projection as of 31 Dec 20XX+2*	Projection as of 31 Mar 20XX*	Projection as of 30 Jun 20XX*	Projection as of 30 Sept 20XX*	Projection as of 31 Dec 20XX*
ASSETS
Investment Assets
Deposits	-	-	-	-	-	-	-	-	-
Sharia Stocks	-	-	-	-	-	-	-	-	-
Sharia Sukuk or Bonds	-	-	-	-	-	-	-	-	-
Sharia Government Securities	-	-	-	-	-	-	-	-	-
Sharia Securities issued by Bank Indonesia	-	-	-	-	-	-	-	-	-
Sharia Securities issued by entities other than the Republic of Indonesia	-	-	-	-	-	-	-	-	-
Sharia Securities issued by multinational institutions	-	-	-	-	-	-	-	-	-
Sharia Mutual Funds	-	-	-	-	-	-	-	-	-
Sharia Asset-Backed Securities	-	-	-	-	-	-	-	-	-
Sharia Financing through cooperation with other parties	-	-	-	-	-	-	-	-	-
Pure Gold	-	-	-	-	-	-	-	-	-
Direct Participation	-	-	-	-	-	-	-	-	-
Buildings with strata rights or land with buildings for investment	-	-	-	-	-	-	-	-	-
Other Investments	-	-	-	-	-	-	-	-	-
Total Investment Assets	-	-	-	-	-	-	-	-	-
Non-Investment Assets
Cash and Bank	-	-	-	-	-	-	-	-	-
Investment Receivables	-	-	-	-	-	-	-	-	-
Investment Result Receivables	-	-	-	-	-	-	-	-	-
Ujrah Receivables from Participants	-	-	-	-	-	-	-	-	-
Surplus Allocation Receivables from Tabarru' Funds	-	-	-	-	-	-	-	-	-
Investment Management Profit-Sharing Receivables from Tabarru' Funds	-	-	-	-	-	-	-	-	-
Qardh Receivables	-	-	-	-	-	-	-	-	-
Buildings with strata rights or land with buildings for own use	-	-	-	-	-	-	-	-	-
Computer Hardware	-	-	-	-	-	-	-	-	-
Other Fixed Assets	-	-	-	-	-	-	-	-	-
Other Assets	-	-	-	-	-	-	-	-	-
Total Non-Investment Assets	-	-	-	-	-	-	-	-	-
TOTAL ASSETS	-	-	-	-	-	-	-	-	-
LIABILITIES AND EQUITY
Liabilities
Commission Payables	-	-	-	-	-	-	-	-	-
Reinsurance Ujrah Payables	-	-	-	-	-	-	-	-	-
Tax Payables	-	-	-	-	-	-	-	-	-
Accrued Expenses	-	-	-	-	-	-	-	-	-
Zakat Payables	-	-	-	-	-	-	-	-	-
Other Payables	-	-	-	-	-	-	-	-	-
Total Liabilities	-	-	-	-	-	-	-	-	-
Subordinated Loans	-	-	-	-	-	-	-	-	-
Sharia Unit Equity
Paid-in Capital	-	-	-	-	-	-	-	-	-
Share Premium	-	-	-	-	-	-	-	-	-
Reserves	-	-	-	-	-	-	-	-	-
Increase (Decrease) in Securities	-	-	-	-	-	-	-	-	-
Difference in Valuation of Fixed Assets	-	-	-	-	-	-	-	-	-
Retained Earnings	-	-	-	-	-	-	-	-	-
Total Sharia Unit Equity	-	-	-	-	-	-	-	-	-
TOTAL LIABILITIES AND SHARIA UNIT EQUITY	-	-	-	-	-	-	-	-	-

Narrative/descriptive explanation of the table above Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.

Financial Position Projection of Tabarru' Funds (in millions of rupiah)

DESCRIPTION	Actual as of 30 Sept 20XX-1*	Projection as of 31 Dec 20XX-1*	Projection Year 1	Projection as of 31 Dec 20XX+1*	Projection as of 31 Dec 20XX+2*	Projection as of 31 Mar 20XX*	Projection as of 30 Jun 20XX*	Projection as of 30 Sept 20XX*	Projection as of 31 Dec 20XX*
ASSETS
Investment Assets
Deposits	-	-	-	-	-	-	-	-	-
Sharia Stocks	-	-	-	-	-	-	-	-	-
Sharia Sukuk or Bonds	-	-	-	-	-	-	-	-	-
Sharia Government Securities	-	-	-	-	-	-	-	-	-
Sharia Securities issued by Bank Indonesia	-	-	-	-	-	-	-	-	-
Sharia Securities issued by entities other than the Republic of Indonesia	-	-	-	-	-	-	-	-	-
Sharia Securities issued by Multinational Institutions	-	-	-	-	-	-	-	-	-
Sharia Mutual Funds	-	-	-	-	-	-	-	-	-
Sharia Asset-Backed Securities	-	-	-	-	-	-	-	-	-
Financing through cooperation with other parties	-	-	-	-	-	-	-	-	-
Pure Gold	-	-	-	-	-	-	-	-	-
Other Investments	-	-	-	-	-	-	-	-	-
Total Investments	-	-	-	-	-	-	-	-	-
Non-Investment Assets	-	-	-	-	-	-	-	-	-
Cash and Bank	-	-	-	-	-	-	-	-	-
Contribution Receivables	-	-	-	-	-	-	-	-	-
Reinsurance Receivables	-	-	-	-	-	-	-	-	-
Investment Receivables	-	-	-	-	-	-	-	-	-
Investment Result Receivables	-	-	-	-	-	-	-	-	-
Other Assets	-	-	-	-	-	-	-	-	-
Total Non-Investment Assets	-	-	-	-	-	-	-	-	-
Total Assets	-	-	-	-	-	-	-	-	-
LIABILITIES AND TABARRU' FUND EQUITY
Liabilities
Payables
Claim Payables	-	-	-	-	-	-	-	-	-
Reinsurance Payables	-	-	-	-	-	-	-	-	-
Ujrah Payables to Sharia Unit	-	-	-	-	-	-	-	-	-
Surplus Allocation Payables to Insured	-	-	-	-	-	-	-	-	-
Surplus Allocation Payables to Sharia Unit	-	-	-	-	-	-	-	-	-
Investment Profit-Sharing Payables from Tabarru' Funds to Sharia Unit	-	-	-	-	-	-	-	-	-
Zakat Payables	-	-	-	-	-	-	-	-	-
Other Payables	-	-	-	-	-	-	-	-	-
Total Payables	-	-	-	-	-	-	-	-	-
Technical Provisions	-	-	-	-	-	-	-	-	-
Contribution Provisions	-	-	-	-	-	-	-	-	-
Provisions for Contributions Not Yet Recognized as Income (KYBMP)	-	-	-	-	-	-	-	-	-
Claim Provisions	-	-	-	-	-	-	-	-	-
Total Technical Provisions	-	-	-	-	-	-	-	-	-
Qardh	-	-	-	-	-	-	-	-	-
Total Liabilities	-	-	-	-	-	-	-	-	-
Tabarru' Fund Equity
Accumulated Tabarru' Funds	-	-	-	-	-	-	-	-	-
Increase (Decrease) in Securities	-	-	-	-	-	-	-	-	-
Valuation Differences based on SAK & SAP	-	-	-	-	-	-	-	-	-
Disallowed Assets	-	-	-	-	-	-	-	-	-
Total Tabarru' Fund Equity	-	-	-	-	-	-	-	-	-
TOTAL LIABILITIES AND TABARRU' FUND EQUITY	-	-	-	-	-	-	-	-	-

Narrative/descriptive explanation of the table above Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.

Financial Position Projection of Participant Investment Funds (in millions of rupiah)

DESCRIPTION	Actual as of 30 Sept 20XX-1*	Projection as of 31 Dec 20XX-1*	Projection Year 1	Projection as of 31 Dec 20XX+1*	Projection as of 31 Dec 20XX+2*	Projection as of 31 Mar 20XX*	Projection as of 30 Jun 20XX*	Projection as of 30 Sept 20XX*	Projection as of 31 Dec 20XX*
ASSETS
Investment Assets
Deposits	-	-	-	-	-	-	-	-	-
Sharia Stocks	-	-	-	-	-	-	-	-	-
Sharia Sukuk or Bonds	-	-	-	-	-	-	-	-	-
Sharia Government Securities	-	-	-	-	-	-	-	-	-
Sharia Securities issued by Bank Indonesia	-	-	-	-	-	-	-	-	-
Sharia Securities issued by entities other than the Republic of Indonesia	-	-	-	-	-	-	-	-	-
Sharia Securities issued by Multinational Institutions	-	-	-	-	-	-	-	-	-
Sharia Mutual Funds	-	-	-	-	-	-	-	-	-
Sharia Asset-Backed Securities	-	-	-	-	-	-	-	-	-
Financing through cooperation with other parties	-	-	-	-	-	-	-	-	-
Pure Gold	-	-	-	-	-	-	-	-	-
Other Investments	-	-	-	-	-	-	-	-	-
Total Investments	-	-	-	-	-	-	-	-	-
Non-Investment Assets
Cash and Bank	-	-	-	-	-	-	-	-	-
Investment Receivables	-	-	-	-	-	-	-	-	-
Investment Result Receivables	-	-	-	-	-	-	-	-	-
Other Assets	-	-	-	-	-	-	-	-	-
Total Non-Investment Assets	-	-	-	-	-	-	-	-	-
TOTAL ASSETS	-	-	-	-	-	-	-	-	-
LIABILITIES
Ujrah/Fee Payables for Fund Management	-	-	-	-	-	-	-	-	-
Investment Profit-Sharing Payables	-	-	-	-	-	-	-	-	-
Investment Fund Withdrawal Payables	-	-	-	-	-	-	-	-	-
Accumulated Participant Investment Funds	-	-	-	-	-	-	-	-	-
TOTAL LIABILITIES	-	-	-	-	-	-	-	-	-

Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.

Narrative/descriptive explanation of the table above

4.2 Comprehensive Income/Loss Projections (For Periods Ending On)
Fill in the format below and describe the content of the table below narratively/descriptively. a. Comprehensive Income/Loss Projections for General Insurance Business / Reinsurance Companies in Sharia Units Comprehensive Income/Loss Projection of Company Funds (in millions of rupiah)

DESCRIPTION	Actual Jan - Sept 20XX-1*	Projection Jan-Des 20XX-1*	Projection Year 1 Jan-Des 20XX-1*	Projection Jan-Des 20XX+1*	Projection Jan-Des 20XX+2*	Projection Jan-Mar 20XX*	Projection Jan-Jun 20XX*	Projection Jan - Sept 20XX*	Projection Jan-Des 20XX*
REVENUE
Ujrah Received
a. Ujrah for risk management	-	-	-	-	-	-	-	-	-
b. Ujrah for Tabarru' Fund investment management	-	-	-	-	-	-	-	-	-
Total Ujrah Received	-	-	-	-	-	-	-	-	-
Commission Received	-	-	-	-	-	-	-	-	-
Tabarru' Fund Investment Management Profit-Sharing	-	-	-	-	-	-	-	-	-
Tabarru' Fund Underwriting Surplus Allocation	-	-	-	-	-	-	-	-	-
Sharia Unit Investment Management Results	-	-	-	-	-	-	-	-	-
Other Business Revenue	-	-	-	-	-	-	-	-	-
Total Revenue	-	-	-	-	-	-	-	-	-
BUSINESS EXPENSES
Commissions Paid	-	-	-	-	-	-	-	-	-
Reinsurance Ujrah	-	-	-	-	-	-	-	-	-
Marketing Expenses	-	-	-	-	-	-	-	-	-
General & Administrative Expenses	-	-	-	-	-	-	-	-	-
Other Business Expenses	-	-	-	-	-	-	-	-	-
Total Business Expenses	-	-	-	-	-	-	-	-	-
Operating Profit (Loss)	-	-	-	-	-	-	-	-	-
Other Non-Business Results (Expenses) Net	-	-	-	-	-	-	-	-	-
PROFIT (LOSS) BEFORE ZAKAT AND TAX	-	-	-	-	-	-	-	-	-
Zakat	-	-	-	-	-	-	-	-	-
PROFIT (LOSS) BEFORE TAX	-	-	-	-	-	-	-	-	-
Income Tax	-	-	-	-	-	-	-	-	-
PROFIT (LOSS) AFTER TAX	-	-	-	-	-	-	-	-	-
Other Comprehensive Income	-	-	-	-	-	-	-	-	-
TOTAL COMPREHENSIVE PROFIT (LOSS)	-	-	-	-	-	-	-	-	-

Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.

Narrative/descriptive explanation of the table above

Tabarru' Fund Underwriting Surplus Projection (in millions of rupiah)

DESCRIPTION	Actual Jan - Sept 20XX-1*	Projection Jan-Des 20XX-1*	Projection Year 1 Jan-Des 20XX-1*	Projection Jan-Des 20XX+1*	Projection Jan-Des 20XX+2*	Projection Jan-Mar 20XX*	Projection Jan-Jun 20XX*	Projection Jan - Sept 20XX*	Projection Jan-Des 20XX*
UNDERWRITING REVENUE
Participant Contributions
Reinsurance Contributions	-	-	-	-	-	-	-	-	-
Decrease (Increase) in Contribution Provisions and KYBMP	-	-	-	-	-	-	-	-	-
a. Decrease (Increase) in Contribution Provisions	-	-	-	-	-	-	-	-	-
b. Decrease (Increase) in KYBMP	-	-	-	-	-	-	-	-	-
Total Decrease (Increase) in Contribution Provisions and KYBMP	-	-	-	-	-	-	-	-	-
Total Net Contribution Revenue	-	-	-	-	-	-	-	-	-
Claim Expenses
a. Gross Claims	-	-	-	-	-	-	-	-	-
b. Reinsurance Claims Received	-	-	-	-	-	-	-	-	-
c. Increase (Decrease) in Claim Provisions	-	-	-	-	-	-	-	-	-
Total Claim Expenses	-	-	-	-	-	-	-	-	-
Adjuster Expenses	-	-	-	-	-	-	-	-	-
Underwriting Surplus (Deficit)	-	-	-	-	-	-	-	-	-

Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.

