Electronic Licensing, Approval, and Reporting for Financing Companies and Sharia Financing Companies — OJK — ID

To:

The Board of Directors of Financing Companies; and
The Board of Directors of Sharia Financing Companies,
At their respective locations.

COPY

CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY REPUBLIC OF INDONESIA NUMBER 20/SEOJK.06/2023

CONCERNING

ELECTRONIC APPLICATION FOR LICENSING, APPROVAL, AND REPORTING FOR FINANCING COMPANIES AND SHARIA FINANCING COMPANIES

In accordance with the mandate of Article 114 paragraph (5) of Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Matters for Financing Companies and Sharia Financing Companies (State Gazette of the Republic of Indonesia Year 2020 Number 264, Additional State Gazette of the Republic of Indonesia Number 6582), it is necessary to further regulate provisions regarding electronic services (e-licensing) for financing companies and Sharia financing companies in this Financial Services Authority Circular Letter as follows:

I. GENERAL PROVISIONS

In this Financial Services Authority Circular Letter, the following terms are defined:

Company means a financing company and a Sharia financing company.
Financing Company means a business entity that conducts financing activities for goods and/or services.
Sharia Financing Company means a Financing Company whose entire business activities involve Sharia financing.
Sharia Financing means the disbursement of financing conducted based on Sharia principles.
Sharia Business Unit, hereinafter abbreviated as UUS, is a work unit of the Financing Company's headquarters that conducts Sharia Financing and/or functions as the head office of offices conducting Sharia Financing.
Board of Directors means the company organ authorized and fully responsible for managing the company for the benefit of the company, in accordance with the company's purpose and objectives, and representing the company, both inside and outside of court, in accordance with the provisions of the Articles of Association.
Board of Commissioners means the company organ tasked with conducting general and/or specific supervision in accordance with the Articles of Association and providing advice to the Board of Directors.
Controlling Shareholder, hereinafter abbreviated as PSP, means an individual, legal entity, and/or business group that owns shares or capital of the Company amounting to 25% (twenty-five percent) or more of the issued shares with voting rights, or owns shares or capital of the Company less than 25% (twenty-five percent) of the issued shares with voting rights but can be proven to have controlled the Company, either directly or indirectly.
Sharia Supervisory Board, hereinafter abbreviated as DPS, is a board that has the task and function of supervision and provides advice to the Board of Directors regarding the implementation of the Company's activities 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 concerning limited liability companies.
Branch Office means the Company's office that has the authority to approve financing to prospective debtors and sign financing agreements or contracts with debtors.
Sharia Business Unit Branch Office, hereinafter referred to as UUS Branch Office, is an office that is directly responsible to the UUS and conducts Sharia Financing activities, and has the authority to approve Sharia Financing to prospective debtors and sign Sharia Financing agreements or contracts with debtors.
Merger means a legal act performed by 1 (one) or more Companies to merge with an existing Company, resulting in the assets, liabilities, and equity of the merging Company transferring by operation of law to the receiving Company, and subsequently the legal entity status of the merging Company ends by operation of law.
Consolidation means a legal act performed by 2 (two) or more Companies to merge by establishing 1 (one) new Company that by operation of law acquires the assets, liabilities, and equity of the consolidating Companies, and the legal entity status of the consolidating Companies ends by operation of law.
Separation means a legal act performed by a Company to separate business operations, resulting in all of the Company's assets, liabilities, and equity transferring by operation of law to 2 (two) or more Companies, or part of the Company's assets, liabilities, and equity transferring by operation of law to 1 (one) or more Companies.

II. SCOPE OF ELECTRONIC APPLICATION FOR LICENSING, APPROVAL, AND REPORTING

Applications for licensing, approval, and reporting as mandated in Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Matters for Financing Companies and Sharia Financing Companies, submitted to the Financial Services Authority, are grouped as follows:
a. licensing applications; b. approval applications; and
c. reporting.
Licensing applications as referred to in item 1 letter a include applications for licenses:
a. Company business license; b. establishment of UUS;
c. opening of Branch Offices;
d. upgrading the status of offices other than Branch Offices to Branch Offices; e. upgrading the status of offices other than UUS Branch Offices to UUS Branch Offices; f. opening of UUS Branch Offices; g. establishment of UUS previously owned by a Company that merged or consolidated in its name; h. opening of Branch Offices previously owned by a Company that merged or consolidated in its name; and
i. opening of Branch Offices in the name of a Sharia Financing Company resulting from conversion.
Approval applications as referred to in item 1 letter b include approvals for:
a. exemption from the obligation to register as a member of an asset recording institution; b. employing foreign workers;
c. closure of UUS;
d. Separation of UUS; e. change of ownership; f. Merger or Consolidation; g. conversion of a Financing Company into a Sharia Financing Company; h. cessation of business activities so that it is no longer a Company;
i. dissolution of the Company due to a GMS decision; and
j. integration.
Reporting as referred to in item 1 letter c includes reporting on:
a. change of UUS leadership; b. cessation of UUS business activities;
c. implementation of GMS approving the Separation of UUS;
d. implementation of Separation of UUS; e. closure of Branch Offices; f. closure of UUS Branch Offices; g. implementation of change of ownership; h. implementation of GMS approving Merger;
i. implementation of Merger;
j. implementation of GMS approving Consolidation; k. implementation of Consolidation;
l. implementation of GMS approving conversion to a Sharia Financing Company;
m. implementation of conversion; n. change of purpose and objectives as well as business activities of the Company; o. change of Company name; p. change of headquarters office location of the Company; q. change of status of a closed company into a public limited company or vice versa; r. change of members of the Board of Directors, members of the Board of Commissioners, and/or members of the Company's DPS; s. change of address of the headquarters office, Branch Offices, and UUS Branch Offices; t. implementation of cessation of business activities; u. process of postponement of debt payment obligations, whether upon own request or upon creditor's request;
v. bankruptcy process, whether upon own request or upon creditor's request; and
w. implementation of dissolution.

III. PROCEDURE FOR SUBMISSION AND REQUIREMENTS FOR ELECTRONIC APPLICATION FOR LICENSING, APPROVAL, AND REPORTING

Companies are required to submit applications for licensing, approval, and reporting to the Financial Services Authority in accordance with the requirements stipulated in Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Matters for Financing Companies and Sharia Financing Companies, and accompanied by supporting documents as required.
The submission of applications for licensing, approval, and reporting as referred to in item 1 is accompanied by a self-assessment form signed by the Company's Board of Directors as set forth in the Appendix which is an integral part of this Financial Services Authority Circular Letter.
Applications for licensing, approval, and reporting as referred to in item 2 are submitted to the Financial Services Authority online via the Financial Services Authority's data communication network system.
With the submission of applications for licensing, approval, and reporting to the Financial Services Authority online as referred to in item 3, Companies are not required to submit printed documents.
Documents for applications for licensing, approval, and reporting submitted online are color scans of the original documents.
In the event that the Financial Services Authority's data communication network system as referred to in item 3 is not yet available, experiences technical disturbances, or in cases of force majeure, the submission of applications for licensing, approval, and reporting is submitted online in the form of electronic documents via email designated by the Financial Services Authority.
In the event of technical disturbances or force majeure as referred to in item 6, the Financial Services Authority announces this on the Financial Services Authority website or via email to the Company.
Force majeure as referred to in item 6 and item 7 includes, among others, fire, mass riots, war, armed conflict, sabotage, pandemic, cyber attacks, and/or natural disasters such as earthquakes or floods.
Companies must declare that documents submitted online or via email are true and identical to the original documents.
Submission of applications for licensing, approval, and reporting in the form of electronic documents via email as referred to in item 6 is submitted via the address mailingroomwismul@ojk.go.id or another address designated by the Financial Services Authority and addressed to:
Executive Head of Supervision of Financing Institutions, Venture Capital Companies, Microfinance Institutions, and Other Financial Service Institutions u.p. Director of Licensing for Financing Institutions, Venture Capital Companies, Microfinance Institutions, and Other Financial Service Institutions.
In the event that the Financial Services Authority's data communication network system or email experiences technical disturbances as referred to in item 6 or the Company experiences disturbances preventing the submission of applications for licensing, approval, and reporting online, applications for licensing, approval, and reporting are submitted offline accompanied by written notification and supporting documents in the form of reports using either compact disk (CD) media or other electronic data storage media, and sent to the Financial Services Authority via a letter signed by the Board of Directors or equivalent and addressed to:
Executive Head of Supervision of Financing Institutions, Venture Capital Companies, Microfinance Institutions, and Other Financial Service Institutions u.p. Director of Licensing for Financing Institutions, Venture Capital Companies, Microfinance Institutions, and Other Financial Service Institutions Wisma Mulia 2 Building, 11th Floor Jalan Jenderal Gatot Subroto Kav. 42 Jakarta 12710.
Submission of applications for licensing, approval, and reporting offline as referred to in item 11 is conducted in one of the following ways:
a. handed directly to the Financial Services Authority office; or b. sent via a courier service company.
In the event of a change in the address of the Financial Services Authority office for the submission of applications for licensing, approval, and reporting as referred to in item 11, the Financial Services Authority provides notification regarding the address change via letter or announcement.
A Company is deemed to have submitted applications for licensing, approval, and reporting with the following conditions:
a. for online submission via:
1) the Financial Services Authority's data communication network system, proven by a receipt from the Financial Services Authority's data communication network system; or
2) email to the Financial Services Authority, proven by proof of email transmission, in the event that transmission via the data communication network cannot be performed; or
b. for offline submission, proven by a receipt from the Financial Services Authority.

IV. DOCUMENT STORAGE

Companies are required to store printed documents of licensing and approval documents that have been submitted via the Financial Services Authority's data communication network system or via email to the Financial Services Authority for as long as such licensing and approval remain valid.
Companies are required to store printed documents of reporting documents that have been submitted via the Financial Services Authority's data communication network system or via email to the Financial Services Authority for a minimum period of 5 (five) years from the date of reporting.
The Financial Services Authority may conduct verification and/or validation of the truthfulness and reasonableness of printed documents of applications for licensing, approval, and reporting that have been submitted by the Company via the Financial Services Authority's data communication network system or via email to the Financial Services Authority.
Companies are required to provide printed documents of applications for licensing, approval, and reporting as referred to in item 3 that have been submitted via the Financial Services Authority's data communication network system or via email to the Financial Services Authority during the implementation of verification and/or validation by the Financial Services Authority.

V. TRANSITIONAL PROVISIONS

Applications for licensing, approval, and reporting that have been submitted to the Financial Services Authority in the form of electronic documents via email or in the form of printed documents (hardcopy) before this Financial Services Authority Circular Letter takes effect and have not received licenses, approvals, and/or reporting recording letters from the Financial Services Authority do not need to be resubmitted online via the Financial Services Authority's data communication network system.

VI. CLOSING

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

Determined in Jakarta on 9 November 2023

EXECUTIVE HEAD OF SUPERVISION OF FINANCING INSTITUTIONS, VENTURE CAPITAL COMPANIES, MICROFINANCE INSTITUTIONS, AND OTHER FINANCIAL SERVICE INSTITUTIONS FINANCIAL SERVICES AUTHORITY REPUBLIC OF INDONESIA, AGUSMAN

s/s

APPENDIX
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY REPUBLIC OF INDONESIA NUMBER 20/SEOJK.06/2023 CONCERNING ELECTRONIC APPLICATION FOR LICENSING, APPROVAL, AND REPORTING FOR FINANCING COMPANIES AND SHARIA FINANCING COMPANIES

TABLE OF CONTENTS
FORM 1 SELF-ASSESSMENT APPLICATION FOR COMPANY BUSINESS LICENSE FORM 2 SELF-ASSESSMENT APPLICATION FOR UUS ESTABLISHMENT LICENSE FORM 3 SELF-ASSESSMENT APPLICATION FOR BRANCH OFFICE OPENING LICENSE FORM 4 SELF-ASSESSMENT APPLICATION FOR UPGRADING THE STATUS OF OFFICES OTHER THAN BRANCH OFFICES TO BRANCH OFFICES FORM 5 SELF-ASSESSMENT APPLICATION FOR UPGRADING THE STATUS OF OFFICES OTHER THAN UUS BRANCH OFFICES TO UUS BRANCH OFFICES FORM 6 SELF-ASSESSMENT APPLICATION FOR UUS BRANCH OFFICE OPENING LICENSE FORM 7 SELF-ASSESSMENT APPLICATION FOR UUS ESTABLISHMENT LICENSE PREVIOUSLY OWNED BY A COMPANY THAT MERGED OR CONSOLIDATED IN ITS NAME FORM 8 SELF-ASSESSMENT APPLICATION FOR BRANCH OFFICE OPENING LICENSE PREVIOUSLY OWNED BY A COMPANY THAT MERGED OR CONSOLIDATED IN ITS NAME FORM 9 SELF-ASSESSMENT APPLICATION FOR BRANCH OFFICE OPENING LICENSE IN THE NAME OF A SHARIA FINANCING COMPANY RESULTING FROM CONVERSION FORM 10 SELF-ASSESSMENT APPLICATION FOR APPROVAL OF EXEMPTION FROM THE OBLIGATION TO REGISTER AS A MEMBER OF AN ASSET RECORDING INSTITUTION FORM 11 SELF-ASSESSMENT APPLICATION FOR APPROVAL TO EMPLOY FOREIGN WORKERS FORM 12 SELF-ASSESSMENT APPLICATION FOR APPROVAL OF UUS CLOSURE FORM 13 SELF-ASSESSMENT APPLICATION FOR APPROVAL OF UUS SEPARATION INTO A SHARIA FINANCING COMPANY FORM 14 SELF-ASSESSMENT APPLICATION FOR APPROVAL OF CHANGE OF OWNERSHIP FORM 15 SELF-ASSESSMENT APPLICATION FOR APPROVAL OF MERGER OR CONSOLIDATION FORM 16 SELF-ASSESSMENT APPLICATION FOR APPROVAL OF CONVERSION OF A FINANCING COMPANY INTO A SHARIA FINANCING COMPANY FORM 17 SELF-ASSESSMENT APPLICATION FOR APPROVAL OF CESSATION OF BUSINESS ACTIVITIES SO THAT IT IS NO LONGER A COMPANY FORM 18 SELF-ASSESSMENT APPLICATION FOR APPROVAL OF COMPANY DISSOLUTION DUE TO GMS DECISION FORM 19 SELF-ASSESSMENT APPLICATION FOR APPROVAL OF A COMPANY TO UNDERGO INTEGRATION FORM 20 SELF-ASSESSMENT REPORTING OF UUS LEADERSHIP CHANGE FORM 21 SELF-ASSESSMENT REPORTING OF UUS BUSINESS CESSATION FORM 22 SELF-ASSESSMENT REPORTING OF IMPLEMENTATION OF GMS APPROVING UUS SEPARATION FORM 23 SELF-ASSESSMENT REPORTING OF IMPLEMENTATION OF UUS SEPARATION FORM 24 SELF-ASSESSMENT REPORTING OF BRANCH OFFICE CLOSURE FORM 25 SELF-ASSESSMENT REPORTING OF UUS BRANCH OFFICE CLOSURE FORM 26 SELF-ASSESSMENT REPORTING OF IMPLEMENTATION OF CHANGE OF OWNERSHIP FORM 27 SELF-ASSESSMENT REPORTING OF IMPLEMENTATION OF GMS APPROVING MERGER FORM 28 SELF-ASSESSMENT REPORTING OF IMPLEMENTATION OF MERGER FORM 29 SELF-ASSESSMENT REPORTING OF IMPLEMENTATION OF GMS APPROVING CONSOLIDATION FORM 30 SELF-ASSESSMENT REPORTING OF IMPLEMENTATION OF CONSOLIDATION FORM 31 SELF-ASSESSMENT REPORTING OF IMPLEMENTATION OF GMS APPROVING CONVERSION TO A SHARIA FINANCING COMPANY FORM 32 SELF-ASSESSMENT REPORTING OF IMPLEMENTATION OF CONVERSION FORM 33 SELF-ASSESSMENT REPORTING OF CHANGE OF PURPOSE AND OBJECTIVES AS WELL AS BUSINESS ACTIVITIES OF THE COMPANY FORM 34 SELF-ASSESSMENT REPORTING OF CHANGE OF COMPANY NAME FORM 35 SELF-ASSESSMENT
REPORTING OF CHANGE OF HEADQUARTERS OFFICE LOCATION OF THE COMPANY FORM 36 SELF-ASSESSMENT REPORTING OF CHANGE OF STATUS OF CLOSED COMPANY INTO PUBLIC LIMITED COMPANY OR VICE VERSA FORM 37 SELF-ASSESSMENT REPORTING OF CHANGE OF MEMBERS OF THE BOARD OF DIRECTORS, MEMBERS OF THE BOARD OF COMMISSIONERS, AND/OR MEMBERS OF THE COMPANY'S DPS FORM 38 SELF-ASSESSMENT REPORTING OF CHANGE OF ADDRESS OF HEADQUARTERS OFFICE, BRANCH OFFICES, AND UUS BRANCH OFFICES FORM 39 SELF-ASSESSMENT REPORTING OF IMPLEMENTATION OF BUSINESS CESSATION FORM 40 SELF-ASSESSMENT REPORTING OF PROCESS OF POSTPONEMENT OF DEBT PAYMENT OBLIGATIONS, WHETHER UPON OWN REQUEST OR UPON CREDITOR'S REQUEST FORM 41 SELF-ASSESSMENT REPORTING OF BANKRUPTCY PROCESS, WHETHER UPON OWN REQUEST OR UPON CREDITOR'S REQUEST FORM 42 SELF-ASSESSMENT REPORTING OF IMPLEMENTATION OF DISSOLUTION