Narrative/descriptive explanation of the table above

b. Comprehensive Income/Loss Projections for Life Insurance Business in Sharia Units Comprehensive Income/Loss Projection of Company Funds (in millions of rupiah)

DESCRIPTION	Actual Jan - Sept 20XX-1*	Projection Jan-Des 20XX-1*	Projection Year 1 Jan-Des 20XX-1*	Projection Jan-Des 20XX+1*	Projection Jan-Des 20XX+2*	Projection Jan-Mar 20XX*	Projection Jan-Jun 20XX*	Projection Jan - Sept 20XX*	Projection Jan-Des 20XX*
REVENUE
Ujrah Received
a. Ujrah for risk management	-	-	-	-	-	-	-	-	-
b. Ujrah for Tabarru' Fund investment management	-	-	-	-	-	-	-	-	-
c. Ujrah for Participant Investment Fund management	-	-	-	-	-	-	-	-	-
Total Ujrah Received	-	-	-	-	-	-	-	-	-
Commission Received	-	-	-	-	-	-	-	-	-
Tabarru' Fund Investment Management Profit-Sharing	-	-	-	-	-	-	-	-	-
Participant Investment Fund Investment Management Profit-Sharing	-	-	-	-	-	-	-	-	-
Tabarru' Fund Underwriting Surplus Allocation	-	-	-	-	-	-	-	-	-
Sharia Unit Investment Management Results	-	-	-	-	-	-	-	-	-
Other Business Revenue	-	-	-	-	-	-	-	-	-
TOTAL REVENUE	-	-	-	-	-	-	-	-	-
BUSINESS EXPENSES
Acquisition Costs	-	-	-	-	-	-	-	-	-
a. Commission Expenses - First Year
b. Commission Expenses - Subsequent Years
c. Commission Expenses – Overriding
d. Other Acquisition Expenses
Total Acquisition Costs
Reinsurance Ujrah	-	-	-	-	-	-	-	-	-
Marketing Expenses	-	-	-	-	-	-	-	-	-
General & Administrative Expenses	-	-	-	-	-	-	-	-	-
Other Business Expenses	-	-	-	-	-	-	-	-	-
Total Business Expenses	-	-	-	-	-	-	-	-	-
DPLK Service Fees / Other Management Services	-	-	-	-	-	-	-	-	-
Operating Profit (Loss)	-	-	-	-	-	-	-	-	-
Other Non-Business Results (Expenses) Net	-	-	-	-	-	-	-	-	-
PROFIT (LOSS) BEFORE ZAKAT AND TAX	-	-	-	-	-	-	-	-	-
Zakat	-	-	-	-	-	-	-	-	-
PROFIT (LOSS) BEFORE TAX	-	-	-	-	-	-	-	-	-
Income Tax	-	-	-	-	-	-	-	-	-
PROFIT (LOSS) AFTER TAX	-	-	-	-	-	-	-	-	-
Other Comprehensive Income	-	-	-	-	-	-	-	-	-
TOTAL COMPREHENSIVE PROFIT (LOSS)	-	-	-	-	-	-	-	-	-

Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.

Narrative/descriptive explanation of the table above

Tabarru' Fund Underwriting Surplus Projection (in millions of rupiah)

DESCRIPTION	Actual Jan - Sept 20XX-1*	Projection Jan-Des 20XX-1*	Projection Year 1 Jan-Des 20XX-1*	Projection Jan-Des 20XX+1*	Projection Jan-Des 20XX+2*	Projection Jan-Mar 20XX*	Projection Jan-Jun 20XX*	Projection Jan - Sept 20XX*	Projection Jan-Des 20XX*
UNDERWRITING REVENUE
Participant Contributions	-	-	-	-	-	-	-	-	-
Reinsurance Contributions	-	-	-	-	-	-	-	-	-
Decrease (Increase) in Contribution Provisions and KYBMP	-	-	-	-	-	-	-	-	-
a. Decrease (Increase) in Contribution Provisions	-	-	-	-	-	-	-	-	-
b. Decrease (Increase) in KYBMP	-	-	-	-	-	-	-	-	-
Total Decrease (Increase) in Contribution Provisions and KYBMP	-	-	-	-	-	-	-	-	-
Total Net Contribution Revenue	-	-	-	-	-	-	-	-	-
Claim Expenses
a. Gross Claims	-	-	-	-	-	-	-	-	-
b. Reinsurance Claims Received	-	-	-	-	-	-	-	-	-
c. Increase (Decrease) in Claim Provisions	-	-	-	-	-	-	-	-	-
Total Claim Expenses	-	-	-	-	-	-	-	-	-
Underwriting Surplus (Deficit)	-	-	-	-	-	-	-	-	-

Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.

Narrative/descriptive explanation of the table above

Participant Investment Fund Change Projection (in millions of rupiah)

DESCRIPTION	Actual Jan – Sept 20XX-1*	Projection Jan-Des 20XX-1*	Projection Year 1 Jan-Des 20XX-1*	Projection Jan-Des 20XX+1*	Projection Jan-Des 20XX+2*	Projection Jan-Mar 20XX*	Projection Jan-Jun 20XX*	Projection Jan - Sept 20XX*	Projection Jan-Des 20XX*
PARTICIPANT INVESTMENT FUNDS
AT THE BEGINNING OF THE YEAR	-	-	-	-	-	-	-	-	-
Additions to Participant Investment Funds in the Current Period
a. Additions from Participant Contributions	-	-	-	-	-	-	-	-	-
b. Additions from Investment Results	-	-	-	-	-	-	-	-	-
Total Additions to Participant Investment Funds	-	-	-	-	-	-	-	-	-
Investment Management Costs and Ujrah	-	-	-	-	-	-	-	-	-
Withdrawals of Participant Investment Funds
a. Withdrawals of Participant Investment Funds that have matured	-	-	-	-	-	-	-	-	-
b. Withdrawals/Redemptions of Participant Investment Funds before maturity	-	-	-	-	-	-	-	-	-
Total Withdrawals of Participant Investment Funds	-	-	-	-	-	-	-	-	-
TOTAL PARTICIPANT INVESTMENT FUNDS AT THE END OF THE YEAR	-	-	-	-	-	-	-	-	-

Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.

Narrative/descriptive explanation of the table above

4.3 Cash Flow Projections
a. Cash Flow Projections for General Insurance Business / Reinsurance Business in Sharia Units Corporate Fund Cash Flow Projection (in millions of rupiah)

DESCRIPTION	Actual	Projection Jan - Sept 20XX*	Projection Jan-Dec 20XX*	Projection Jan-Mar 20XX*	Projection Jan-Jun 20XX*	Projection Jan - Sept 20XX*	Projection Jan-Dec 20XX*	Projection Year 1 Jan-Dec 20XX-1*	Projection Year 1 Jan-Dec 20XX+1*	Projection Year 2 Jan-Dec 20XX+2*
Beginning Cash and Bank Balance	-	-	-	-	-	-	-	-	-	-
CASH FLOWS FROM OPERATING ACTIVITIES
Cash Inflows
a. Ujrah received	-	-	-	-	-	-	-	-	-	-
b. Others	-	-	-	-	-	-	-	-	-	-
Total Cash Inflows	-	-	-	-	-	-	-	-	-	-
Cash Outflows
a. Commissions	-	-	-	-	-	-	-	-	-	-
b. Marketing expenses	-	-	-	-	-	-	-	-	-	-
c. Reinsurance ujrah payments	-	-	-	-	-	-	-	-	-	-
d. Rent payments	-	-	-	-	-	-	-	-	-	-
e. Zakat payments	-	-	-	-	-	-	-	-	-	-
f. Tax payments	-	-	-	-	-	-	-	-	-	-
g. Others	-	-	-	-	-	-	-	-	-	-
Total Cash Outflows	-	-	-	-	-	-	-	-	-	-
Net Cash Flows from Operating Activities	-	-	-	-	-	-	-	-	-	-
CASH FLOWS FROM INVESTING ACTIVITIES
Cash Inflows
a. Sharia unit investment returns received	-	-	-	-	-	-	-	-	-	-
b. Tabarru' fund surplus allocation received	-	-	-	-	-	-	-	-	-	-
c. Tabarru' fund investment profit sharing received	-	-	-	-	-	-	-	-	-	-
d. Investment withdrawals	-	-	-	-	-	-	-	-	-	-
e. Sale of fixed assets	-	-	-	-	-	-	-	-	-	-
f. Others	-	-	-	-	-	-	-	-	-	-
Total Cash Inflows	-	-	-	-	-	-	-	-	-	-
Cash Outflows
a. Investment placements	-	-	-	-	-	-	-	-	-	-
b. Purchase of fixed assets	-	-	-	-	-	-	-	-	-	-
c. Others	-	-	-	-	-	-	-	-	-	-
Total Cash Outflows	-	-	-	-	-	-	-	-	-	-
Net Cash Flows from Investing Activities	-	-	-	-	-	-	-	-	-	-
CASH FLOWS FROM FINANCING ACTIVITIES
Cash Inflows
a. Subordinated loans	-	-	-	-	-	-	-	-	-	-
b. Capital injections / working capital	-	-	-	-	-	-	-	-	-	-
c. Qardh received	-	-	-	-	-	-	-	-	-	-
d. Others	-	-	-	-	-	-	-	-	-	-
Total Cash Inflows	-	-	-	-	-	-	-	-	-	-
Cash Outflows
a. Subordinated loan repayments	-	-	-	-	-	-	-	-	-	-
b. Dividend payments	-	-	-	-	-	-	-	-	-	-
c. Qardh repayments	-	-	-	-	-	-	-	-	-	-
d. Others	-	-	-	-	-	-	-	-	-	-
Total Cash Outflows	-	-	-	-	-	-	-	-	-	-
Net Cash Flows from Financing Activities	-	-	-	-	-	-	-	-	-	-
ENDING CASH AND BANK BALANCE	-	-	-	-	-	-	-	-	-	-

Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.
Narrative/descriptive explanation of the table above

Tabarru' Fund Cash Flow Projection (in millions of rupiah)

DESCRIPTION	Actual	Projection Jan - Sept 20XX*	Projection Jan-Dec 20XX*	Projection Jan-Mar 20XX*	Projection Jan-Jun 20XX*	Projection Jan - Sept 20XX*	Projection Jan-Dec 20XX*	Projection Year 1 Jan-Dec 20XX-1*	Projection Year 1 Jan-Dec 20XX+1*	Projection Year 2 Jan-Dec 20XX+2*
Beginning Cash and Bank Balance	-	-	-	-	-	-	-	-	-	-
CASH FLOWS FROM OPERATING ACTIVITIES
Cash Inflows
a. Participant contributions	-	-	-	-	-	-	-	-	-	-
b. Reinsurance claims received	-	-	-	-	-	-	-	-	-	-
c. Reinsurance underwriting surplus distribution received	-	-	-	-	-	-	-	-	-	-
Total Cash Inflows	-	-	-	-	-	-	-	-	-	-
Cash Outflows
a. Insurance ujrah payments	-	-	-	-	-	-	-	-	-	-
b. Reinsurance contributions paid	-	-	-	-	-	-	-	-	-	-
c. Claims paid	-	-	-	-	-	-	-	-	-	-
d. Others	-	-	-	-	-	-	-	-	-	-
Total Cash Outflows	-	-	-	-	-	-	-	-	-	-
NET CASH FLOWS FROM OPERATING ACTIVITIES	-	-	-	-	-	-	-	-	-	-
CASH FLOWS FROM INVESTING ACTIVITIES
Cash Inflows
a. Tabarru' fund investment returns received	-	-	-	-	-	-	-	-	-	-
b. Tabarru' fund investment withdrawals	-	-	-	-	-	-	-	-	-	-
c. Sale of land and buildings	-	-	-	-	-	-	-	-	-	-
d. Others	-	-	-	-	-	-	-	-	-	-
Total Cash Inflows	-	-	-	-	-	-	-	-	-	-
Cash Outflows
a. Investment placements	-	-	-	-	-	-	-	-	-	-
b. Underwriting surplus distribution payment to Sharia units	-	-	-	-	-	-	-	-	-	-
c. Underwriting surplus distribution payment to participants	-	-	-	-	-	-	-	-	-	-
d. Tabarru' fund investment profit sharing payment to Sharia units	-	-	-	-	-	-	-	-	-	-
e. Others	-	-	-	-	-	-	-	-	-	-
Total Cash Outflows	-	-	-	-	-	-	-	-	-	-
NET CASH FLOWS FROM INVESTING ACTIVITIES	-	-	-	-	-	-	-	-	-	-
CASH FLOWS FROM FINANCING ACTIVITIES
Cash Inflows
a. Qardh	-	-	-	-	-	-	-	-	-	-
b. Others	-	-	-	-	-	-	-	-	-	-
Total Cash Inflows	-	-	-	-	-	-	-	-	-	-
Cash Outflows
a. Qardh repayments	-	-	-	-	-	-	-	-	-	-
b. Others	-	-	-	-	-	-	-	-	-	-
Total Cash Outflows	-	-	-	-	-	-	-	-	-	-
NET CASH FLOWS FROM FINANCING ACTIVITIES	-	-	-	-	-	-	-	-	-	-
ENDING CASH AND BANK BALANCE	-	-	-	-	-	-	-	-	-	-

Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.
Narrative/descriptive explanation of the table above

b. Cash Flow Projections for Life Insurance Business in Sharia Units Corporate Fund Cash Flow Projection (in millions of rupiah)

DESCRIPTION	Actual	Projection Jan - Sept 20XX*	Projection Jan-Dec 20XX*	Projection Jan-Mar 20XX*	Projection Jan-Jun 20XX*	Projection Jan - Sept 20XX*	Projection Jan-Dec 20XX*	Projection Year 1 Jan-Dec 20XX-1*	Projection Year 1 Jan-Dec 20XX+1*	Projection Year 2 Jan-Dec 20XX+2*
Beginning Cash and Bank Balance	-	-	-	-	-	-	-	-	-	-
CASH FLOWS FROM OPERATING ACTIVITIES
Cash Inflows
a. Ujrah received	-	-	-	-	-	-	-	-	-	-
b. Others	-	-	-	-	-	-	-	-	-	-
Total Cash Inflows	-	-	-	-	-	-	-	-	-	-
Cash Outflows
a. Commissions	-	-	-	-	-	-	-	-	-	-
b. Marketing expenses	-	-	-	-	-	-	-	-	-	-
c. Reinsurance ujrah payments	-	-	-	-	-	-	-	-	-	-
d. Rent payments	-	-	-	-	-	-	-	-	-	-
e. Zakat payments	-	-	-	-	-	-	-	-	-	-
f. Tax payments	-	-	-	-	-	-	-	-	-	-
g. Others	-	-	-	-	-	-	-	-	-	-
Total Cash Outflows	-	-	-	-	-	-	-	-	-	-
Net Cash Flows from Operating Activities	-	-	-	-	-	-	-	-	-	-
CASH FLOWS FROM INVESTING ACTIVITIES
Cash Inflows
a. Sharia unit investment returns received	-	-	-	-	-	-	-	-	-	-
b. Tabarru' fund surplus allocation received	-	-	-	-	-	-	-	-	-	-
c. Tabarru' fund investment profit sharing received	-	-	-	-	-	-	-	-	-	-
d. Investment withdrawals	-	-	-	-	-	-	-	-	-	-
e. Sale of fixed assets	-	-	-	-	-	-	-	-	-	-
f. Others	-	-	-	-	-	-	-	-	-	-
Total Cash Inflows	-	-	-	-	-	-	-	-	-	-
Cash Outflows
a. Investment placements	-	-	-	-	-	-	-	-	-	-
b. Purchase of fixed assets	-	-	-	-	-	-	-	-	-	-
c. Others	-	-	-	-	-	-	-	-	-	-
Total Cash Outflows	-	-	-	-	-	-	-	-	-	-
Net Cash Flows from Investing Activities	-	-	-	-	-	-	-	-	-	-
CASH FLOWS FROM FINANCING ACTIVITIES
Cash Inflows
a. Subordinated loans	-	-	-	-	-	-	-	-	-	-
b. Capital injections / working capital	-	-	-	-	-	-	-	-	-	-
c. Qardh received	-	-	-	-	-	-	-	-	-	-
d. Others	-	-	-	-	-	-	-	-	-	-
Total Cash Inflows	-	-	-	-	-	-	-	-	-	-
Cash Outflows
a. Subordinated loan repayments	-	-	-	-	-	-	-	-	-	-
b. Dividend payments	-	-	-	-	-	-	-	-	-	-
c. Qardh repayments	-	-	-	-	-	-	-	-	-	-
d. Others	-	-	-	-	-	-	-	-	-	-
Total Cash Outflows	-	-	-	-	-	-	-	-	-	-
Net Cash Flows from Financing Activities	-	-	-	-	-	-	-	-	-	-
ENDING CASH AND BANK BALANCE	-	-	-	-	-	-	-	-	-	-

Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.
Narrative/descriptive explanation of the table above

Tabarru' Fund Cash Flow Projection (in millions of rupiah)

DESCRIPTION	Actual	Projection Jan - Sept 20XX*	Projection Jan-Dec 20XX*	Projection Jan-Mar 20XX*	Projection Jan-Jun 20XX*	Projection Jan - Sept 20XX*	Projection Jan-Dec 20XX*	Projection Year 1 Jan-Dec 20XX-1*	Projection Year 1 Jan-Dec 20XX+1*	Projection Year 2 Jan-Dec 20XX+2*
Beginning Cash and Bank Balance	-	-	-	-	-	-	-	-	-	-
CASH FLOWS FROM OPERATING ACTIVITIES
Cash Inflows
a. Participant contributions	-	-	-	-	-	-	-	-	-	-
b. Reinsurance claims received	-	-	-	-	-	-	-	-	-	-
c. Reinsurance underwriting surplus distribution received	-	-	-	-	-	-	-	-	-	-
Total Cash Inflows	-	-	-	-	-	-	-	-	-	-
Cash Outflows
a. Insurance ujrah payments	-	-	-	-	-	-	-	-	-	-
b. Reinsurance contributions paid	-	-	-	-	-	-	-	-	-	-
c. Claims paid	-	-	-	-	-	-	-	-	-	-
d. Others	-	-	-	-	-	-	-	-	-	-
Total Cash Outflows	-	-	-	-	-	-	-	-	-	-
NET CASH FLOWS FROM OPERATING ACTIVITIES	-	-	-	-	-	-	-	-	-	-
CASH FLOWS FROM INVESTING ACTIVITIES
Cash Inflows
a. Tabarru' fund investment returns received	-	-	-	-	-	-	-	-	-	-
b. Tabarru' fund investment withdrawals	-	-	-	-	-	-	-	-	-	-
c. Sale of land and buildings	-	-	-	-	-	-	-	-	-	-
d. Others	-	-	-	-	-	-	-	-	-	-
Total Cash Inflows	-	-	-	-	-	-	-	-	-	-
Cash Outflows
a. Investment placements	-	-	-	-	-	-	-	-	-	-
b. Underwriting surplus distribution payment to Sharia units	-	-	-	-	-	-	-	-	-	-
c. Underwriting surplus distribution payment to participants	-	-	-	-	-	-	-	-	-	-
d. Tabarru' fund investment profit sharing payment to Sharia units	-	-	-	-	-	-	-	-	-	-
e. Others	-	-	-	-	-	-	-	-	-	-
Total Cash Outflows	-	-	-	-	-	-	-	-	-	-
NET CASH FLOWS FROM INVESTING ACTIVITIES	-	-	-	-	-	-	-	-	-	-
CASH FLOWS FROM FINANCING ACTIVITIES
Cash Inflows
a. Qardh	-	-	-	-	-	-	-	-	-	-
b. Others	-	-	-	-	-	-	-	-	-	-
Total Cash Inflows	-	-	-	-	-	-	-	-	-	-
Cash Outflows
a. Qardh repayments	-	-	-	-	-	-	-	-	-	-
b. Others	-	-	-	-	-	-	-	-	-	-
Total Cash Outflows	-	-	-	-	-	-	-	-	-	-
NET CASH FLOWS FROM FINANCING ACTIVITIES	-	-	-	-	-	-	-	-	-	-
ENDING CASH AND BANK BALANCE	-	-	-	-	-	-	-	-	-	-

Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.

DESCRIPTION	Actual	Projection per 30 Sept 20XX*	Projection per 31 Dec 20XX*	Projection per 31 Mar 20XX*	Projection per 30 Jun 20XX*	Projection per 30 Sept 20XX*	Projection per 31 Dec 20XX*	Projection Year 1 per 31 Dec 20XX-1*	Projection Year 1 per 31 Dec 20XX+1*	Projection Year 2 per 31 Dec 20XX+2*
I. TABARRU' FUND
A. SOLVENCY LEVEL RATIO
Tabarru' Fund Solvency Level
Permitted Assets	-	-	-	-	-	-	-	-	-	-
Liabilities	-	-	-	-	-	-	-	-	-	-
Total Solvency Level (a)	-	-	-	-	-	-	-	-	-	-
Total Funds Required to Anticipate Risk (b)	-	-	-	-	-	-	-	-	-	-
Solvency Achievement Ratio (a÷b)	-	-	-	-	-	-	-	-	-	-
B. FINANCIAL HEALTH RATIOS OTHER THAN SOLVENCY
i. Liquidity Ratio
a. Current Assets	-	-	-	-	-	-	-	-	-	-
b. Current Liabilities	-	-	-	-	-	-	-	-	-	-
c. Ratio (a ÷ b)	-	-	-	-	-	-	-	-	-	-
ii. Investment Sufficiency Ratio
a. Investments + Cash & Bank (See SAP Balance Sheet)	-	-	-	-	-	-	-	-	-	-
b. Own Retention Technical Provisions	-	-	-	-	-	-	-	-	-	-
c. Own Retention Claim Payables + Other Payables to Participants	-	-	-	-	-	-	-	-	-	-
d. Ratio (a ÷ (b + c))	-	-	-	-	-	-	-	-	-	-
iii. Investment Return vs Net Contribution Income Ratio
a. Investment Returns	-	-	-	-	-	-	-	-	-	-
b. Net Contribution Income	-	-	-	-	-	-	-	-	-	-
c. Ratio (a ÷ b)	-	-	-	-	-	-	-	-	-	-
iv. Net Claim Expense vs Net Contribution Income Ratio	-	-	-	-	-	-	-	-	-	-
II. CORPORATE FUND
i. Qardh Available Wealth Ratio
a. Wealth Available for Qardh	-	-	-	-	-	-	-	-	-	-
b. Wealth Required to be Provided for Qardh	-	-	-	-	-	-	-	-	-	-
c. Qardh Available Wealth Ratio (a ÷ b)	-	-	-	-	-	-	-	-	-	-
ii. Corporate Fund Solvency Ratio
a. Corporate Fund Solvency	-	-	-	-	-	-	-	-	-	-
b. The Larger Amount Between Wealth Required to be Provided for Qardh or Required Own Capital	-	-	-	-	-	-	-	-	-	-
c. Corporate Fund Solvency Ratio (a ÷ b)	-	-	-	-	-	-	-	-	-	-

Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.
If there are accounts that must be filled from accumulation calculations, e.g., from the income statement, they must be filled with the accumulated value. Narrative/descriptive explanation of the table above

b. Ratio Projections and Other Specific Items for Life Insurance Business in Sharia Units (in millions of rupiah) (ratios in percentage)

DESCRIPTION	Actual	Projection per 30 Sept 20XX*	Projection per 31 Dec 20XX*	Projection per 31 Mar 20XX*	Projection per 30 Jun 20XX*	Projection per 30 Sept 20XX*	Projection per 31 Dec 20XX*	Projection Year 1 per 31 Dec 20XX-1*	Projection Year 1 per 31 Dec 20XX+1*	Projection Year 2 per 31 Dec 20XX+2*
I. TABARRU' FUND
i. SOLVENCY LEVEL RATIO
1. Tabarru' Fund Solvency Level
a. Permitted Assets	-	-	-	-	-	-	-	-	-	-
b. Liabilities	-	-	-	-	-	-	-	-	-	-
c. Total Solvency Level (a-b)	-	-	-	-	-	-	-	-	-	-
d. Total Funds Required to Anticipate Risk	-	-	-	-	-	-	-	-	-	-
e. Solvency Achievement Ratio (c÷d)	-	-	-	-	-	-	-	-	-	-
ii. FINANCIAL HEALTH RATIOS OTHER THAN SOLVENCY
1. Liquidity Ratio
a. Current Assets	-	-	-	-	-	-	-	-	-	-
b. Current Liabilities	-	-	-	-	-	-	-	-	-	-
c. Ratio (a ÷ b)	-	-	-	-	-	-	-	-	-	-
2. Investment Sufficiency Ratio
a. Investments + Cash & Bank (See SAP Balance Sheet)	-	-	-	-	-	-	-	-	-	-
b. Own Retention Technical Provisions	-	-	-	-	-	-	-	-	-	-
c. Own Retention Claim Payables + Other Payables to Participants	-	-	-	-	-	-	-	-	-	-
d. Ratio (a ÷ (b + c))	-	-	-	-	-	-	-	-	-	-
3. Investment Return vs Net Contribution Income Ratio
a. Investment Returns	-	-	-	-	-	-	-	-	-	-
b. Net Contribution Income	-	-	-	-	-	-	-	-	-	-
c. Ratio (a ÷ b)	-	-	-	-	-	-	-	-	-	-
4. Net Claim Expense vs Net Contribution Income Ratio	-	-	-	-	-	-	-	-	-	-
II. CORPORATE FUND
i. Qardh Available Wealth Ratio
a. Wealth Available for Qardh	-	-	-	-	-	-	-	-	-	-
b. Wealth Required to be Provided for Qardh	-	-	-	-	-	-	-	-	-	-
Qardh Available Wealth Ratio (a ÷ b)	-	-	-	-	-	-	-	-	-	-
ii. Sharia Unit Fund Solvency Ratio
a. Corporate Fund Solvency	-	-	-	-	-	-	-	-	-	-
b. The Larger Amount Between Wealth Required to be Provided for Qardh or Required Own Capital	-	-	-	-	-	-	-	-	-	-
Corporate Fund Solvency Ratio (a ÷ b)	-	-	-	-	-	-	-	-	-	-

Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.
If there are accounts that must be filled from accumulation calculations, e.g., from the income statement, they must be filled with the accumulated value. Narrative/descriptive explanation of the table above

No. Assumption	Actual	Projection Jan - Sept 20XX*	Projection Jan-Dec 20XX*	Projection Year 1 Jan-Dec 20XX-1*	Projection Year 1 Jan-Dec 20XX+1*	Projection Year 2 Jan-Dec 20XX+2*	Projection Jan-Mar 20XX*	Projection Jan-Jun 20XX*	Projection Jan - Sept 20XX*	Projection Jan-Dec 20XX*
ACTUAL DATA
1 Rupiah exchange rate	4
2 Inflation rate	5
3 Catastrophic losses (in rupiah)	6
4 Investment return rate	7
5 New coverage amount (in premium rupiah)	8
6 Policy lapse rate (policies lapsed / total policies at start of period)	9
7 Claim rate (gross claims / gross premiums)	8
8 etc. (other relevant assumptions)
OPTIMISTIC ASSUMPTION
1 Rupiah exchange rate
2 Inflation rate
3 Catastrophic losses
4 Investment return rate
5 New coverage amount (in premium rupiah)
6 Policy lapse rate
7 Claim rate
8 etc. (other relevant assumptions)
NORMAL ASSUMPTION
1 Rupiah exchange rate
2 Inflation rate
3 Catastrophic losses
4 Investment return rate
5 New coverage amount (in premium rupiah)
6 Policy lapse rate
7 Claim rate
8 etc. (other relevant assumptions)
PESSIMISTIC ASSUMPTION
1 Rupiah exchange rate
2 Inflation rate
3 Catastrophic losses
4 Investment return rate
5 New coverage premium amount
6 Policy lapse rate
7 Claim rate
8 etc. (other relevant assumptions)

Note:
1 Columns or rows colored gray are not filled.
2 If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc. If quarterly assumptions are not available, annual assumptions can be used. 4 The reported BI exchange rate value is the BI mid-rate on the date of the quarterly report, e.g., for the quarterly report for January - March, the exchange rate used is the BI rate on March 31. 5 Inflation rate per month, data can be obtained from data issued by BPS. 6 Data can be obtained from claims and claim reserves. 7 Guidelines for calculating the investment return rate are explained based on SAK calculations. 8 The projection is adjusted to the amount of new coverage added during that period. 9 Policy lapse rate = policies lapsed / total policies at start of period. 10 For numbers 1, 2, and 7, use Jan-Sept period data (accumulated).

CHAPTER V
SHARIA UNIT PLAN

5.1. Capital Plan
The capital plan must at least include plans for capital changes, including plans for capital additions from existing shareholders or new shareholders, plans for capital additions through the capital market, and other capital addition plans. Sharia units can use the table format below if they do not have a standard format. The example table below applies to Sharia insurance units / Sharia reinsurance units, and can be modified as needed. (in millions of rupiah)

DESCRIPTION	Actual per 30 Sept 20XX*	Projection per 31 Dec 20XX*	Projection Year 1 per 31 Dec 20XX-1*	Projection Year 1 per 31 Dec 20XX+1*	Projection Year 2 per 31 Dec 20XX+2*	Projection per 31 Mar 20XX*	Projection per 30 Jun 20XX*	Projection per 30 Sept 20XX*	Projection per 31 Dec 20XX*
CAPITAL POSITION
Shareholders
1. --------------- (filled with nominal)
2. ---------------
3. ---------------
4. ---------------
Total Paid-up Capital
IPO (Initial Public Offering) - Go Public	-
Issuance of new shares
Others (such as subordinated loans)
SHARIA UNIT WORKING CAPITAL POSITION

Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.
Narrative/descriptive explanation of the table above

5.2. Investment Plan
Describe the annual investment plan for corporate funds, Tabarru' funds, and participant investment funds, at least including:
a. plans for the composition of investment types; b. estimated investment return rates for each type of investment; and
c. considerations underlying the planned composition of investment types.

5.3. Reinsurance Plan
Describe the reinsurance plan, at least including:
a. details of maximum own retention for each risk or event after reinsurance is placed, according to business class/business line; b. details of the main reinsurer including name, address, and country of origin of the reinsurer;
c. description of own retention including proportional automatic reinsurance support and/or non-proportional automatic reinsurance support; and
d. significant proportion of the program underwritten by one reinsurer or reinsurers affiliated with one insurance business group, additional information about the reasons for selecting the said reinsurer, including details of guarantees provided and financial health.

5.4 Plan for Product Development and Insurance Product Marketing for Insurance Companies or Plan for Reinsurance Program Development for Reinsurance Companies
a. Sharia Insurance Product Development Plan in Sharia units must at least contain:
i. business lines to be developed for the next 1 (one) year;
ii. Sharia product development study considering the following data:

community needs or demand for similar Sharia insurance products;
marketing trends of similar Sharia insurance products by other insurance companies;
availability of company resources to market similar Sharia insurance products;
risk and loss profiles suitable for the Sharia insurance product to be marketed and the target market segment;
cost profiles suitable for the Sharia product to be marketed;
current performance of the Sharia unit's investment portfolio;
investment portfolio suitable for the Sharia insurance product to be marketed;
capital adequacy; and
risks that may arise for the Sharia unit and their mitigation.

iii. plan for issuing new Sharia insurance products
Only for Sharia insurance products that have never been issued before by the Sharia unit.

No. New Product Name	Business Line	Type of Coverage	Risks Covered	Benefits Guaranteed	Coverage Period	Marketing Method	Target Market	Plan for Issuance or Implementation Date	Purpose/Benefit for Policyholders	Risks Arising for Sharia Unit	etc.
1	2	3

1 If already determined, fill in with individual, group, or individual and group separately. 2 Type of coverage, fill in with more detail. 3 Explanation/Description.

b. Insurance Product Marketing Plan must at least contain:
i. distribution channels used and cooperation with third parties;
ii. cooperation with third parties.