FORM 1: SELF-ASSESSMENT APPLICATION FOR COMPANY BUSINESS LICENSE SELF-ASSESSMENT FORM APPLICATION FOR COMPANY BUSINESS LICENSE Company Name :
Application Letter Number :
Application Letter Date :
Brief Description of
Business Activities Conducted
:
Contact Person (Name,
Tel/Email)
:
Article 12 of Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Matters for Financing Companies and Sharia Financing Companies
NO. DESCRIPTION YES NO LEGAL BASIS NOTES

Is the application
letter signed by the Board of Directors?
Name of signatory letter: …..
Has the application
attached a photocopy of proof of payment of OJK levies related to Business License?
Government Regulation of the Republic of
Indonesia Number 11 Year 2014
Concerning Levies by the Financial Services
Authority
Proof of payment includes reference number and payment date
Has the application
attached a Copy of the
Deed of Establishment of the Legal Entity that has been approved by the competent authority?
Article 12 of Financial
Services Authority
Regulation Number
47/POJK.05/2020 concerning Business
Licensing and
Institutional Matters for Financing
Companies and
Sharia Financing
Companies
(POJK
No.47/POJK.05/2020)
Deed Number:
Deed Date:
Approval Number from Ministry of Law and Human Rights:
Approval Date
Ministry of Law and Human Rights:
Has the application
attached a copy of the latest amendment to the Articles of Association accompanied by proof of approval, and/or letter of acceptance of notification from the competent authority? Number of the latest Articles of Association amendment (If any):
Date of the latest
Articles of Association amendment (If any)
Approval Number
Ministry of Law and Human Rights:
Approval Date
Ministry of Law and Human Rights:
Does the deed of
establishment contain the Name and Place of Domicile?
Article:
Name:
Place of Domicile:
Does the company
name meet the provisions regarding Name as referred to in Article 6 of POJK No.47/POJK.05/2020? - -
Does the deed of
establishment contain the purpose and objectives as well as business activities?
Article:
Purpose and Objectives:
Business Activities:
Do the purpose and
objectives as well as business activities comply with the provisions of Article 2 paragraph (1) and paragraph (2) of POJK 35/POJK.05/2018?
Does the deed of
establishment contain a description of capital?
Article:
Authorized Capital:
Paid-up Capital:
Is the minimum paid-up
capital amount in accordance with the provisions of
Article 8 of POJK
No.47/POJK.05/2020?
Does the deed of
establishment contain a description of share ownership?
Article:
shareholder structure and share composition:
Is there foreign
ownership, either directly or indirectly?
In the event of foreign
ownership, does the amount of foreign ownership meet the provisions of
Article 9 of POJK
No.47/POJK.05/2020?
Amount of foreign ownership both directly and indirectly: …%
In the event of foreign
ownership, has the application attached a photocopy of the cooperation agreement between the shareholder in the form of a foreign legal entity and the Indonesian shareholder? Agreement Number:… Agreement Date:… Photocopy of cooperation agreement between shareholders in the form of foreign legal entities and Indonesian shareholders for Companies that include participation from foreign legal entities
Does the cooperation
agreement between shareholders in the form of foreign legal entities and Indonesian shareholders contain capital composition and details of authority, at least containing provisions regarding voting rights, profit and loss sharing, and appointment of members of the Board of Directors and members of the Board of Commissioners of the Company? Agreement Article… - -
Does the cooperation
agreement between shareholders in the form of foreign legal entities and Indonesian shareholders contain the obligation of shareholders in the form of foreign legal entities to compile and implement education and training programs according to their field of expertise? Agreement Article…
Does the deed of
establishment contain a description of authority, responsibility, term of office of members of the Board of Directors, members of the Board of Commissioners, and/or members of the DPS?
Article:
Description of authority, responsibility, term of office of members of the Board of Directors, members of the Board of Commissioners, and/or members of the DPS
Has the application
attached a list of shareholders including details of each share ownership up to the last shareholder and/or beneficial owner? If there is no information up to the last shareholder, describe the reason.
Has the application
attached a list of other companies owned by shareholders?
Has the application
attached a director's statement of the financing company signed on stamp paper that Based on Presidential Regulation Number 13 Year 2018 Concerning Implementation of the Principle of Knowing the Beneficial Owner in

indicating who the beneficial owner of the financing company is?

Anti-Money Laundering and Counter-Terrorism Financing Prevention Framework, every corporation is required to submit beneficial owner/ Beneficial Owner (BO) data to the General Legal Administration System (AHU) online managed by the Ministry of Law and Human Rights. Information regarding the beneficial owner/BO of the financing company is taken from reports that have been submitted to the AHU online System above. Briefly describe the profile of the beneficial owner/BO and the form of control from the beneficial owner/BO against the financing company.