No. Third Party Name	Affiliation/non-affiliation	Business Field	Product Name	General Description of Product	Model/Form/Type of Cooperation	Cooperation Period	Marketing
etc.

c. Reinsurance Program Development Plan for Sharia Reinsurance Units must at least contain:
i. business lines to be developed for the next 1 (one) year;
ii. reinsurance program development study considering the following data:

needs or demand of other companies for similar reinsurance programs;
marketing trends of similar reinsurance programs by other Reinsurance Companies;
availability of Sharia reinsurance unit resources to market similar reinsurance programs;
risk and loss profiles suitable for the reinsurance program to be marketed and the target market segment;
cost profiles suitable for the reinsurance program to be marketed;
current performance of the Sharia unit's investment portfolio;
investment portfolio suitable for the reinsurance program to be marketed;
capital adequacy; and
risks that may arise for the Sharia unit and their mitigation.

d. Human Resource Development Plan Related to Sharia Insurance Product Development Describe the human resource development plan related to the Sharia product development plan.

5.5 Organizational and Human Resource Development Plan
The organizational and human resource development plan must at least include:
i. an organizational development plan containing plans for the formation/change of work units and/or committees adjusted to the size and complexity of the Sharia business unit;
ii. an HR development plan containing:

plans for HR quantity requirements;
plans for HR education and training requirements and education/training cost/budget plans in accordance with applicable regulations;
iii. a plan for the utilization of foreign labor and outsourcing that includes plans for the use of labor outside permanent labor, both foreign and local, including the number and fields of assignment.
Note:
For point i, the format is free. If the Sharia business unit does not yet have a format for points ii and iii, the Sharia business unit can use the format as attached below.

HR REQUIREMENT PLAN
No
Total
HR as of Sept 30
20XX-1*
HR
Number per Job Level
Recruitment to be Implemented as of Dec 31 20XX-1* as of Mar 31 20XX* as of Jun 30 20XX* as of Sept 30 20XX* as of Dec 31 20XX* as of Dec 31 20XX+1* as of Dec 31 20XX+2*

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.

No
Training Material
Training Method
Training 2
Estimated
Time
Training 3
Duration
Training 4
Place
Name
Speaker/
Institution
Training
Total Participants
Number
Participants per Job Level
Training Cost

HR EDUCATION REQUIREMENT PLAN
AND COST/BUDGET AND TRAINING
EDUCATION AND TRAINING
1 e.g.: risk management, marketing, etc... filled with in-house training or out-house 2 training filled with the month of training implementation, e.g.: month 3 March 2015 4 filled with the duration of training, e.g.: 3 days

FOREIGN LABOR UTILIZATION PLAN 1
No
Field of Assignment and Position
Number
Name of Foreign Worker
Nationality of Foreign Worker
Tenure
Name
Companion
Staff
Knowledge Transfer
Program
Position
Scope of Work/Job Description
Start Date
End Date
1 Commissioner
2 Board of Directors
Office Management
Branch Office Management
Office Management
Outside Branch Office
Expert/Consultant Staff
Other Positions 2
Reasons for using Foreign Workers and reasons for not/not yet using Indonesian Workers: ..................................................
a...............................................................................................................................................................................................

No
Field of Assignment and Position
Number
Name of Foreign Worker
Nationality of Foreign Worker
Tenure
Name
Companion
Staff
Knowledge Transfer
Program
Position
Scope of Work/Job Description
Start Date
End Date
b ...............................................................................................................................................................................................
and so on ...............................................................................................................................................................................................
1 filled with NIHIL if the Sharia business unit does not have a plan for utilizing Foreign Workers if any in accordance with OJK approval

PLAN FOR TERMINATION OF UTILIZATION OF FOREIGN WORKERS CURRENTLY HOLDING/WORKING AT THE SHARIA UNIT 1 PT.XYZ No. Foreign Worker Tenure Knowledge Transfer Program Final Result Knowledge Transfer Program 2 Name Nationality Position Field of Assignment/ Job Description Start Date End Date

No.
Foreign Worker
Tenure
Knowledge Transfer
Program
Final Result
Knowledge Transfer
Program
Name
Nationality
Position
Field of Assignment/
Job Description
Start Date
End Date
Reasons for terminating the utilization of Foreign Workers
a..................................................................................................................................................................
b .................................................................................................................................................................
and so on...............................................................................................................................................................
Note:
1 filled with NIHIL if the Sharia business unit does not have a plan for terminating Foreign Workers. 2 filled with:

the position or job description will be filled/continued by another foreign worker.
the position or job description can already be filled by an Indonesian citizen.
other relevant reasons

5.6 Information Technology System Development Plan
The information technology system development plan must at least meet the following requirements:

can provide current and accurate information regarding the insurance portfolio as well as risk and loss profiles;
can support reporting to the Financial Services Authority;

Plans for the development and/or change of office networks must at least include plans for the opening and merging of offices outside the head office of the Sharia business unit.

PLAN FOR DEVELOPMENT AND/OR CHANGE OF OFFICE NETWORK No TYPE OF OFFICE TIME IMPLEMENTATION 1 ESTIMATED INVESTMENT/COST LOCATION 2 NOTE 3 A. OFFICE OPENING Offices that have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims Offices that do not have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims B. STATUS CHANGE Offices that have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims Offices that do not have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims

No
TYPE OF OFFICE
TIME
IMPLEMENTATION 1
ESTIMATED
INVESTMENT/COST
LOCATION 2
NOTE 3
C.
MERGER
Offices that have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims a. Between offices that have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims b. Between offices that do not have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims and so on D. ADDRESS TRANSFER

No
TYPE OF OFFICE
TIME
IMPLEMENTATION 1
ESTIMATED
INVESTMENT/COST
LOCATION 2
NOTE 3
E.
CLOSURE
Note:
1 Filled with the month of the planned implementation time. 2 For locations in the DKI Jakarta region, at least mention the name of the province of DKI Jakarta. For locations outside the DKI Jakarta region, at least include the name of the Regency/City. 3 - Detailed notes can be attached in a separate sheet

Specifically for offices that have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims, the expert personnel who will fill the office must be informed

5.8 Other Information
Other information must at least include information that needs to be submitted because it affects the business activities of the Sharia business unit, which is not mentioned in the scope of the Business Plan above. Examples:

merger, acquisition, and consolidation plans;
insurance portfolio transfer plans;
plans to change the insurance business field;
plans to change conventional business activities not based on Sharia principles to be based on Sharia principles.

Determined in Jakarta on December 9, 2014 EXECUTIVE HEAD OF INSURANCE SUPERVISOR, PENSION FUNDS, FINANCING INSTITUTIONS, AND OTHER FINANCIAL SERVICE INSTITUTIONS FINANCIAL SERVICES AUTHORITY, Signed. FIRDAUS DJAELANI Copy in accordance with the original Legal Director 1 Legal Department, Signed. Signed. Tini Kustini

APPENDIX VII
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 15/SEOJK.05/2014 REGARDING CORPORATE PLAN AND BUSINESS PLAN OF INSURANCE COMPANIES, SHARIA INSURANCE COMPANIES, REINSURANCE COMPANIES, AND SHARIA REINSURANCE COMPANIES

BUSINESS PLAN
SHARIA GENERAL INSURANCE COMPANY/
SHARIA REINSURANCE COMPANY/ SHARIA
LIFE INSURANCE COMPANY 1
Year .............................. 2
PT. XYZ
2 Business Plan Period reported, e.g., year 2015 – 2017

Company Name :
Full Address :
Telephone and Fax :
Email :
Taxpayer Identification Number (NPWP) :
License No. & Date :
Shareholders :
Share Ownership
Name of Shareholder
Rupiah
Percentage
Board of Directors and Commissioners:
Sharia Supervisory Board (DPS) :
Name of DPS Position
Business Plan PIC (1 person)
,
PT. XYZ
Total

Board of Directors

TABLE OF CONTENTS
Page
Company Profile
Table of Contents
Executive Summary
CHAPTER I MANAGEMENT POLICY AND STRATEGY
1.1 Analysis of Company Position in Business Competition
1.2 Management Policy
1.3 Risk Management and Compliance Policy
1.4 Business Development Strategy
1.5 HR Development Strategy
CHAPTER II APPLICATION OF RISK MANAGEMENT AND COMPLIANCE
2.1 Application of Risk Management
2.2 Application of Good Corporate Governance
2.3 Application of Compliance
CHAPTER III CURRENT COMPANY PERFORMANCE
3.1 Contribution
3.2 Investment Results
3.3 Profit and Capital
CHAPTER IV FINANCIAL STATEMENT PROJECTIONS AND ASSUMPTIONS USED
4.1 Financial Position Projections
4.2 Comprehensive Profit/Loss Projections
4.3 Cash Flow Projections
4.4 Ratio Projections
4.5 Assumptions Used
CHAPTER V SHARIA INSURANCE COMPANY/SHARIA
REINSURANCE COMPANY PLAN
5.1 Capital Plan
5.2 Investment Plan
5.3 Reinsurance Plan
5.4 Product Development and Product Marketing Plan
5.5 Organizational and Human Resource Development Plan
5.6 Information Technology System Development Plan

e 5.7 Office Network Development and/or Change Plan
5.8 Other Information

EXECUTIVE SUMMARY
The executive summary must at least include:
a. vision, mission, and strategic values (corporate value) and company organizational structure; b. company policy direction containing information regarding the direction and policy of business development to be carried out by the company in the short term 1 (one) year ahead and the medium term 3 (three) years ahead;
c. key financial indicators including company performance as of the end of September in the year of Business Plan preparation and projections of capital, solvency ratio, investment adequacy ratio, and other financial ratios as well as risk level assessment, specifically asset and liability risk, insurance risk, and operational risk; and
d. short-term activity targets of the company for the next 1 (one) year and medium-term activity targets of the company for the next 3 (three) years.

1.3 Risk Management and Compliance Policy
Risk management and compliance policy containing information regarding steps in implementing risk management prepared based on evaluation of the company's risk profile and improvement efforts to be taken as well as explanation regarding policy in carrying out the compliance function.
1.4 Business Development Strategy
Business development strategy containing information on strategic steps to achieve the company's established business goals, including explanation regarding organizational and information technology development strategy, and strategy to anticipate changes in external conditions.

1.5 HR Development Strategy
Human resource development strategy and remuneration policy which must at least contain information regarding general policy regulating the provision of salaries, allowances, incentives, and other financial facilities to members of the Board of Commissioners, members of the Board of Directors, and employees, including to the Sharia Supervisory Board for companies that fully conduct business activities based on Sharia principles.

CHAPTER II
APPLICATION OF RISK MANAGEMENT AND COMPLIANCE
2.1 Application of Risk Management
Application of risk management, including risk profile assessment for all risks identified by the company.
2.2 Application of Good Corporate Governance
Briefly describe the application of good corporate governance principles as regulated in the POJK Regarding Good Corporate Governance for Insurance Companies.
2.3 Application of Compliance with Sharia Principles
Explain the application of compliance with Sharia principles in the company.

CHAPTER III
CURRENT COMPANY PERFORMANCE
3.1 Contribution
Describe the contribution of the current Sharia company both qualitatively and quantitatively.
3.2 Investment Results
Describe the investment results obtained by the company currently both qualitatively and quantitatively.
3.3 Profit and Capital
Describe the profit and capital of the company currently both qualitatively and quantitatively.

CHAPTER IV
FINANCIAL STATEMENT PROJECTIONS AND ASSUMPTIONS USED
4.1 Financial Position Projections (Not Consolidated)
Fill in the format below and describe the content of the table below narratively/descriptively. a. Financial Position Projections for Sharia General Insurance Business/ Sharia Reinsurance Business Financial Position Projections Company Fund (in millions of Rupiah) DESCRIPTION Actual as of Sept 30 20XX-1* Projection as of Dec 31 20XX-1* Projection Year 1 Projection as of Dec 31 20XX+1* as of Dec 31 20XX+2* as of Mar 31 20XX* as of Jun 30 20XX* as of Sept 30 20XX * as of Dec 31 20XX * ASSETS Investment Assets Deposits - - - - - - - - Sharia Stocks - - - - - - - - Sharia Sukuk or Bonds - - - - - - - - Sharia Securities State - - - - - - - - Sharia Securities issued by Bank Indonesia

Sharia Securities issued by other than the Republic of Indonesia

Sharia Mutual Funds - - - - - - - -
Sharia Asset-Backed Securities - - - - - - - - Financing through collaboration with other parties Sharia.

Pure Gold - - - - - - - -
Direct Participation - - - - - - - -
Buildings with strata rights or land with buildings for investment

Other Investments - - - - - - - -
Total Investment Assets - - - - - - - -
Non-Investment Assets -
Cash and Bank - - - - - - - -
Investment Receivables - - - - - - - -
Investment Result Receivables - - - - - - - - Ujrah Receivables to Participants - - - - - - - - Surplus Allocation Receivables Tabarru' Fund - - - - - - - - Profit Sharing Receivables Investment Management Tabarru' Fund

Computer Hardware - - - - - - - -
Other Fixed Assets - - - - - - - -
Other Assets - - - - - - - -
Total Non-Investment Assets - - - - - - - - TOTAL ASSETS - - - - - - - - LIABILITIES AND EQUITY Liabilities Commission Payables - - - - - - - - Reinsurance Ujrah Payables - - - - - - - - Tax Payables - - - - - - - - Accrued Expenses - - - - - - - - Zakat Payables - - - - - - - - Other Payables - - - - - - - - Total Liabilities - - - - - - - -

DESCRIPTION
Actual as of Sept 30
20XX-1*
Projection as of Dec 31
20XX-1*
Projection
Year 1
Projection as of Dec 31
20XX+1* as of Dec 31
20XX+2* as of Mar 31
20XX* as of Jun 30
20XX* as of Sept 30
20XX * as of Dec 31
20XX *
Subordinated Loans - - - - - - - -
Company Equity
Paid-up Capital - - - - - - - -
Share Premium - - - - - - - -
Reserves - - - - - - - -
Increase (Decrease) in Securities - - - - - - - - Difference in Valuation of Fixed Assets - - - - - - - - Retained Earnings - - - - - - - - Total Company Equity - - - - - - - - TOTAL LIABILITIES AND EQUITY COMPANY

description of the table above narratively/descriptively Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.

Financial Position Projections Tabarru' Fund (in millions of Rupiah) DESCRIPTION Actual as of Sept 30 20XX-1* Projection as of Dec 31 20XX-1* Projection Year 1 Projection as of Dec 31 20XX+1* as of Dec 31 20XX+2* as of Mar 31 20XX* as of Jun 30 20XX* as of Sept 30 20XX * as of Dec 31 20XX * n ASSETS H n 1M 1M n 1M Investment Assets n ITI ITI n ITI Deposits - - - - - - - - Sharia Stocks - - - - - - - - Sharia Sukuk or Bonds - - - - - - - - Sharia Securities State

Sharia Securities issued by Bank
Indonesia

Sharia Securities issued by other than
NKRI

Sharia Securities issued by
Multinational Institutions

Sharia Mutual Funds - - - - - - - -
Sharia Asset-Backed Securities - - - - - - - - Financing through collaboration with other parties.

Pure Gold - - - - - - - -
Other Investments - - - - - - - -
Total Investments - - - - - - - -

DESCRIPTION
Actual as of Sept 30
20XX-1*
Projection as of Dec 31
20XX-1*
Projection
Year 1
Projection as of Dec 31
20XX+1* as of Dec 31
20XX+2* as of Mar 31
20XX* as of Jun 30
20XX* as of Sept 30
20XX * as of Dec 31
20XX *
Non-Investment Assets - - - - - - -
Cash and Bank - - - - - - - -
Contribution Receivables - -
Reinsurance Receivables - - - - - - - -
Investment Receivables - - - - - - - -
Investment Result Receivables - - - - - - - - Other Assets - - - - - - - - Total Non-Investment Assets - - - - - - - - Total Assets - - - - - - - - LIABILITIES AND TABARRU' FUND EQUITY 7 O,, 558 ’ Liabilities Payables Claim Payables - - - - - - - - Reinsurance Payables - - - - - - - - Ujrah Payables to Company - - - - - - - - Surplus Allocation Payables to Policyholders - - - - - - - - Surplus Allocation Payables to Company - - - - - - - - Profit Sharing Payables Tabarru' Fund Investment to - - - - - - - -

Technical Provisions - - - - - - -
Contribution Provisions - - - - - - - -
Provisions for Contributions
Not Yet Income (PKYBMP)

Claim Provisions - - - - - - - -
Total Technical Provisions - - - - - - - - Qardh - Total Liabilities - - - - - - - - Tabarru' Fund Equity Accumulated Tabarru' Funds - - - - - - - - Increase (Decrease) in Securities - - - - - - - - Difference in Valuation Based on SAK & SAP - - - - - - - - Disallowed Assets - - - - - - - - Total Tabarru' Fund Equity NDEDLLX - - - - - - - - TOTAL LIABILITIES - - - - - - - -

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.

b. Financial Position Projections for Sharia Life Insurance Business Financial Position Projections Company Fund (in millions of Rupiah) DESCRIPTION Actual as of Sept 30 20XX-1* Projection as of Dec 31 20XX-1* Projection Year 1 Projection as of Dec 31 20XX+1* as of Dec 31 20XX+2* as of Mar 31 20XX* as of Jun 30 20XX* as of Sept 30 20XX * as of Dec 31 20XX * ASSETS Investment Assets Deposits - - - - - - - - Sharia Stocks - - - - - - - - Sharia Sukuk or Bonds - - - - - - - - Sharia Securities State - - - - - - - - Sharia Securities issued by Bank Indonesia

Sharia Securities issued by other than the Republic of Indonesia

Sharia Securities issued by multinational institutions

Sharia Mutual Funds - - - - - - - -
Sharia Asset-Backed Securities - - - - - - - - Financing through collaboration with other parties - - - - - - - -

DESCRIPTION
Actual as of Sept 30
20XX-1*
Projection as of Dec 31
20XX-1*
Projection
Year 1
Projection as of Dec 31
20XX+1* as of Dec 31
20XX+2* as of Mar 31
20XX* as of Jun 30
20XX* as of Sept 30
20XX * as of Dec 31
20XX *
Sharia.
Pure Gold - - - - - - - -
Direct Participation - - - - - - - -
Buildings with strata rights or land with buildings for investment

Qardh Receivables - - - - - - - -
Buildings with strata rights or land with buildings for own use

Computer Hardware - - - - - - - -

DESCRIPTION
Actual as of Sept 30
20XX-1*
Projection as of Dec 31
20XX-1*
Projection
Year 1
Projection as of Dec 31
20XX+1* as of Dec 31
20XX+2* as of Mar 31
20XX* as of Jun 30
20XX* as of Sept 30
20XX * as of Dec 31
20XX *
Other Fixed Assets - - - - - - - -
Other Assets - - - - - - - -
Total Non-Investment Assets - - - - - - - - TOTAL ASSETS - - - - - - - - LIABILITIES AND EQUITY Liabilities Commission Payables - - - - - - - - Reinsurance Ujrah Payables - - - - - - - - Tax Payables - - - - - - - - Accrued Expenses - - - - - - - - Zakat Payables - - - - - - - - Other Payables - - - - - - - - Total Liabilities - - - - - - - - Subordinated Loans - - - - - - - - Company Equity Paid-up Capital - - - - - - - - Share Premium - - - - - - - - Reserves - - - - - - - - Increase (Decrease) in Securities - - - - - - - -

DESCRIPTION
Actual as of Sept 30
20XX-1*
Projection as of Dec 31
20XX-1*
Projection
Year 1
Projection as of Dec 31
20XX+1* as of Dec 31
20XX+2* as of Mar 31
20XX* as of Jun 30
20XX* as of Sept 30
20XX * as of Dec 31
20XX *
Difference in Valuation of Fixed
Assets - - - - - - - -
Retained Earnings - - - - - - - -
Total Company Equity - - - - - - - -
TOTAL LIABILITIES
AND EQUITY
COMPANY

description of the table above narratively/descriptively Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.

Sharia Securities issued by Bank
Indonesia

Sharia Securities issued by other than
NKRI

Sharia Securities issued by
Multinational Institutions

Sharia Mutual Funds - - - - - - - -
Sharia Asset-Backed Securities - - - - - - - - Financing through collaboration with other parties.

Pure Gold - - - - - - - -
Other Investments - - - - - - - -
Total Investments - - - - - - - -

DESCRIPTION
Actual as of 30 Sept
20XX-1*
Projection as of 31 Dec
20XX-1*
Projection
Year 1
Projection as of 31 Dec
20XX+1*
Projection as of 31 Dec
20XX+2*
Projection as of 31 Mar
20XX*
Projection as of 30 Jun
20XX*
Projection as of 30 Sept
20XX*
Projection as of 31 Dec
20XX*
Non-Investment Assets - - - - - - -
Cash and Bank - - - - - - - -
Contributions Receivable - -
Reinsurance Receivable - - - - - - - -
Investment Receivable - - - - - - - -
Investment Income Receivable - - - - - - - - Other Assets - - - - - - - - Total Non-Investment Assets - - - - - - - - Total Assets - - - - - - - - LIABILITIES AND TABARRU FUND EQUITY 7 O,, 558 ’ Liabilities Debts Claims Payable - - - - - - - - Reinsurance Payable - - - - - - - - Ujrah Payable to Company - - - - - - - - Surplus Allocation Payable to Policyholders - - - - - - - - Surplus Allocation Payable to Company - - - - - - - - Investment Profit Sharing Payable for Tabarru Fund - - - - - - - -

Technical Provisions - - - - - - -
Contribution Provisions - - - - - - - -
Provisions for Contributions
Not Yet Recognized as Income
(PKYBMP)

Claims Provisions - - - - - - - -
Total Technical Provisions - - - - - - - - Qardh - Total Liabilities - - - - - - - - Tabarru Fund Equity DEDLLU’ Accumulated Tabarru Fund - - - - - - - - Increase (Decrease) in Securities - - - - - - - - Valuation Difference Based on SAK & SAP - - - - - - - - Non-Permitted Assets - - - - - - - - Total Tabarru Fund Equity DEDLLX - - - - - - - - TOTAL LIABILITIES - - - - - - - -

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.

Projection of Participant Investment Fund Financial Position (in millions of rupiah) DESCRIPTION Actual as of 30 Sept 20XX-1* Projection as of 31 Dec 20XX-1* Projection Year 1 Projection as of 31 Dec 20XX+1* Projection as of 31 Dec 20XX+2* Projection as of 31 Mar 20XX* Projection as of 30 Jun 20XX* Projection as of 30 Sept 20XX* Projection as of 31 Dec 20XX* ASSETS Investment Assets Deposits - - - - - - - - Sharia Stocks - - - - - - - - Sharia Sukuk or Bonds - - - - - - - - Sharia Government Securities - - - - - - - - Sharia Securities Issued by Bank Indonesia

Sharia Securities Issued by
Other Than NKRI

Sharia Securities Issued by
Multinational Institutions

Sharia Mutual Funds - - - - - - - -
Sharia Asset-Backed Securities - - - - - - - - Financing Through Cooperation with Other Parties.

Pure Gold - - - - - - - -
Other Investments - - - - - - - -

DESCRIPTION
Actual as of 30 Sept
20XX-1*
Projection as of 31 Dec
20XX-1*
Projection
Year 1
Projection as of 31 Dec
20XX+1*
Projection as of 31 Dec
20XX+2*
Projection as of 31 Mar
20XX*
Projection as of 30 Jun
20XX*
Projection as of 30 Sept
20XX*
Projection as of 31 Dec
20XX*
Total Investments - - - - - - - -
Non-Investment Assets
Cash and Bank - - - - - - - -
Investment Receivable - -
Investment Income Receivable - - - - - - - - Other Assets - - - - - - - - Total Non-Investment Assets - - - - - - - - TOTAL ASSETS - - - - - - - - LIABILITIES Ujrah/Fee Payable for Fund Management - - - - - - - - Investment Profit Sharing Payable - - - - - - - - Investment Fund Withdrawal Payable - - - - - - - - Accumulated Participant Investment Fund - - - - - - - - TOTAL LIABILITIES - - - - - - - - Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.

narrative/descriptive explanation of the table above
4.2 Comprehensive Income/Loss Projection (For Periods Ending On)
Fill in the format below and provide a narrative/descriptive explanation of the contents of the table below. a. Comprehensive Income/Loss Projection for Sharia General Insurance Business/Sharia Reinsurance Business Projection of Comprehensive Income/Loss for Corporate Fund (in millions of rupiah) DESCRIPTION Actual Projection Jan - Sept Jan-Dec Year 1 Jan-Dec 20XX+1* Jan-Dec 20XX-1* Jan-Dec 20XX-1* 20XX+2* Jan-Mar 20XX* Jan-Jun 20XX* Jan - Sept 20XX* Jan-Dec 20XX* INCOME Ujrah Received a. Ujrah for risk management - - - - - - - - b. Ujrah for management of tabarru fund investment - - - - - - - - Total Ujrah Received - - - - - - - - Commission Received - - - - - - - - Profit Sharing for Tabarru Fund Investment Management - - - - - - - -

DESCRIPTION
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1* Jan-Dec
20XX-1* 20XX+2* Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX* tabarru
Tabarru Fund Underwriting Surplus
Allocation - - - - - - - -
Company Investment Management
Results - - - - - - - -
Other Business Income - - - - - - - -
Total Income - - - - - - - -

BUSINESS EXPENSES -
Commissions Paid - - - - - - - -
Reinsurance Ujrah - - - - - - - -
Marketing Expenses - - - - - - - -
General & Administrative Expenses - - - - - - - - Other Business Expenses - - - - - - - - Total Business Expenses - - - - - - - - Operating Profit (Loss) - - - - - - - - Non-Business Other Income (Expense) Net - - - - - - - - PROFIT (LOSS) BEFORE ZAKAT AND TAX - - - - - - - - Zakat - - - - - - - - PROFIT (LOSS) BEFORE TAX - - - - - - - - Income Tax - - - - - - - - PROFIT (LOSS) AFTER TAX - - - - - - - -

DESCRIPTION
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1* Jan-Dec
20XX-1* 20XX+2* Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX*
Other Comprehensive Income - - - - - - - - TOTAL COMPREHENSIVE INCOME (LOSS) - - - - - - - - Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.
narrative/descriptive explanation of the table above

Projection of Tabarru Fund Underwriting Surplus (in millions of rupiah) DESCRIPTION Actual Projection Jan - Sept Jan-Dec Year 1 Jan-Dec 20XX+1* Jan-Dec 20XX-1* Jan-Dec 20XX-1* 20XX+2* Jan-Mar 20XX* Jan-Jun 20XX* Jan - Sept 20XX* Jan-Dec 20XX* UNDERWRITING INCOME Contributions from Participants Reinsurance Contributions - - - - - - - - Decrease (Increase) in Provisions for Contributions and KYBMP - - - - - - - - a. Decrease (Increase) in Provisions for Contributions - - - - - - - - b. Decrease (Increase) in KYBMP - - - - - - - - Total Decrease (Increase) in Provisions for Contributions and KYBMP - - - - - - - - Total Net Contribution Income - - - - - - - - Claims Expenses a. Gross Claims - - - - - - - - b. Reinsurance Claims Received - - - - - - - -
c. Increase (Decrease) in
Claims Provisions - - - - - - - -
Total Claims Expenses - - - - - - - -
Adjuster Costs - - - - - - - -
Underwriting Surplus (Deficit) - - - - - - - - Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.

narrative/descriptive explanation of the table above b. Comprehensive Income/Loss Projection for Sharia Life Insurance Business Projection of Comprehensive Income/Loss for Corporate Fund (in millions of rupiah) DESCRIPTION Actual Projection Jan - Sept Jan-Dec Year 1 Jan-Dec 20XX+1* Jan-Dec 20XX-1* Jan-Dec 20XX-1* 20XX+2* Jan-Mar 20XX* Jan-Jun 20XX* Jan - Sept 20XX* Jan-Dec 20XX* INCOME Ujrah Received a. Ujrah for risk management - - - - - - - - b. Ujrah for management of tabarru fund investment - - - - - - - -
c. Ujrah for management of
participant investment fund - - - - - - - - Total Ujrah Received - - - - - - - - Commission Received - - - - - - - - Profit Sharing for Tabarru Fund Investment Management - - - - - - - - Profit Sharing for Participant Investment Fund Management

DESCRIPTION
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1* Jan-Dec
20XX-1* 20XX+2* Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX*
Tabarru Fund Underwriting Surplus
Allocation - - - - - - - -
Company Investment Management
Results - - - - - - - -
Other Business Income - - - - - - - -
TOTAL INCOME - - - - - - - -

BUSINESS EXPENSES -
Acquisition Costs - - - - - - - - a. Commission Expense - First Year b. Commission Expense - Renewal Year
c. Commission Expense - Overriding
d. Other Acquisition Expenses
Total Acquisition Costs
Reinsurance Ujrah - - - - - - - -
Marketing Expenses - - - - - - - -
General & Administrative Expenses - - - - - - - - Other Business Expenses - - - - - - - - Total Business Expenses - - - - - - - - DPLK Service Remuneration/Other Management Services - - - - - - - - Operating Profit (Loss) - - - - - - - - Non-Business Other Income (Expense) Net - - - - - - - -

DESCRIPTION
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1* Jan-Dec
20XX-1* 20XX+2* Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX*
PROFIT (LOSS) BEFORE ZAKAT
AND TAX - - - - - - - -
Zakat - - - - - - - -
PROFIT (LOSS) BEFORE TAX - - - - - - - - Income Tax - - - - - - - - PROFIT (LOSS) AFTER TAX - - - - - - - - Other Comprehensive Income - - - - - - - - TOTAL COMPREHENSIVE INCOME (LOSS) - - - - - - - - Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.
narrative/descriptive explanation of the table above

Projection of Tabarru Fund Underwriting Surplus (in millions of rupiah) DESCRIPTION Actual Projection Jan - Sept Jan-Dec Year 1 Jan-Dec 20XX+1* Jan-Dec 20XX-1* Jan-Dec 20XX-1* 20XX+2* Jan-Mar 20XX* Jan-Jun 20XX* Jan - Sept 20XX* Jan-Dec 20XX* UNDERWRITING INCOME Contributions from Participants - - - - - - - - Reinsurance Contributions - - - - - - - - Decrease (Increase) in Provisions for Contributions and KYBMP - - - - - - - - a. Decrease (Increase) in Provisions for Contributions - - - - - - - - b. Decrease (Increase) in KYBMP - - - - - - - - Total Decrease (Increase) in Provisions for Contributions and KYBMP - - - - - - - - Total Net Contribution Income - - - - - - - - Claims Expenses a. Gross Claims - - - - - - - - b. Reinsurance Claims Received - - - - - - - -
c. Increase (Decrease) in
Claims Provisions - - - - - - - -
Total Claims Expenses - - - - - - - -
Underwriting Surplus (Deficit) - - - - - - - - Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.