Has the application
attached Shareholder Data other than
Controlling Shareholders, namely:
Data submitted is for shareholders whose ownership is less than 25%.
Shareholder Name:
… a. Copy of the deed of establishment of the legal entity, including the articles of association along with amendments to the articles of association regarding business activities, capital structure, shareholding structure, and management that are the latest, accompanied by Deed Title:
Deed Number:
Date of Deed:
Name and Position of the Notary Making the Deed:
Content of Approval in the Deed:
Number of the receipt letter of notification from

-
- with proof of approval, consent, registration, and/or receipt letter of notification from the competent agency; (Only for shareholders in the form of Limited Liability Companies) the competent agency:
Date of the receipt letter of notification from the competent agency:
b. Financial reports that have been audited by a public accountant and the financial report non-consolidated latest before capital deposit that has been signed by the board of directors or the equivalent of the shareholder; (Only for shareholders in the form of Limited Liability Companies) Audited financial report of PT … year … Non-consolidated financial report of PT … month … Provide an explanation regarding which assets are in the latest monthly financial report (before capital deposit) that are used to make capital deposits to the Financing Company Case Example:
On April 1, 2022, the Financing Company PT X Finance submitted an application for a business license as a financing company to OJK. Regarding this application, the shareholder of PT X Finance namely PT ABC has carried out paid-in capital participation of Rp1 billion on March 15, 2022. Furthermore, regarding this application, PT X Finance is required to attach documents including:

Consolidated and non-consolidated financial reports of PT
ABC for the year 2021 period that have been audited by a public accountant;
Financial report of
PT ABC as of
February 2022 that has been signed by the Board of Directors (period before capital participation);
Explanation
regarding which assets are in the financial report of PT ABC in the month of February 2022 that are used as the source of capital participation on the date March 15, 2022. Suppose the source of funds used by PT ABC is from the payment of third-party receivables, then PT X Finance must also attach an explanation that the asset in the form of third-party receivables has been listed in the financial report of PT ABC in February 2022. However, if it turns out that the financial report of PT ABC in February 2022 does not list the ownership of assets in the form of third-party receivables, then PT X Finance is required to submit detailed explanation

- regarding the non-listing of such assets in the financial report of PT ABC.
Note:
OJK will conduct research on financial capacity and sources of funds up to several layers of ownership if necessary.
c. Copy of the tax notification letter
(SPT) for the last 2 (two) years before carrying out the capital participation and documents showing financial capacity and sources of funds, for prospective individual shareholders SPT completed with asset and liability attachments SPT year … from … Provide an explanation regarding which assets are used as the source of funds for capital participation in the SPT concerned and documents supporting it Case Example:
On April 1, 2022, the Financing Company PT X Finance submitted an application for a business license as a financing company to OJK. Regarding this application, the shareholder of PT X Finance namely Mr. Boni has carried out capital participation in PT X Finance amounting to Rp1 billion which was deposited cash on March 15, 2022, with funds originating from the sale of land in Bali. Therefore, PT X Finance needs to submit

- copy of Mr. Boni's SPT for years
2020 and 2021 complete with asset and liability attachments.
Furthermore, considering the source of funds that will be used by Mr. Boni to carry out additional paid-in capital to PT X Finance originates from the sale of land in Bali, then PT X Finance must also attach an explanation that the asset in the form of land in Bali has been listed in the SPT attachment for years 2020 and year 2021 belonging to Mr. Boni. However, if it turns out that the SPT attachment for years 2020 and year 2021 belonging to Mr. Boni does not list the ownership of assets in the form of land in Bali, then PT X Finance is required to submit detailed explanation regarding the non-listing of such assets in the SPT belonging to Mr. Boni. Note:
OJK will conduct research on financial capacity and sources of funds up to several layers of ownership if necessary. d. Copy of identification card in the form of resident identity card or passport that is still valid; (Applicable to individual shareholders. Name:
ID Number:

-
For shareholders in the form of
Limited Liability Companies, attach a copy of identification for all Directors listed in the latest articles of association) e. Copy of tax identification number; (Applicable to individual shareholders . For shareholders in the form of Limited Liability Companies accompanied by Corporate NPWP and Director NPWP) Name:
NPWP:
Issued on date:
f. List of resumes completed with color passport photos sized 4 x 6 cm; (Applicable to individual shareholders. For shareholders in the form of Limited Liability Companies, attach a resume list for all Directors listed in the latest articles of association) Name:
… g. Statement letter stating the points in Article 12 paragraph (2) letter d number 1 letter d) POJK No.47/POJK.05/2020 (For individual shareholders) h. Statement letter of Directors or equivalent stating the points in Article 12 paragraph (2) letter d number 2 letter d) number 4) POJK No.47/POJK.05/2020 For shareholders in the form of Limited Liability Companies (Directors are those appointed to represent

- the company according to the articles of association)
i. Copy of government regulations regarding
capital participation by the State
Republic of Indonesia for the establishment of the Company; For shareholders in the form of Central Government Government Regulation number … year … regarding … j. Copy of regional regulations regarding capital participation by the region for the establishment of the Company; For shareholders in the form of Regional Government Regional Regulation number … year … regarding …
22. Has the application
attached a statement letter from the shareholders of the Financing Company signed on stamped paper stating that:
a. the source of funds for capital participation does not originate from money laundering activities, terrorism financing, and other financial crimes; b. the source of funds for capital participation does not originate from loans; Statement Letter from the shareholder of the company
23. Has the application
attached a copy of proof of settlement of paid-in capital in the form:
a. Cash deposit proof from the shareholder;
Deposit receipt at Bank …. date …, containing transactions from … at Bank … to … at Bank … amounting to Rp…. Provide an explanation regarding the flow of capital participation sources and supporting documents, among other things, the shareholder's bank statement who carried out the capital participation for a period of 1 month before depositing capital. Case Example:
On April 1, 2022, the Financing Company PT X Finance submitted an application for a business license as a financing company to OJK. Regarding this application, the shareholder of PT X Finance namely Mr. Boni has carried out capital participation in PT X Finance amounting to Rp1 billion which was deposited cash on March 15, 2022 Furthermore, regarding this application, PT X Finance is required to attach documents including:

Copy of Mr. Boni's bank statement
(i.e., the account used to deposit capital) for the period February 15

March 15
2022 (1 month before depositing capital).

If from the copy of Mr. Boni's bank statement
it is known that there are inflows of funds before the capital participation transaction, then it is necessary

- to also attach an explanation regarding the source of the inflow of funds accompanied by documents supporting it. Suppose before Mr. Boni deposits capital on March 15, 2022 worth Rp1 billion, there are funds entering Mr. Boni's account on March 13, 2022 worth Rp3 billion, originating from the sale of land in Bali owned by Mr. Boni. Then PT X Finance also needs to submit proof or supporting documents related to the land sale transaction owned by Mr. Boni, among others, in the form of a notarial deed of sale. Note: • To facilitate the explanation of fund flows and sources for the company and/or shareholders, it is advisable to make capital deposits via inter-bank transfer transactions (not cash).

OJK will
carry out tracing of the flow of fund sources up to several layers of ownership if necessary. b. Bank statement of the Financing Company since the date of deposit Bank statement of PT... at Bank … number … period …

- of capital from the shareholder until the date of application for business license; and
c. Copy of proof of placement of paid-in capital in the form
of time deposits in the name of the
Financing Company concerned at one of the general banks, sharia general banks, or sharia business units of general banks in Indonesia for the Financing Company, legalized by the bank that is still valid during the process of applying for a business license. Financing Company Account Number:
Deposit Serial Number:
Nominal:
Maturity Date:
The amount of paid-in capital in the form of time deposits must be the same as the amount of paid-in capital listed in the Deed of Establishment or the latest amendment to the articles of association
24. Has the application
attached certification proof for Directors, Board of Commissioners, and officials one level below the Director according to the organizational structure at the time of submitting the business license application? Provide an organizational structure chart
25. Has the application
attached a copy of the RUPS minutes deed regarding the appointment of DPS members, for Sharia Financing Companies, accompanied by a receipt letter of notification from the competent agency? . Has the application attached proof of operational readiness supporting business activities at least in the form of:
a. Organizational structure completed with job descriptions, authorities, responsibilities and personnel and clearly depicting at least the functions:
1) administration and
accounting;
2) marketing,
financing feasibility analysis and collection;
3) risk management,
internal control, and compliance;
4) implementation
of anti-money laundering programs and counter-terrorism financing;
5) information system
management;
6) customer
complaint services;
7) fraud
control; and
8) financial literacy and inclusion.
b. Work procedures;
c. List of fixed assets and
inventories; d. Proof of ownership or control of the office building showing the office address of the Company along with photos of the exterior of the building and interior photos as well as room layout; Deed Number:
Date of Deed:
Lease period:
e. Example of financing agreement;
Draft financing agreement for business activities to be carried out by the Company. The financing agreement must comply with the provisions of Article 34 POJK Number 35/POJK.05/2018 regarding Implementation of Business of Financing Companies f. Example of sharia financing agreement, for Sharia Financing Companies The financing agreement must comply with the provisions of Article 5 and/or Article 6 POJK Number 10/POJK.05/2019 regarding Implementation of Business of Sharia Financing Companies and Sharia Business Units of Financing Companies g. Information system infrastructure; h. Tax identification number. Name:
NPWP:
Issued on date:
. Has the application attached a business plan for the first 3 (three) years at least containing:
a. Vision, mission, and business strategy; b. Management policies and plans, including:
1) business activity plans;
2) plans for
development or expansion of business activities;
3) capital plans;
4) funding plans;
5) plans for
development and/or changes in office networks or distribution channels;
6) plans for
organizational development, human resources, and/or information technology; and