narrative/descriptive explanation of the table above Projection of Changes in Participant Investment Fund (in millions of rupiah) Description Actual Projection Jan – Sept Jan-Dec Year 1 Jan-Dec 20XX+1* Jan-Dec 20XX-1* Jan-Dec 20XX-1* 20XX+2* Jan-Mar 20XX* Jan-Jun 20XX* Jan - Sept 20XX* Jan-Dec 20XX* PARTICIPANT INVESTMENT FUND AT THE BEGINNING OF THE YEAR

Additions to Participant Investment Fund for the Current Period a. Additions from Participant Contributions

b. Additions from Investment
Results

Total Additions to Participant
Investment Fund

Investment Management Costs and Ujrah

Participant Investment Fund Withdrawals a. Withdrawal of Participant Investment Fund that has Matured - - - - - - - -

Description
Actual Projection
Jan – Sept Jan-Dec Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1* Jan-Dec
20XX-1* 20XX+2* Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX* b. Withdrawal/Redemption of Participant Investment Fund before Maturity

Total Participant Investment Fund
Withdrawals

TOTAL PARTICIPANT INVESTMENT FUND
AT THE END OF THE YEAR

Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.
narrative/descriptive explanation of the table above

4.3 Cash Flow Projection
a. Cash Flow Projection for Sharia General Insurance Business/Sharia Reinsurance Business Projection of Corporate Fund Cash Flow (in millions of rupiah) DESCRIPTION Actual Projection Jan - Sept Jan-Dec Year 1 Jan-Dec 20XX+1* Jan-Dec 20XX-1* Jan-Dec 20XX-1* 20XX+2* Jan-Mar 20XX* Jan-Jun 20XX* Jan - Sept 20XX* Jan-Dec 20XX* Beginning Cash and Bank Balance - - - - - - - - CASH FLOWS FROM OPERATING ACTIVITIES Cash Inflows a. Ujrah Received - - - - - - - - b. Others - - - - - - - - Total Cash Inflows - - - - - - - - Cash Outflows a. Commission - - - - - - - - b. Marketing Expenses - - - - - - - -
c. Reinsurance Ujrah Payment - - - - - - - -
d. Rent Payment - - - - - - - - e. Zakat Payment - - - - - - - - f. Tax Payment - - - - - - - - g. Others - - - - - - - - Total Cash Outflows - - - - - - - - Net Cash Flows from Operating Activities - - - - - - - - CASH FLOWS FROM INVESTING ACTIVITIES Cash Inflows a. Company Investment Income Received - - - - - - - -

DESCRIPTION
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1* Jan-Dec
20XX-1* 20XX+2* Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX* b. Tabarru Fund Surplus Allocation Received - - - - - - - -
c. Tabarru Fund Investment Profit Sharing
Received - - - - - - - - d. Investment Liquidation - - - - - - - - e. Sale of Fixed Assets - - - - - - - - f. Others - - - - - - - - Total Cash Inflows - - - - - - - - Cash Outflows a. Investment Placement - - - - - - - - b. Purchase of Fixed Assets - - - - - - - -
c. Others - - - - - - - -
Total Cash Outflows - - - - - - - -
Net Cash Flows from Investing
Activities - - - - - - - -
CASH FLOWS FROM FINANCING ACTIVITIES
Cash Inflows a. Subordinated Loans - - - - - - - - b. Capital/Working Capital Deposits - - - - - - - -
c. Qardh Received - - - - - - - -
d. Others - - - - - - - -
Total Cash Inflows - - - - - - - -
Cash Outflows a. Subordinated Loan Repayment - - - - - - - - b. Dividend Payment - - - - - - - -

DESCRIPTION
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1* Jan-Dec
20XX-1* 20XX+2* Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX*
c. Qardh - - - - - - - -
d. Others - - - - - - - -
Total Cash Outflows - - - - - - - -
Net Cash Flows from Financing
Activities -
ENDING CASH AND BANK BALANCE
Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.
narrative/descriptive explanation of the table above

Projection of Tabarru Fund Cash Flow (in millions of rupiah) DESCRIPTION Actual Projection Jan - Sept Jan-Dec Year 1 Jan-Dec 20XX+1* Jan-Dec 20XX-1* Jan-Dec 20XX-1* 20XX+2* Jan-Mar 20XX* Jan-Jun 20XX* Jan - Sept 20XX* Jan-Dec 20XX* BEGINNING CASH AND BANK BALANCE - - - - - - - - CASH FLOWS FROM OPERATING ACTIVITIES Cash Inflows a. Contributions from Participants - - - - - - - - b. Reinsurance Claims Received - - - - - - - -
c. Reinsurance Underwriting Surplus
Distribution Received - - - - - - - -
Total Cash Inflows
Cash Outflows - - - - - - - - a. Insurance Ujrah Payment - - - - - - - - b. Reinsurance Contributions Paid - - - - - - - -
c. Claims Paid - - - - - - - -
d. Others - - - - - - - -
Total Cash Outflows - - - - - - - -
NET CASH FLOWS FROM
OPERATING ACTIVITIES - - - - - - - -
CASH FLOWS FROM INVESTING ACTIVITIES
Cash Inflows a. Tabarru Fund Investment Income Received - - - - - - - - b. Tabarru Fund Investment Liquidation - - - - - - - -
c. Sale of Land and Buildings - - - - - - - -
d. Others - - - - - - - -
Total Cash Inflows - - - - - - - -

DESCRIPTION
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1* Jan-Dec
20XX-1* 20XX+2* Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX*
Cash Outflows a. Investment Placement - - - - - - - - b. Payment of Underwriting Surplus Distribution to Company - - - - - - - -
c. Payment of Underwriting Surplus
Distribution to Participants - - - - - - - - d. Payment of Profit Sharing for Tabarru Fund Investment to Company

e. Others - - - - - - - -
Total Cash Outflows - - - - - - - -
NET CASH FLOWS FROM
INVESTING ACTIVITIES - - - - - - - -
CASH FLOWS FROM FINANCING ACTIVITIES
Cash Inflows a. Qardh - - - - - - - - b. Others - - - - - - - - Total Cash Inflows - - - - - - - - Cash Outflows a. Qardh Repayment - - - - - - - - b. Others - - - - - - - - Total Cash Outflows - - - - - - - - NET CASH FLOWS FROM FINANCING ACTIVITIES - - - - - - - - ENDING CASH AND BANK BALANCE - - - - - - - - Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.

narrative/descriptive explanation of the table above b. Cash Flow Projection for Sharia Life Insurance Business Projection of Corporate Fund Cash Flow (in millions of rupiah) DESCRIPTION Actual Projection Jan - Sept Jan-Dec Year 1 Jan-Dec 20XX+1* Jan-Dec 20XX-1* Jan-Dec 20XX-1* 20XX+2* Jan-Mar 20XX* Jan-Jun 20XX* Jan - Sept 20XX* Jan-Dec 20XX* Beginning Cash and Bank Balance - - - - - - - - CASH FLOWS FROM OPERATING ACTIVITIES Cash Inflows a. Ujrah Received - - - - - - - - b. Others - - - - - - - - Total Cash Inflows - - - - - - - - Cash Outflows a. Commission - - - - - - - - b. Marketing Expenses - - - - - - - -
c. Reinsurance Ujrah Payment - - - - - - - -

DESCRIPTION
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1* Jan-Dec
20XX-1* 20XX+2* Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX* d. Rent Payment - - - - - - - - e. Zakat Payment - - - - - - - - f. Tax Payment - - - - - - - - g. Others - - - - - - - - Total Cash Outflows - - - - - - - - Net Cash Flows from Operating Activities - - - - - - - - CASH FLOWS FROM INVESTING ACTIVITIES Cash Inflows a. Company Investment Income Received - - - - - - - - b. Tabarru Fund Surplus Allocation Received - - - - - - - -
c. Tabarru Fund Investment Profit Sharing
Received - - - - - - - - d. Investment Liquidation - - - - - - - - e. Sale of Fixed Assets - - - - - - - - f. Others - - - - - - - - Total Cash Inflows - - - - - - - - Cash Outflows a. Investment Placement - - - - - - - - b. Purchase of Fixed Assets - - - - - - - -
c. Others - - - - - - - -
Total Cash Outflows - - - - - - - -
Net Cash Flows from Investing
Activities - - - - - - - -

DESCRIPTION
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1* Jan-Dec
20XX-1* 20XX+2* Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX*
CASH FLOWS FROM FINANCING ACTIVITIES
Cash Inflows a. Subordinated Loans - - - - - - - - b. Capital/Working Capital Deposits - - - - - - - -
c. Qardh Received - - - - - - - -
d. Others - - - - - - - -
Total Cash Inflows - - - - - - - -
Cash Outflows a. Subordinated Loan Repayment - - - - - - - - b. Dividend Payment - - - - - - - -
c. Qardh - - - - - - - -
d. Others - - - - - - - -
Total Cash Outflows - - - - - - - -
Net Cash Flows from Financing
Activities -
ENDING CASH AND BANK BALANCE
Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.
narrative/descriptive explanation of the table above

e. Others - - - - - - - -
Total Cash Outflows - - - - - - - -
NET CASH FLOWS FROM
INVESTING ACTIVITIES - - - - - - - -
CASH FLOWS FROM FINANCING ACTIVITIES
Cash Inflows a. Qardh - - - - - - - - b. Others - - - - - - - - Total Cash Inflows - - - - - - - - Cash Outflows a. Qardh Repayment - - - - - - - - b. Others - - - - - - - - Total Cash Outflows - - - - - - - - NET CASH FLOWS FROM FINANCING ACTIVITIES - - - - - - - - ENDING CASH AND BANK BALANCE - - - - - - - - Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.

4.4 Ratio Projections
Ratio projections must at least contain projections of core financial ratios and other specific items that can provide information for assessing capital conditions, solvency, liquidity, investment, and liabilities. a. Ratio Projections and Other Specific Items for Sharia General Insurance Business/Sharia Reinsurance Business (in millions of rupiah) (ratios in percentage) DESCRIPTION Actual Projection Projection as of 30 Sept as of 31 Dec Year 1 as of 31 Dec 20XX+1* as of 31 Dec 20XX+2* 20XX-1* 20XX-1* as of 31 Mar 20XX* as of 30 Jun 20XX* as of 30 Sept 20XX* as of 31 Dec 20XX*
I. TABARRU FUND
A. SOLVENCY LEVEL RATIOS
Tabarru Fund Solvency Level
Permitted Assets - - - - - - - -
Liabilities - - - - - - - -
Total Solvency Level (a) - - - - - - - - Total Funds Required for Risk Anticipation (b) - - - - - - - - Solvency Achievement Ratio (a÷b) - - - - - - - - B. FINANCIAL HEALTH RATIOS OTHER THAN SOLVENCY
i. Liquidity Ratio
a. Current Assets - - - - - - - - b. Current Liabilities - - - - - - - -
c. Ratio (a ÷ b) - - - - - - - -

DESCRIPTION
Actual Projection Projection as of 30 Sept as of 31 Dec Year 1 as of 31 Dec 20XX+1* as of 31 Dec 20XX+2* 20XX-1* 20XX-1* as of 31 Mar 20XX* as of 30 Jun 20XX* as of 30 Sept 20XX* as of 31 Dec 20XX*
ii. Investment Adequacy Ratio
a. Investments + Cash & Bank (See
SAP Balance Sheet) - - - - - - - - b. Retained Technical Provisions - - - - - - - -
c. Retained Claims Payable +
Other Payables to Participants - - - - - - - - d. Ratio (a ÷ (b + c)) - - - - - - - -
iii. Investment Income to Net
Contribution Income Ratio a. Investment Income - - - - - - - - b. Net Contribution Income - - - - - - - -
c. Ratio (a ÷ b) - - - - - - - -
iv. Net Claims Expense to Net
Contribution Income Ratio - - - - - - - -
II. CORPORATE FUND
i. Qardh Available Wealth Ratio
a. Wealth Available for
Qardh - - - - - - - - b. Wealth Required to be Provided for Qardh - - - - - - - -
c. Qardh Available Wealth Ratio (a ÷ b) - - - - - - -

ii. Corporate Fund Solvency Ratio
a. Corporate Fund Solvency - - - - - - - - b. The Largest Amount Between Wealth Required to be Provided for Qardh or Own Capital - - - - - - - -

DESCRIPTION
Actual Projection Projection as of 30 Sept as of 31 Dec Year 1 as of 31 Dec 20XX+1* as of 31 Dec 20XX+2* 20XX-1* 20XX-1* as of 31 Mar 20XX* as of 30 Jun 20XX* as of 30 Sept 20XX* as of 31 Dec 20XX* Required
c. Company Fund Solvency Ratio
(a ÷ b) - - - - - - - -
Note:
*If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc. If there are accounts that must be filled from cumulative calculations, e.g., from the income statement, they must be filled with cumulative values. narrative/descriptive explanation of the table above

b. Projection of Ratios -Ratios and Other Specific Items For Sharia Life Insurance Business (in millions of rupiah) (ratio in percentage) DESCRIPTION Actual Projection Projection as of 30 Sept as of 31 Dec Year 1 as of 31 Dec 20XX+1* as of 31 Dec 20XX+2* 20XX-1* 20XX-1* as of 31 Mar 20XX* as of 30 Jun 20XX* as of 30 Sept 20XX* as of 31 Dec 20XX*
I. 111$ 1$ 17 $ °/$ 5 5 8 ’
i. SOLVENCY LEVEL RATIO

Company Fund Solvency Level
7 MUu’ a. Permitted Assets - - - - - - - - b. Liabilities - - - - - - - -
c. Total Solvency Level
(a-b)

d. Total Funds Required to Anticipate Risks

e. Solvency Achievement Ratio
(c÷d)

ii. FINANCIAL HEALTH LEVEL RATIO OTHER
THAN SOLVENCY

Liquidity Ratio
a. Current Assets - - - - - - - - b. Current Liabilities - - - - - - - -
c. Ratio (a ÷ b) - - - - - - - -
Investment Adequacy Ratio

DESCRIPTION
Actual Projection Projection as of 30 Sept as of 31 Dec Year 1 as of 31 Dec 20XX+1* as of 31 Dec 20XX+2* 20XX-1* 20XX-1* as of 31 Mar 20XX* as of 30 Jun 20XX* as of 30 Sept 20XX* as of 31 Dec 20XX* a. Investments + Cash & Bank (See SAP Balance Sheet) - - - - - - - - b. Technical Provisions for Own Retention - - - - - - - -
c. Own Retention Claim Payables +
Other Payables to Participants - - - - - - - - d. Ratio (a ÷ (b + c)) - - - - - - - -
3. Ratio of Investment Returns to
Net Contribution Income a. Investment Returns - - - - - - - - b. Net Contribution Income - - - - - - - -
c. Ratio (a ÷ b) - - - - - - - -
4. Ratio of Net Claim Expenses to
Net Contribution Income - - - - - - - -
II. COMPANY FUNDS
i. Ratio of Wealth Available for
Qardh a. Wealth Available for
Qardh - - - - - - - - b. Wealth Required to be Provided for Qardh - - - - - - - - Ratio of Wealth Available for Qardh (a ÷ b) - - - - - - - -
ii. Company Fund Solvency Ratio
a. Company Fund Solvency - - - - - - - - b. The Largest Amount Between Wealth Required to be Provided for Qardh or Own Capital - - - - - - - -