7) activity plans to
increase financial literacy and inclusion;
c. Initial financial position report;
d. Monthly projections of:
1) financial position reports;
2) comprehensive income statements; and
3) cash flow statements, along with the assumptions used.
e. Projections of ratios and certain items.
28. Has the application
attached confirmation from the supervisory authority in the country of origin of the foreign party, if there is direct participation by a foreign legal entity that has a supervisory authority in its home country? Country of Origin:
Supervisory Authority:
Number:
Date:
29. Has the application
attached a copy of the guidelines for the implementation of the anti-money laundering program, counter-terrorism financing, and prevention of mass destruction weapon proliferation financing in the financial services sector? POJK Number 8 Year 2023 regarding Implementation of Anti-Money Laundering Programs, Counter-Terrorism Financing, and Prevention of Mass Destruction Weapon Proliferation Financing in the Financial Services Sector (POJK 8/2023) Guidelines for implementation of anti-money laundering, counter- terrorism financing, and prevention of mass destruction weapon proliferation financing in the financial services sector according to the provisions of Article 3 POJK 8/2023 which include:
a. active supervision by the Board of Directors and Board of Commissioners; b. policies and procedures;
c. internal control;
d. information management system; and e. human resources and training
30. Has the application
attached a copy of the good corporate governance guidelines POJK 29/POJK.05/2020 regarding the Amendment to the Implementation of Good Corporate Governance Principles at least for the Company? above POJK Number 30/POJK.05/2014 regarding Good Corporate Governance for Financing Companies at least manifested in:
a. implementation of duties and responsibilities of the Board of Directors, Board of Commissioners, and DPS; b. completeness and implementation of duties of committees and working units that carry out internal control functions;
c. handling of
Conflicts of Interest; d. implementation of compliance functions, internal audit, and external audit; e. implementation of risk management and internal control systems; f. implementation of remuneration policies; g. transparency of financial and non-financial conditions; and h. business plan. As per Article 2 paragraph (4) of POJK No.29/POJK.05/2020
31. Has the PSP in the form of a legal entity operated for at least 2 (two) years before carrying out capital participation in the Financing Company as referred to in Article 4 paragraph (2) of POJK
No.47/POJK.05/2020
POJK
No.47/POJK.05/2020
32. Does the Company have at least 1 (one) PSP as referred to in Article 5 of POJK
No.47/POJK.05/2020?
In the event that shareholders meeting the criteria as PSP are more than 1 (one) party, the Company is required to designate all shareholders meeting the criteria as PSP as PSP.
33. Has the total capital participation of shareholders in the Company met the provisions of Article 4 paragraph (4) or Article 4 paragraph (7) of POJK
No.47/POJK.05/2020?
34. Has the company submitted the Application for assessment of competence and propriety for principal parties?
POJK Number
27/POJK.03/2016 regarding Assessment of Competence and Propriety for Principal Parties of Financial Service Institutions
35. Other documents (if any, specify)
We, the undersigned, hereby declare that the above entries are in accordance with the actual conditions. The application and documents uploaded to the application are the same as the originals and the original documents are stored by the Company. In the event that OJK requires the original documents stored by the Company at a later date, we are willing to submit the said documents to OJK. Jakarta, Board of Directors of PT signature (Clear Name)

FORM 2: SELF-ASSESSMENT APPLICATION FOR UUS ESTABLISHMENT LICENSE SELF-ASSESSMENT FORM FOR UUS ESTABLISHMENT LICENSE APPLICATION Company Name :
Application Letter Number :
Application Letter Date :
Brief Description of
Business Activities Conducted
:
Contact Person (Name, Phone/Email)
:
Article 31 of the Financial Services Authority Regulation Number 47/POJK.05/2020 regarding Business Licensing and Institutional Structure of Financing Companies and Sharia Financing Companies
NO. DESCRIPTION YES NO LEGAL BASIS NOTES

Is the application letter signed by the Board of Directors?
Has the application attached the amendment to the articles of association accompanied by proof
of approval and/or receipt letter of notification from the competent agency?
Article 31 POJK
47/POJK.05/2020
Deed Number:
Date of Deed:
Kumham Approval Number:
Kumham Approval Date:
Number of the latest amendment to the Articles of Association (If any):
Date of amendment
Does the deed of establishment contain one of the purposes and objectives of the company, namely
carrying out financing business activities based on sharia principles?
Does the deed of establishment contain the authority and
responsibilities of the DPS?
Has the working capital amount complied with the provisions of Article 30 of POJK
47/POJK.05/2020?
Working Capital Amount :
Has the application attached a copy of proof
of working capital deposit in the form of time deposits in the name of the Financing Company and placed at one of the sharia general banks or sharia business units of general banks in Indonesia that is legalized by the receiving bank that is still valid during the licensing process? Bank Name :
Amount :
Duration :
Legalizing Official:

-
7. Has the application attached a Board of Directors decision letter approving the placement
of working capital in the UUS accompanied by the amount of the placement of working capital? Letter Number :
Date :
Subject :
Directors who signed :
8. Has the application attached the data of the UUS leadership, including :
a. copy of valid ID card or passport; b. copy of NPWP;
c. resume list
with the latest color passport photo sized
4x6cm; d. proof of appointment as UUS leadership ; e. statement letter stating:
1) does not have non-performing loans and/or financing; and
2) does not hold dual positions in other functions in the same
Financing Company; f. proof of expertise, training, and/or experience in the field of sharia finance .
9. Does the company attach proof of
ownership or control of the office building showing the office address of the UUS of the financing company?
10. Is the lessee/borrower/owner listed on the proof
of building control in the name of the UUS office of the financing company?
11. Is the UUS office address of the
financing company listed on the application letter consistent with the branch office address listed on the proof of building control?
12. Is the lease/borrow start date listed on the proof of building control less than 3 months from the date of the UUS office opening report of the
financing company?
13. Has the application attached along with photos of the exterior of the building and interior photos as well as room layout?
14. Has the application attached DPS data, including:
a. proof of application for competence and propriety assessment for DPS; and Number of DECISION :
Date of DECISION :
Notes pass/fail:
b. RUPS minutes regarding the appointment of DPS .
15. Has the application attached the initial financial report of the UUS that is separate from the business activities of the Financing Company?
16. Has the application attached documents on the reporting of the use of agreements or approval of the use of agreements other than the reported agreement used in sharia financing activities and examples of sharia financing agreements as regulated in the OJK Regulation regarding the implementation of sharia financing business?
17. Has the application attached the work plan for the UUS to be opened which at least contains:
a. feasibility study of market opportunities and economic potential; b. Sharia Financing disbursement targets and steps that will be taken to achieve the aforementioned targets;
c. systems and work procedures;
d. number and composition of personnel; and e. monthly cash flow projections for 12 (twelve) months over:
1) financial position reports;
2) comprehensive income statements;
3) cash flow statements, along with the assumptions used.
For shareholders of the
Republic of Indonesia
18. Other documents (if any, specify).
We, the undersigned, hereby declare that the above entries are in accordance with the actual conditions. The application and documents uploaded to the application are the same as the originals and the original documents are stored by the Company. In the event that OJK requires the original documents stored by the Company at a later date, we are willing to submit the said documents to OJK. Jakarta, Board of Directors of PT signature (Clear Name)