DESCRIPTION
Actual Projection Projection as of 30 Sept as of 31 Dec Year 1 as of 31 Dec 20XX+1* as of 31 Dec 20XX+2* 20XX-1* 20XX-1* as of 31 Mar 20XX* as of 30 Jun 20XX* as of 30 Sept 20XX* as of 31 Dec 20XX* Required Company Fund Solvency Ratio (a ÷ b) - - - - - - - - Note:
*If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc. If there are accounts that must be filled from cumulative calculations, e.g., from the income statement, they must be filled with cumulative values. narrative/descriptive explanation of the table above

4.4 Assumptions Used
Assumptions using optimistic, normal, and pessimistic assumptions. These assumptions include both micro and macro assumptions. The example table below applies to Sharia general insurance companies/Sharia life insurance companies/Sharia reinsurance companies. (in millions of rupiah) No. Assumption Actual Projection Jan - Sept Jan-Dec Year 1 Jan-Dec 20XX+12 Jan-Dec 20XX+22 20XX-1 20XX-12 Jan-Mar 20XX 2 Jan-Jun 20XX 2 Jan - Sept 20XX 2 Jan-Dec 20XX 2 ACTUAL DATA 1 Rupiah exchange rate 4 2 Inflation rate 5 Catastrophic losses (in rupiah) 6 4 Investment return rate 7 Total new coverage (in contribution rupiah) 8 Policy lapse rate (policies lapsed/total policies at beginning of period) 9 Claim rate (gross claims/gross contributions) 8 etc. (other relevant assumptions) OPTIMISTIC ASSUMPTION 1 Rupiah exchange rate 2 Inflation rate 3 Catastrophic losses 4 Investment return rate Total new coverage (in contribution rupiah)

No. Assumption
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+12
Jan-Dec
20XX+22 20XX-1
20XX-12
Jan-Mar
20XX 2
Jan-Jun
20XX 2
Jan - Sept
20XX 2
Jan-Dec
20XX 2
6 Policy lapse rate
7 Claim rate
8 etc. (other relevant assumptions)
NORMAL
ASSUMPTION
1 Rupiah exchange rate
2 Inflation
3 Catastrophic losses
4 Investment return rate
Total new coverage
(in contribution rupiah)
Policy lapse rate (policies lapsed/total policies at beginning of period) 7 Claim rate 8 etc. (other relevant assumptions) PESSIMISTIC ASSUMPTION 1 Rupiah exchange rate 2 Inflation 3 Catastrophic losses 4 Investment return rate Total new coverage contributions 6 Policy lapse rate 7 Claim rate

No. Assumption
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+12
Jan-Dec
20XX+22 20XX-1
20XX-12
Jan-Mar
20XX 2
Jan-Jun
20XX 2
Jan - Sept
20XX 2
Jan-Dec
20XX 2
8 etc. (other relevant assumptions)
Note:
1 Grey columns or rows are not filled.
2 If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc. If quarterly assumptions are not available, annual assumptions can be used. 4 The reported BI exchange rate value is the BI mid-rate on the date of the quarterly report, e.g., for the quarterly report for January - March, the rate used is the BI rate on March 31. 5 Inflation rate per month, data can be obtained from data issued by BPS. 6 Data can be obtained from claims and claim reserves. 7 Guidelines for calculating investment return rates are explained based on SAK calculations. 8 Projections are adjusted to the increase in new coverage during that period. 9 Policy lapse rate = policies lapsed/total policies at beginning of period. 10 For figures 1, 2, and 7, use Jan-Sept period data (accumulated).

CHAPTER V
SHARIA INSURANCE COMPANY/SHARIA REINSURANCE COMPANY PLAN
5.1. Capital Plan
The capital plan must at least include plans for capital changes, including plans for capital additions from existing shareholders or new shareholders, plans for capital additions through the capital market, and other capital addition plans. Companies may use the table format below if they do not have a standard format. The example table below applies to Sharia general insurance companies/Sharia life insurance companies/Sharia reinsurance companies, and can be modified as needed. (in millions of rupiah) Description Actual Projection as of 30 Sept as of 31 Dec Year 1 as of 31 Dec 20XX+1 as of 31 Dec 20XX+2 20XX-1 20XX-1 as of 31 Mar 20XX as of 30 Jun 20XX as of 30 Sept 20XX as of 31 Dec 20XX CAPITAL POSITION Shareholders

(filled with nominal)
2. -------------
3. -------------
4. -------------
Total Paid-up Capital
IPO (Initial Public Offering) -
Go Public
Issuance of new shares
Others (such as subordinated loans)

Description
Actual Projection as of 30 Sept as of 31 Dec Year 1 as of 31 Dec 20XX+1 as of 31 Dec 20XX+2 20XX-1 20XX-1 as of 31 Mar 20XX as of 30 Jun 20XX as of 30 Sept 20XX as of 31 Dec 20XX SHARIA UNIT WORKING CAPITAL POSITION Note:

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.
narrative/descriptive explanation of the table above

5.2. Investment Plan Explain the annual investment plan for company funds, tabarru' funds, and participant investment funds at least including:
a. plan for the composition of investment types; b. estimated investment return rate for each type of investment; and
c. considerations underlying the plan for the composition of investment types.
5.3. Reinsurance Plan Explain the reinsurance plan at least including:
a. details of maximum own retention for each risk or event after reinsurance is placed, according to business class/business line; b. details of the main reinsurer including name, address, country of origin of the reinsurer;
c. description of own retention including proportional automatic reinsurance support and/or non-proportional automatic reinsurance support; and
d. significant proportion of the program covered by one reinsurer or a reinsurer affiliated with one insurance business group, additional information regarding the reasons for choosing the said reinsurer, including details of guarantees provided and financial health.

5.4 Plan for Product Development and Marketing of Insurance Products for Sharia Insurance Companies or Plan for Development of Reinsurance Coverage Programs for Sharia Reinsurance Companies
a. Sharia Insurance Product Development Plan for Sharia Insurance Companies which must at least contain:
i. business lines to be developed for the next 1 (one) year;
ii. study on Sharia product development considering the following data:

community needs or demand for similar Sharia insurance products;
marketing trends of similar Sharia insurance products by other Sharia insurance companies;
availability of company resources to market similar Sharia insurance products;
risk and loss profiles suitable for the Sharia insurance product to be marketed and the target market segment;
cost profiles suitable for the Sharia product to be marketed;
performance of current Sharia unit investment portfolio;
investment portfolio suitable for the Sharia insurance product to be marketed;
capitalization; and
risks that may arise for the company and their mitigation.

iii. plan for issuing new Sharia insurance products
No. Name
New Product 1
Business
Line
Type of
Coverage 2
Risks
Covered
Benefits
Provided
Coverage
Period
Marketing
Method
Target
Market
Plan Time for Issuance or
Implementation
Purpose/Benefit
Risks that may
Arise 3
For Sharia Unit For Policyholders etc
..
1 If
2 Type
Explanation/Description already established coverage, the filled with individual, more detailed collection can be attached or individual, sheets separately.

b. Sharia Insurance Product Marketing Plan must at least contain:
i. distribution channels used and cooperation with third parties
ii. cooperation with third parties
No. Name of Third Party Affiliation/non-affiliation Business Field Name of Product General Description Product Model/Form/Type Cooperation Duration Cooperation Marketing

No. Name of Third Party Affiliation/non-affiliation Business Field Name of Product General Description Product Model/Form/Type Cooperation Duration Cooperation Marketing etc..
c. Plan for Development of Reinsurance Coverage Programs for Sharia Reinsurance Companies which must at least contain:
i. business lines to be developed for the next 1 (one) year;
ii. study on development of reinsurance coverage programs considering the following data:

needs or demand of other companies for similar reinsurance coverage programs;
marketing trends of similar reinsurance coverage programs by other Sharia reinsurance companies;
availability of reinsurance company resources to market similar reinsurance coverage programs;
risk and loss profiles suitable for the reinsurance coverage program to be marketed and the target market segment;
cost profiles suitable for the reinsurance coverage program to be marketed;
current company investment portfolio performance;
investment portfolio suitable for the reinsurance coverage program to be marketed;
capitalization; and
risks that may arise for the company and their mitigation.

d. Human Resource Development Plan Related to the Development of Sharia Insurance Products Explain the human resource development plan related to the Sharia product development plan.

5.5 Organizational and Human Resource Development Plan
The organizational and human resource development plan must at least include:
i. organizational development plan containing plans for formation/change of work units and/or committees adjusted to the size and complexity of the company's business;
ii. human resource development plan containing:

plan for the number of human resources needed;
plan for human resource education and training needs and education/training cost/budget plans according to applicable regulations;
iii. plan for the utilization of foreign labor and outsourcing which includes plans for the use of labor outside permanent labor, both foreign and local labor, including the number and field of assignment.
Note:
For point i, the format is free. If the company does not yet have a format for points ii and iii, the Sharia unit can use the format attached below. HUMAN RESOURCE NEEDS PLAN No. Total number of HR as of 30 Sept 20XX-1* Number of HR per Job Level Recruitment to be Implemented as of 31 Dec 20XX-1* as of 31 Mar 20X X* as of 30 Jun 20X X* as of 30 Sept 20XX* as of 31 Dec 20XX* as of 31 Dec 20XX+1* as of 31 Dec 20XX+2*

If the business plan submission is for the years 2015 - 2017, then 20XX-1 is
the year 2014 (current year), 20XX is the year 2015, etc.

HUMAN RESOURCE EDUCATION AND TRAINING NEEDS PLAN AND EDUCATION/TRAINING COSTS/BUDGET No. Material Training 1 Method Training 2 Estimated Time Training 3 Duration Training 4 Place Name Speaker/ Institution Total Number of Participants Number of Participants per Job Level Training Cost 1 e.g.: risk management, marketing, etc... filled with in-house training or out-house 2 training filled with the month of training implementation, e.g.: month 3 March 2015 4 filled with the duration of training, e.g.: 3 days

PLAN FOR USE OF FOREIGN LABOR 1
No.
Field of Assignment and Position
Number Name of Foreign Worker Foreign Worker Citizenship Term of Office Name of Accompanying Staff Plan for Knowledge Transfer Position of Job Scope of Work/ Job Description Start Date End Date 1 Commissioners 2 Board of Directors Office Management Office Management Outside Office Branch Expert Personnel/ Consultant Other Positions 2
Reasons for using Foreign Workers and reasons for not/not yet using Indonesian Workers: ..................................................
a...............................................................................................................................................................................................

No.
Field of Assignment and Position
Number Name of Foreign Worker Foreign Worker Citizenship Term of Office Name of Accompanying Staff Plan for Knowledge Transfer Position of Job Scope of Work/ Job Description Start Date End Date
b ..............................................................................................................................................................................................
etc ............................................................................................................................................................................................
1 filled with NIHIL if the company has no plan to utilize Foreign Workers if any according to OJK approval PLAN FOR TERMINATION OF USE OF FOREIGN WORKERS CURRENTLY HOLDING/WORKING AT THE COMPANY 1 PT. XYZ No. Foreign Worker Term of Office Knowledge Transfer Program Final Result Knowledge Transfer Program 2 Name Citizenship Position Field of Assignment/ Job Description Start Date End Date

No.
Foreign Worker Term of Office
Knowledge Transfer
Program
Final Result
Knowledge Transfer
Program 2
Name Citizenship Position
Field of Assignment/
Job Description Start Date End Date
Reasons for termination of use of Foreign Workers A
a ..................................................................................................................................................................
b..................................................................................................................................................................
etc...............................................................................................................................................................
Note:
1 filled with NIHIL if the company has no plan to terminate Foreign Workers. 2 filled with:

position or job description will be filled/continued by another foreign worker.
position or job description can already be filled by an Indonesian citizen.
other relevant reasons

5.6 Information Technology System Development Plan
The information technology system development plan must at least meet the following requirements:

can provide current and accurate information regarding coverage portfolio and risk and loss profiles;
can support reporting to the Financial Services Authority;

Plan for development and/or change of office network must at least include plans for opening and merging offices outside the head office. PLAN FOR DEVELOPMENT AND/OR CHANGE OF OFFICE NETWORK No. TYPE OF OFFICE TIME OF IMPLEMENTATION 1 ESTIMATED INVESTMENT/COST LOCATION 2 NOTES 3 A. OFFICE OPENING Offices with authority to accept or reject insurance underwriting, sign policies, approve payment or rejection of claims Offices without authority to accept or reject insurance underwriting, sign policies, approve payment or rejection of claims B. STATUS CHANGE Offices with authority to accept or reject insurance underwriting, sign policies, approve payment or rejection of claims Offices without authority to accept or reject insurance underwriting, sign policies, approve payment or rejection of claims C. MERGER Offices with authority to accept or reject insurance underwriting, sign policies, approve payment or rejection of claims a. Between offices with authority to accept or reject insurance underwriting, sign policies, approve payment or rejection of claims

No. TYPE OF OFFICE TIME
OF IMPLEMENTATION 1
ESTIMATED
INVESTMENT/COST LOCATION 2 NOTES 3 sign policies, approve payment or rejection of claims b. Between offices without authority to accept or reject insurance underwriting, sign policies, approve payment or rejection of claims etc. D. ADDRESS TRANSFER E. CLOSURE Note:
1 Filled with the month of planned implementation time.
2 For locations in the DKI Jakarta region, at least mention the name of the DKI Jakarta province. For locations outside the DKI Jakarta region, at least include the name of the Regency/City. 3 - Detailed notes can be attached in a separate sheet

Specifically for offices with authority to accept or reject insurance underwriting, sign policies, approve payment or rejection of claims,
the expert personnel who will fill the office must be informed

merger, acquisition, and consolidation plans;
plan for transfer of coverage portfolio;
plan for change of insurance business field;
plan for change of business activities from non-Sharia principles to Sharia principles.
Determined in Jakarta on December 9, 2014 EXECUTIVE HEAD OF INSURANCE SUPERVISOR, PENSION FUND, FINANCING INSTITUTION, AND OTHER FINANCIAL SERVICES INSTITUTIONS FINANCIAL SERVICES AUTHORITY, Signed, FIRDAUS DJAELANI Copy matches the original Legal Director 1 Legal Department, Signed Signed Tini Kustini

APPENDIX VIII
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 15/SEOJK.05/2014 REGARDING CORPORATE PLAN AND BUSINESS PLAN OF INSURANCE COMPANIES, SHARIA INSURANCE COMPANIES, REINSURANCE COMPANIES, AND SHARIA REINSURANCE COMPANIES

BUSINESS PLAN REALIZATION REPORT AND
SUPERVISORY BOARD OVERSIGHT RESULTS REPORT FOR GENERAL INSURANCE COMPANY/LIFE INSURANCE COMPANY/ REINSURANCE COMPANY PT. XYZ
YEAR............................
1.1 Business Plan Realization Report
a. Explanation regarding the achievement of the Business Plan including focus and priority of Business Plan achievement and comparison between plan and realization. 1 b. Financial ratios and specific items

c. Explanation regarding deviations from the Business Plan realization, such as causes and
obstacles faced. d. Follow-up or efforts to be made to improve the achievement of Business Plan realization. Note:
1 Companies also need to explain the magnitude of realization related to financial projections and capital plans.