FORM 3: SELF-ASSESSMENT APPLICATION FOR BRANCH OFFICE OPENING LICENSE SELF-ASSESSMENT FORM APPLICATION FOR BRANCH OFFICE OPENING LICENSE Company Name :
Application Letter Number :
Application Letter Date :
Branch Office Name (according to city/regency) :
Branch Office Address :
Contact Person (Name,
Phone/Email)
:
Article 49 of the Financial Services Authority Regulation Number 47/POJK.05/2020 regarding Business Licensing and Institutional Structure of Financing Companies and Sharia Financing Companies
NO. DESCRIPTION YES NO NOTES

Is the application letter signed by the Board of Directors that has been recorded by OJK?
Name of the signatory of the letter: …..
Number and date of the approval decision as a principal party from OJK: …..
Number and date of the recording letter from OJK:
….
Has the plan for
opening the branch office been included in the company's business plan?
Business plan year:
Specify the location of the branch office to be opened:
In the event that the branch office to be opened is not yet included in the business plan, specify the reason.
Does the company have a health level with a minimum assessment result of PK-2?
Is the company not currently subject to sanctions by the Financial Services Authority?
Has the application attached the market potential analysis document?
Roughly containing data:

Analysis of demographic and economic conditions in the area where the branch office will be opened
Overview of community characteristics
Specify the name of goods/service providers in the area (dealer/showroom) and the number of their sales (both cash and credit) for the last one year in units.
Example:
Data on used car sales in City A for the last one year Showroom A: credit sales are 2000 units and cash sales are 500 units

Showroom B: credit sales are 3000 units and cash sales are 300 units Showroom C: credit sales are 1000 units and cash sales are 100 units
6. Has the application included a business competition analysis document?
It should roughly contain data:

Name of the financing company that is a competitor along with the number of sales (in units) and its market share percentage, for the last one year
Example:
Used car showroom sales in City A for the last one year on credit are 2000 units, financed by:
Finance X: 300 units (....%)
Finance Y: 500 units (....%)
Finance Z: 1000 units (....%)
Thus, there is still potential for credit sales of 200 units (....%)
Estimated market share percentage for the branch office to be opened

Has the application included a work plan for the branch office to be opened?
Does the branch office work plan include financing targets?
Branch office financing targets are prepared by considering market potential data and business competition data and are presented in rupiah and units For example:
From the market potential and business competition data, the company sets the target for the branch office to be opened at 180 units per year or worth Rp560 Million.
Does the branch office work plan include steps to achieve the established targets?
Steps taken by the branch office to achieve the established targets are explained
Does the work plan include systems and work procedures?
List what SOPs are used for the financing process at the branch office
Does the work plan include an organizational structure?
Explain the organizational structure and personnel at the branch office
Does the branch office work plan include monthly financial position report projections for the next 12 (twelve) months?
Prepared monthly for 12 months starting from when the branch office begins operations.

12 (twelve) months ahead?
13. Does the branch office work plan include monthly comprehensive income statement projections for the next 12 (twelve) months?
Prepared monthly for 12 months starting from when the branch office begins operations.
14. Does the branch office work plan include monthly cash flow projections for the next 12 (twelve) months ahead?
Prepared monthly for 12 months starting from when the branch office begins operations.
15. Does the branch office work plan include the assumptions used in preparing the financial position report projections, income statement projections, and cash flow projections?
These three assumptions are prepared separately.
16. Has the application included proof of ownership or control of the office building showing the Branch Office address?
Type of ownership proof:
Number:
Date:
17. Is the lessee/borrower/owner listed on the proof of control of the building in the name of the financing company?
If the lessee/borrower/owner is an individual, then attach a letter of explanation made by the Board of Directors of the Financing Company explaining the relationship between the lessee/borrower/owner and the Financing Company that will open the branch office (including information regarding the granting of power of attorney to the lessee to represent the Financing Company)
18. Is the branch office address listed on the application letter consistent with the branch office address listed on the proof of control of the building?
If not, then write the full address that will be used in the writing of the SK.
19. Is the lease/loan start date listed on the proof of control of the building less than 3 months from the branch office opening report date?
If the difference between the lease/loan start date and the branch office opening permit application date is more than 3 months, then include the reason.
20. Has the application included photos of the exterior of the building and photos of the interior as well as the room layout?
21. Has the application included data regarding human resources who have experience and/or training regarding finance or Sharia finance for the Branch Office of a Sharia Financing Company?
21. Has the application included proof of basic level certification in the field of financing and/or Sharia Financing for the Branch Office Head?
Include information as shown in the image below:
22. Has the branch office for which the permit is requested conducted financing activities before obtaining the permit?
If yes, provide an explanation of when the branch office started operating and why the permit is only being applied for now?
22. Other documents (if any, specify)
We, the undersigned, hereby declare that the above entries are consistent with the actual conditions. The application and documents uploaded to the application are the same as the originals, and the original documents are kept by the Company. In the event that the OJK later requires the original documents kept by the Company, we are willing to submit said documents to the OJK. Jakarta, Board of Directors of PT signature (Clear Name)

FORM 4: SELF-ASSESSMENT APPLICATION FOR PERMIT TO UPGRADE STATUS OF OFFICE OTHER THAN BRANCH OFFICE TO BRANCH OFFICE SELF-ASSESSMENT FORM APPLICATION FOR PERMIT TO UPGRADE STATUS OF OFFICE OTHER THAN BRANCH OFFICE TO BRANCH OFFICE Company Name :
Application Letter Number :
Date of Application Letter :
Name of Office Other Than Branch Office
:
OJK recording number for the opening of the Office Other Than Branch Office and letter of recording of address change (if any) :
Address of Office Other Than Branch Office
:
Name of Branch Office (according to city/regency) :
Brief Description Regarding the Background of Status Upgrade :
Contact Person (Name, Tel/Email)
:
Article 58 of Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Licensing of Business and Institutions of Financing Companies and Sharia Financing Companies
NO. DESCRIPTION YES NO NOTES

Is the application letter signed by the Board of Directors recorded by the OJK?
Name of signatory: ….
Number and date of approval decision as the main party from OJK: …..
Number and date of recording letter from OJK: ….
Has the status upgrade plan for the Office Other Than Branch Office to Branch Office been included in the company's business plan?
Business plan year:
Specify the location of the KSKC to be upgraded to a branch office:
In the event that the status upgrade of KSKC to KC is not included in the business plan, specify the reason.
Has the application included a market potential analysis document?
It should roughly contain data:

Analysis of demographic and economic conditions in the area where the branch office will be opened
Description of community characteristics
List the name of goods/service providers in that area (dealer/showroom) and the number of their sales (both cash and credit) for the last one year in units.
Example:
Used car sales data in City A for the last one year

Showroom A: credit sales are 2000 units and cash sales are 500 units Showroom B: credit sales are 3000 units and cash sales are 300 units Showroom C: credit sales are 1000 units and cash sales are 100 units
4. Has the application included a business competition analysis document?
It should roughly contain data:

Name of the financing company that is a competitor along with the number of sales (in units) and its market share percentage, for the last one year
Example:
Used car showroom sales in City A for the last one year on credit are 2000 units, financed by:
Finance X: 300 units (....%)
Finance Y: 500 units (....%)
Finance Z: 1000 units (....%)
Thus, there is still potential for credit sales of 200 units (....%)
Estimated market share percentage for the branch office to be opened