1.2 Realization Report of Development and/or Change of Office Network
No. OFFICE NAME HEAD OFFICE DATE OF REALIZATION LOCATION 1 NOTES 2 A. OPENING 1 Offices with authority to accept or reject insurance underwriting, sign policies, approve payment or rejection of claims 2 Offices without authority to accept or reject insurance underwriting, sign policies, approve payment or rejection of claims B. STATUS CHANGE 1 Offices with authority to accept or reject insurance underwriting, sign policies, approve payment or rejection of claims 2 Offices without authority to accept or reject insurance underwriting, sign policies, approve payment or rejection of claims

No. OFFICE NAME HEAD OFFICE DATE OF REALIZATION LOCATION 1 NOTES 2 or rejection of claims
C. MERGER
1 Offices with authority to accept or reject insurance underwriting, sign policies, approve payment or rejection of claims a. Between offices with authority to accept or reject insurance underwriting, sign policies, approve payment or rejection of claims b. Between offices without authority to accept or reject insurance underwriting, sign policies, approve payment or rejection of claims etc.

No. OFFICE NAME HEAD OFFICE DATE OF REALIZATION LOCATION 1 NOTES 2 D. ADDRESS TRANSFER D. CLOSURE 1 Must mention the full address of the location 2 Detailed notes can be attached in a separate sheet

1.3 Realization Report on the Use of Foreign Labor (TKA) and Knowledge Transfer to Accompanying Staff
No.
Foreign Worker Accompanying Staff Education/ Training for Accompanying Staff by Foreign Worker Evaluation Result of Foreign Worker on Accompanying Staff Name Position Field of Assignment Name Position Etc.
1.4 Realization Report on Training/Teaching by Foreign Labor
(accompanied by attachment of training activity photos) No. Name of Foreign Worker Time of Training/Teaching Location of Training/Teaching Number of Participants Duration 1 1 2 1 etc. etc.

1.5 Realization Report on Product Development
No.
Name of New Product Business Line Type of Coverage Risks Covered Benefits Provided Coverage Period Time of Issuance/Implementation etc..

1.6 Supervisory Board Oversight Results Report on the Implementation of the Business Plan
a. Supervisory Board's assessment of factors affecting the Company's performance in general, for example related to premium income aspects, investment returns, profit and capitalization both qualitatively and quantitatively. b. Supervisory Board's assessment of business plan realization regarding non-financial factors e.g. related to products, marketing, human resources etc. both qualitatively and quantitatively.

c. Board of Commissioners' Recommendations regarding efforts to improve or further enhance the Company's performance and non-financial aspects related to the business plan.

Note:
1 The Board of Commissioners' assessment in letters a to c can be supplemented with the Board of Commissioners' own assessment regarding external factors affecting the company's operations.

Established in Jakarta on December 9, 2014 EXECUTIVE HEAD OF INSURANCE SUPERVISOR, PENSION FUNDS, FINANCING INSTITUTIONS, AND OTHER FINANCIAL SERVICE INSTITUTIONS FINANCIAL SERVICES AUTHORITY, Signed, FIRDAUS DJAELANI

Copy matches the original
Legal Director 1
Legal Department,
Signed. Signed.
Tini Kustini

APPENDIX IX
FINANCIAL SERVICES AUTHORITY CIRCULAR LETTER NUMBER 15/SEOJK.05/2014 REGARDING CORPORATE PLAN AND BUSINESS PLAN OF INSURANCE COMPANIES, SHARIA INSURANCE COMPANIES, REINSURANCE COMPANIES, AND SHARIA REINSURANCE COMPANIES

BUSINESS PLAN REALIZATION REPORT AND
BOARD OF COMMISSIONERS' SUPERVISION RESULTS REPORT FOR GENERAL INSURANCE COMPANIES / LIFE INSURANCE COMPANIES / REINSURANCE COMPANIES THAT HAVE A SHARIA UNIT1 PT. XYZ
YEAR.............................

Part I
Business Plan Realization Report and Board of Commissioners' Supervision Results Report For Insurance Companies or Reinsurance Companies

1.1 Business Plan Realization Report
a. Explanation regarding the achievement of the Business Plan, including the focus and priority of Business Plan achievement as well as the comparison between the plan and its realization. 2 b. Financial ratios and specific items

c. Explanation regarding deviations in the realization of the Business Plan, such as causes and obstacles faced.
d. Follow-up actions or efforts to be taken to improve the achievement of Business Plan realization.

Note:
1 Write one according to the company's field of business.
2 Companies also need to explain the magnitude of realization related to financial projections and capital plans.

1.2 Report on the Realization of Office Network Development and/or Changes

No	OFFICE NAME	HEAD OFFICE	DATE OF REALIZATION	LOCATION 1	NOTES 2
A. OPENING
1	Offices that have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
2	Offices that do not have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
B. STATUS CHANGES
1	Offices that have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
2	Offices that do not have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
C. MERGER
1	Offices that have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
a. Between offices that have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
b. Between offices that do not have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
D. ADDRESS TRANSFER
E. CLOSING

1 Must mention the complete address of the location 2 Detailed notes can be attached on a separate sheet

1.3 Report on the Realization of Foreign Worker (TKA) Utilization and Knowledge Transfer to Companion Workers

No	TKA	Companion	Education/Training for Companion by TKA	Evaluation Result of TKA on Companion	Job Title	Field of Task	Job Title

1
...

1.4 Report on the Realization of Training/Teaching by Foreign Workers
(accompanied by attachment of training activity photos)

No.	TKA Name	Date of Training/Teaching	Location of Training/Teaching	Number of Participants	Duration
1
2
...

1.5 Report on Product Development Realization

No.	New Product Name	Business Line	Type of Insurance	Risks Covered	Promised Benefits	Insurance Period	Date of Issuance/Implementation

1
...

1.6 Board of Commissioners' Supervision Results Report on the Implementation of the Business Plan
a. Board of Commissioners' assessment of factors affecting the Company's performance in general, for example related to premium income aspects, investment results, profit, and capital, both qualitatively and quantitatively. b. Board of Commissioners' assessment of business plan realization regarding non-financial factors, for example related to products, marketing, human resources, etc., both qualitatively and quantitatively.
c. Board of Commissioners' Recommendations regarding efforts to improve or further enhance the Company's performance and non-financial aspects related to the business plan.

Note:
1 The Board of Commissioners' assessment in letters a to c can be supplemented with the Board of Commissioners' own assessment regarding external factors affecting the Company's operations.

Part II
Business Plan Realization Report and Board of Commissioners' Supervision Results Report For Sharia Units

Note:
1 Sharia units also need to explain the magnitude of realization related to financial projections and capital plans.

1.3 Report on the Realization of Office Network Development and/or Changes

No	OFFICE NAME	HEAD OFFICE	SHARIA UNIT	DATE OF REALIZATION	LOCATION 1	NOTES 2
A. OPENING
1	Offices that have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
2	Offices that do not have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
B. STATUS CHANGES
1	Offices that have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
2	Offices that do not have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
C. MERGER
1	Offices that have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
c. Between offices that have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
d. Between offices that do not have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
D. ADDRESS TRANSFER
E. CLOSING

1 Must mention the complete address of the location 2 Detailed notes can be attached on a separate sheet

1.3 Report on the Realization of Foreign Worker (TKA) Utilization and Knowledge Transfer to Companion Workers

No	TKA	Companion	Education/Training for Companion by TKA	Evaluation Result of TKA on Companion	Job Title	Field of Task	Job Title

1
...

1.4 Report on the Realization of Training/Teaching by Foreign Workers
(accompanied by attachment of training activity photos)

No.	TKA Name	Date of Training/Teaching	Location of Training/Teaching	Number of Participants	Duration
1
2
...

1.5 Report on Sharia Insurance Product Development Realization

No.	New Product Name	Business Line	Type of Insurance	Risks Covered	Promised Benefits	Insurance Period	Date of Issuance/Implementation

...

1.6 Board of Commissioners' Supervision Results Report on the Implementation of the Business Plan
a. Board of Commissioners' assessment of factors affecting the Sharia unit's performance in general, for example related to contribution aspects, investment results, profit, and capital, both qualitatively and quantitatively. b. Board of Commissioners' assessment of business plan realization regarding non-financial factors, for example related to products, marketing, human resources, etc., both qualitatively and quantitatively.
c. Board of Commissioners' Recommendations regarding efforts to improve or further enhance the Sharia unit's performance and non-financial aspects related to the business plan.

Note:
1 The Board of Commissioners' assessment in letters a to c can be supplemented with the Board of Commissioners' own assessment regarding external factors affecting the Sharia unit's operations.

Copy matches the original
Legal Director 1
Legal Department,
Signed. Signed.
Tini Kustini

APPENDIX X
FINANCIAL SERVICES AUTHORITY CIRCULAR LETTER NUMBER 15/SEOJK.05/2014 REGARDING CORPORATE PLAN AND BUSINESS PLAN OF INSURANCE COMPANIES, SHARIA INSURANCE COMPANIES, REINSURANCE COMPANIES, AND SHARIA REINSURANCE COMPANIES

BUSINESS PLAN REALIZATION REPORT AND
BOARD OF COMMISSIONERS' SUPERVISION RESULTS REPORT FOR SHARIA GENERAL INSURANCE COMPANIES / SHARIA REINSURANCE COMPANIES / SHARIA LIFE INSURANCE COMPANIES 1 PT. XYZ
YEAR ....................................

Note:
1 Write one according to the company's field of business.
2 Companies also need to explain the magnitude of realization related to financial projections and capital plans.

1.2 Report on the Realization of Office Network Development and/or Changes

No	OFFICE NAME	HEAD OFFICE	DATE OF REALIZATION	LOCATION 1	NOTES 2
A. OPENING
1	Offices that have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
2	Offices that do not have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
B. STATUS CHANGES
1	Offices that have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
2	Offices that do not have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
C. MERGER
1	Offices that have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
a. Between offices that have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
b. Between offices that do not have the authority to accept or reject insurance closures, sign policies, determine to pay or reject claims
D. ADDRESS TRANSFER
E. CLOSING

1 Must mention the complete address of the location 2 Detailed notes can be attached on a separate sheet

1.3 Report on the Realization of Foreign Worker (TKA) Utilization and Knowledge Transfer to Companion Workers

No	TKA	Companion	Education/Training for Companion by TKA	Evaluation Result of TKA on Companion	Job Title	Field of Task	Job Title

...

1.4 Report on the Realization of Training/Teaching by Foreign Workers
(accompanied by attachment of training activity photos)

No.	TKA Name	Date of Training/Teaching	Location of Training/Teaching	Number of Participants	Duration
1
2
...

1.5 Report on Product Development Realization

No.	New Product Name	Business Line	Type of Insurance	Risks Covered	Promised Benefits	Insurance Period	Date of Issuance/Implementation
...

1.6 Board of Commissioners' Supervision Results Report on the Implementation of the Business Plan
a. Board of Commissioners' assessment of factors affecting the Company's performance in general, for example related to contribution aspects, investment results, profit, and capital, both qualitatively and quantitatively. b. Board of Commissioners' assessment of business plan realization regarding non-financial factors, for example related to products, marketing, human resources, etc., both qualitatively and quantitatively.
c. Board of Commissioners' Recommendations regarding efforts to improve or further enhance the Company's performance and non-financial aspects related to the business plan.

Note:
1 The Board of Commissioners' assessment in letters a to c can be supplemented with the Board of Commissioners' own assessment regarding external factors affecting the company's operations.

Copy matches the original
Legal Director 1
Legal Department,
Signed. Signed.
Tini Kustini

Circular Letter of the Financial Services Authority Regarding Corporate Plans and Business Plans for Insurance Companies, Sharia Insurance Companies, Reinsurance Companies, and Sharia Reinsurance Companies

Description
Projection
Jan - Dec
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
BEGINNING CASH AND BANK BALANCE
CASH FLOWS FROM OPERATING ACTIVITIES
Cash Inflows a. Premium b. Co-insurance Claims
c. Reinsurance Claims
d. Commission e. Receivables f. Others
Total Cash Inflows
Cash Outflows

CASH FLOWS FROM FINANCING ACTIVITIES
Cash Inflows a. Subordinated loans

c. Qardh received

Direct participation

PROFIT AFTER TAX

DESCRIPTION
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1* 20XX-1* 20XX+2* Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX*
c. Others
Total Cash Outflows

Description
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1* 20XX-1* 20XX+2* Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX*
TOTAL CASH FLOWS FROM
FINANCING ACTIVITIES
ENDING CASH AND BANK BALANCE

Description
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1* 20XX-1* 20XX+2* Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX*
TOTAL CASH FLOWS FROM
FINANCING ACTIVITIES
CASH AND BANK BALANCE END

Board of Directors

Lineage: Superseded

Timeline

Circular Letter of the Financial Services Authority Regarding Corporate Plans and Business Plans for Insurance Companies, Sharia Insurance Companies, Reinsurance Companies, and Sharia Reinsurance Companies

Description Projection Jan - Dec 20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4* BEGINNING CASH AND BANK BALANCE CASH FLOWS FROM OPERATING ACTIVITIES Cash Inflows a. Premium b. Co-insurance Claims c. Reinsurance Claims d. Commission e. Receivables f. Others Total Cash Inflows Cash Outflows

CASH FLOWS FROM FINANCING ACTIVITIES Cash Inflows a. Subordinated loans

c. Qardh received

Direct participation

PROFIT AFTER TAX

DESCRIPTION Actual Projection Jan - Sept Jan-Dec Year 1 Jan-Dec 20XX+1* Jan-Dec 20XX-1* 20XX-1* 20XX+2* Jan-Mar 20XX* Jan-Jun 20XX* Jan - Sept 20XX* Jan-Dec 20XX* c. Others Total Cash Outflows

Description Actual Projection Jan - Sept Jan-Dec Year 1 Jan-Dec 20XX+1* Jan-Dec 20XX-1* 20XX-1* 20XX+2* Jan-Mar 20XX* Jan-Jun 20XX* Jan - Sept 20XX* Jan-Dec 20XX* TOTAL CASH FLOWS FROM FINANCING ACTIVITIES ENDING CASH AND BANK BALANCE

Description Actual Projection Jan - Sept Jan-Dec Year 1 Jan-Dec 20XX+1* Jan-Dec 20XX-1* 20XX-1* 20XX+2* Jan-Mar 20XX* Jan-Jun 20XX* Jan - Sept 20XX* Jan-Dec 20XX* TOTAL CASH FLOWS FROM FINANCING ACTIVITIES CASH AND BANK BALANCE END

Board of Directors

Lineage: Superseded

Timeline

Description
Projection
Jan - Dec
20XX* 20XX+1* 20XX+2* 20XX+3* 20XX+4*
BEGINNING CASH AND BANK BALANCE
CASH FLOWS FROM OPERATING ACTIVITIES
Cash Inflows a. Premium b. Co-insurance Claims
c. Reinsurance Claims
d. Commission e. Receivables f. Others
Total Cash Inflows
Cash Outflows

CASH FLOWS FROM FINANCING ACTIVITIES
Cash Inflows a. Subordinated loans

DESCRIPTION
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1* 20XX-1* 20XX+2* Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX*
c. Others
Total Cash Outflows

Description
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1* 20XX-1* 20XX+2* Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX*
TOTAL CASH FLOWS FROM
FINANCING ACTIVITIES
ENDING CASH AND BANK BALANCE

Description
Actual Projection
Jan - Sept Jan-Dec Year 1
Jan-Dec
20XX+1*
Jan-Dec
20XX-1* 20XX-1* 20XX+2* Jan-Mar
20XX*
Jan-Jun
20XX*
Jan - Sept
20XX*
Jan-Dec
20XX*
TOTAL CASH FLOWS FROM
FINANCING ACTIVITIES
CASH AND BANK BALANCE END