Has the application included a work plan for the branch office to be opened?
Does the branch office work plan include financing targets?
Branch office financing targets are prepared by considering market potential data and business competition data and are presented in rupiah and units For example:
From the market potential and business competition data, the company sets the target for the branch office to be opened at 180 units per year or worth Rp560 Million.
Does the branch office work plan include steps to achieve the established targets?
Steps taken by the branch office to achieve the established targets are explained
Does the work plan include systems and work procedures?
List what SOPs are used for the financing process at the branch office
Does the work plan include an organizational structure?
Explain the organizational structure and personnel at the branch office
Does the branch office work plan include monthly financial position report projections for the next 12 (twelve) months?
Prepared monthly for 12 months starting from when the branch office begins operations.
Does the branch office work plan include monthly comprehensive income statement projections for the next 12 (twelve) months?
Prepared monthly for 12 months starting from when the branch office begins operations.
Does the branch office work plan include monthly cash flow projections for the next 12 (twelve) months ahead?
Prepared monthly for 12 months starting from when the branch office begins operations.
Does the branch office work plan include the assumptions used in preparing the financial position report projections, income statement projections, and cash flow projections?
These three assumptions are prepared separately.
Has the application included proof of ownership or control of the office building showing the Branch Office address?
Type of ownership proof:
Number:
Date:
Is the lessee/borrower/owner listed on the proof of control of the building in the name of the financing company?
If the lessee/borrower/owner is an individual, then attach a letter of explanation made by the Board of Directors of the Financing Company explaining the relationship between the lessee/borrower/owner and the Financing Company that will open the branch office (including information regarding the granting of power of attorney to the lessee to represent the Financing Company)
Is the branch office address listed on the application letter consistent with the branch office address listed on the proof of control of the building?
If not, then write the full address that will be used in the writing of the SK.
Is the lease/loan start date listed on the proof of control of the building less than 3 months from the branch office opening report date?
If the difference between the lease/loan start date and the branch office opening permit application date is more than 3 months, then include the reason.
Has the application included photos of the exterior of the building and photos of the interior as well as the room layout?
Has the application included data regarding human resources who have experience and/or training regarding finance or Sharia finance for the Branch Office of a Sharia Financing Company?
Has the application included proof of basic level certification in the field of financing and/or Sharia Financing for the Branch Office Head?
Include information as shown in the image below:
Has the branch office for which the permit is requested conducted financing activities before obtaining the permit?
If yes, provide an explanation of when the branch office started operating and why the permit is only being applied for now?
Other documents (if any, specify)
We, the undersigned, hereby declare that the above entries are consistent with the actual conditions. The application and documents uploaded to the application are the same as the originals, and the original documents are kept by the Company. In the event that the OJK later requires the original documents kept by the Company, we are willing to submit said documents to the OJK.

Jakarta,
Board of Directors of PT signature
(Clear Name)

FORM 5: SELF-ASSESSMENT APPLICATION FOR APPROVAL TO UPGRADE STATUS OF OFFICE OTHER THAN BRANCH OFFICE UUS TO BRANCH OFFICE UUS SELF-ASSESSMENT FORM APPLICATION FOR APPROVAL TO UPGRADE STATUS OF OFFICE OTHER THAN BRANCH OFFICE UUS TO BRANCH OFFICE UUS Company Name :
Application Letter Number :
Date of Application Letter :
Brief Description of the Type of Business Activity Conducted :
Contact Person (Name, Tel/Email)
:
Article 69 of Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Licensing of Business and Institutions of Financing Companies and Sharia Financing Companies
NO. DESCRIPTION NOTES
Description Yes No Legal Basis Notes
1.
Is the application letter signed by the Board of Directors?
2. Has the application included the following documents:
a. market potential and competition analysis; b. work plan for the Branch Office UUS to be opened at least containing:
1) financing targets and steps to achieve financing targets;
2) systems and work procedures;
3) organizational structure; and
4) monthly projections for 12 (twelve) months on:
a) financial position report; b) comprehensive income statement; and c) cash flow report, along with the assumptions used;
c. proof of ownership or control of the office building

showing the address of the Branch Office UUS along with photos of the exterior of the building and photos of the interior as well as the room layout; d. human resource data who have experience and/or training regarding finance or Sharia finance; and e. proof of basic level certification in the field of financing and/or Sharia Financing for the head of the Branch Office UUS.
6. Other documents (if any, specify)
We, the undersigned, hereby declare that the above entries are consistent with the actual conditions. The application and documents uploaded to the application are the same as the originals, and the original documents are kept by the Company. In the event that the OJK later requires the original documents kept by the Company, we are willing to submit said documents to the OJK. Jakarta, Board of Directors of PT signature (Clear Name)

FORM 6: SELF-ASSESSMENT APPLICATION FOR PERMIT TO OPEN BRANCH OFFICE UUS SELF-ASSESSMENT FORM APPLICATION FOR PERMIT TO OPEN BRANCH OFFICE UUS Company Name :
Application Letter Number :
Date of Application Letter :
Brief Description of the Type of Business Activity Conducted :
Contact Person (Name, Tel/Email)
:
Article 61 of Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Licensing of Business and Institutions of Financing Companies and Sharia Financing Companies
No. DESCRIPTION NOTES
Description Yes No Legal Basis Notes

Is the application letter signed by the Board of Directors?
Does the UUS that will open the Branch Office UUS meet the following requirements:
Article 61 POJK
Number
47/POJK.05/2 a. has included the plan to open the Branch Office UUS in the business plan; b. Sharia financial health level with a minimum assessment result of PK-2;
c. is not currently subject to sanctions by the OJK;
d. has human resources who have experience and/or training regarding Sharia finance.
Has the company included documents consisting of market potential analysis?
It should roughly contain data:

Analysis of demographic and economic conditions in the area where the branch office UUS will be opened
Description of community characteristics
List the name of goods/service providers in that area (dealer/showroom) and the number of their sales (both cash and credit) for the last one year in units.
One year unit sales.
Example:
Used car sales data in City A for the last one year Showroom A: credit sales are 2000 units and cash sales are 500 units Showroom B: credit sales are 3000 units and cash sales are 300 units Showroom C: credit sales are 1000 units and cash sales are 100 units . Has the application included a business competition analysis document? It should roughly contain data: • Name of the financing company that is a competitor along with the number of sales (in units) and its market share percentage, for the last one year Example:
Used car showroom sales in City A for the last one year on credit are 2000 units, financed by:
Finance X: 300 units (....%)
Finance Y: 500 units (....%)
Finance Z: 1000 units (....%)
Thus, there is still potential for credit sales of 200 units (....%) Estimated market share percentage for the branch office UUS to be opened

-
. Does the work plan for the Branch Office UUS include Sharia financing targets?
Branch office UUS financing targets are prepared by considering market potential data and business competition data and are presented in rupiah and units For example:
From the market potential and business competition data, the company sets the target for the branch office to be opened at 180 units per year or worth Rp560 Million. . Does the work plan for the Branch Office UUS include steps to achieve the established targets? Steps taken by the branch office UUS to achieve the established targets are explained . Does the work plan include systems and work procedures? List what SOPs are used for the financing process at the branch office UUS . Does the work plan include an organizational structure? Explain the organizational structure and personnel at the branch office UUS . Does the work plan for the Branch Office UUS include monthly financial position report projections for the next 12 (twelve) months? Prepared monthly for 12 months starting from when the branch office UUS begins operations. . Does the work plan for the Branch Office UUS include monthly comprehensive income statement projections for the next 12 (twelve) months ahead? Prepared monthly for 12 months starting from when the branch office UUS begins operations. . Does the work plan for the Branch Office UUS include monthly cash flow projections for the next 12 (twelve) months ahead? Prepared monthly for 12 months starting from when the branch office UUS begins operations. . Does the work plan for the Branch Office UUS include the assumptions used in preparing the financial position report projections, income statement projections, and cash flow projections? These three assumptions are prepared separately.

-
. Has the application included proof of ownership or control of the office building showing the address of the Branch Office UUS? Type of ownership proof:
Number:
Date:
. Is the lessee/borrower/owner listed on the proof of control of the building in the name of the financing company? If the lessee/borrower/owner is an individual, then attach a letter of explanation made by the Board of Directors of the Financing Company explaining the relationship between the lessee/borrower/owner and the Financing Company that will open the branch office (including information regarding the granting of power of attorney to the lessee to represent the Financing Company) . Is the address of the Branch Office UUS listed on the application letter consistent with the branch office address listed on the proof of control of the building? If not, then write the full address that will be used in the writing of the SK. . Is the lease/loan start date listed on the proof of control of the building less than 3 months from the branch office opening report date for the Branch Office UUS? If the difference between the lease/loan start date and the branch office opening permit application date is more than 3 months, then include the reason. . Has the application included photos of the exterior of the building and photos of the interior as well as the room layout? . Has the application included data regarding human resources who have experience and/or training regarding finance or Sharia finance for the Branch Office UUS?

Has the application included proof of basic level certification in the field of financing and/or Sharia Financing for the head of the Branch Office UUS?
Include information as shown in the image below:
Has the branch office UUS for which the permit is requested conducted financing activities before obtaining the permit?
If yes, provide an explanation of when the branch office started operating and why the permit is only being applied for now?
Other documents (if any, specify).
We, the undersigned, hereby declare that the above entries are consistent with the actual conditions. The application and documents uploaded to the application are the same as the originals, and the original documents are kept by the Company. In the event that the OJK later requires the original documents kept by the Company, we are willing to submit said documents to the OJK. Jakarta, Board of Directors of PT signature (Clear Name)

FORM 7: SELF-ASSESSMENT APPLICATION FOR PERMIT TO ESTABLISH UUS PREVIOUSLY OWNED BY A COMPANY THAT MERGES OR ABSORBS IN ITS NAME SELF-ASSESSMENT FORM APPLICATION FOR PERMIT TO ESTABLISH UUS PREVIOUSLY OWNED BY A COMPANY THAT MERGES OR ABSORBS IN ITS NAME Company Name :
Application Letter Number :
Date of Application Letter :
Effective Date of Merger or Absorption
Number & Date of OJK Letter of Approval for Merger or Absorption Plan :
Number of UUS Offices :
Name of UUS Office & SK of UUS Office
:
Contact Person (Name, Tel/Email)
:
Article 86 of Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Licensing of Business and Institutions of Financing Companies and Sharia Financing Companies
NO. DESCRIPTION YES NO NOTES

Is the application letter signed by the Board of Directors recorded at the OJK?
Name of signatory: …..
Number and date of approval decision as the main party from OJK: …..
Number and date of recording letter from OJK: ….
Has the UUS branch office opening permit application included a copy of the UUS branch office opening permit previously owned by the Company that merges or absorbs?
Has the application included a list of UUS offices and addresses of UUS offices for which UUS office permit determination is requested?
Has the resulting Company of the merger or absorption operated the UUS Office previously owned by the Company that merges or absorbs before obtaining permission from the Financial Services Authority?
Other documents (if any, specify)
We, the undersigned, hereby declare that the above entries are consistent with the actual conditions. The application and documents uploaded to the application are the same as the originals, and the original documents are kept by the Company. In the event that the OJK later requires the original documents kept by the Company, we are willing to submit said documents to the OJK. Jakarta, Board of Directors of PT signature (Clear Name)

FORM 8: SELF-ASSESSMENT APPLICATION FOR BRANCH OFFICE OPENING PERMIT FOR A COMPANY PREVIOUSLY OWNED BY A MERGING OR ABSORBING COMPANY

SELF-ASSESSMENT APPLICATION FORM FOR BRANCH OFFICE OPENING PERMIT FOR A COMPANY PREVIOUSLY OWNED BY A MERGING OR ABSORBING COMPANY

Company Name :
Request Letter Number :
Request Letter Date :
Effective Date of Merger or Absorption
OJK Letter Number & Date of Approval for Merger or Absorption Plan Number of Branch Offices :
Branch Office Name & Branch Office Decision Letter : Contact Person (Name, Phone/Email) : Article 86 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies

NO. DESCRIPTION YES NO NOTES

Is the request letter signed by the Board of Directors registered with OJK?
Signatory Name: …..
OJK approval decision number and date as the main party: …..
OJK recording letter number and date: …..
Has the branch office opening request included a copy of the branch office opening permit previously owned by the merging or absorbing company?
Has the request included a list of branch offices and addresses of branch offices for which branch office permits are requested?
Has the resulting company of the merger or absorption operated branch offices previously owned by the merging or absorbing company before obtaining OJK approval?
Other documents (if any, specify)

We, the undersigned, hereby declare that the above entries are in accordance with the actual conditions. The requests and documents uploaded to the application are identical to the originals, and the original documents are retained by the Company. In the event that OJK subsequently requires the original documents retained by the Company, we are willing to submit such documents to OJK.

Jakarta,
Board of Directors PT signature
(Clear Name)

FORM 9: SELF-ASSESSMENT APPLICATION FOR BRANCH OFFICE OPENING PERMIT FOR A SHARIA FINANCING COMPANY RESULTING FROM CONVERSION

SELF-ASSESSMENT APPLICATION FORM FOR BRANCH OFFICE OPENING PERMIT FOR A SHARIA FINANCING COMPANY RESULTING FROM CONVERSION

Company Name :
Request Letter Number :
Request Letter Date :
Brief Description of Business Activities Conducted : Contact Person (Name, Phone/Email) : Article 92 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies

NO. DESCRIPTION NOTES
Description Yes No Legal Basis Notes

Is the request letter signed by the Board of Directors?
Article 92 POJK Number 47/POJK.05/2020
Has the request included the branch office opening permit previously owned by the financing company?
Has the branch office opening permit request been submitted simultaneously with the report on the implementation of the General Meeting of Shareholders (GMS) approving the conversion into a Sharia financing company?
Other documents (if any, specify)

Jakarta,
Board of Directors PT signature
(Clear Name)

FORM 10: SELF-ASSESSMENT APPLICATION FOR APPROVAL OF EXEMPTION FROM THE OBLIGATION TO BECOME A MEMBER OF AN ASSET RECORDING INSTITUTION

SELF-ASSESSMENT APPLICATION FORM FOR APPROVAL OF EXEMPTION FROM THE OBLIGATION TO BECOME A MEMBER OF AN ASSET RECORDING INSTITUTION

Company Name :
Request Letter Number :
Request Letter Date :
Contact Person (Name, Phone/Email)
: Article 18 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies

NO. DESCRIPTION NOTES
Description Yes No Legal Basis Notes

Is the approval letter signed by the Board of Directors?
Has the approval letter included details of the types of collateral owned by the Company?
Article 18 POJK Number 47/POJK.05/2020
Has the approval letter included details of the value of collateral owned by the Company?
Can be in the form of an announcement
Has the company submitted a strategic plan for business development and types of collateral managed over the next 5 (five) years?
Other documents (if any, specify)

Jakarta,
Board of Directors PT signature
(Clear Name)

FORM 11: SELF-ASSESSMENT APPLICATION FOR APPROVAL TO EMPLOY FOREIGN WORKERS

SELF-ASSESSMENT APPLICATION FORM FOR APPROVAL TO EMPLOY FOREIGN WORKERS

Company Name :
Request Letter Number :
Request Letter Date :
Contact Person (Name, Phone/Email)
: Article 27 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies

NO. DESCRIPTION NOTES
Description Yes No Legal Basis Notes

Is the approval letter signed by the Board of Directors?
Does the Company have 25% or more of its shares owned by Foreign Citizens (WNA) and/or Foreign Business Entities (BHA), directly or indirectly?
Article 22 POJK Number 47/POJK.05/2020
Has the Company included a plan for the use of foreign workers other than the Board of Directors and Board of Commissioners in the Company's business plan?
Has the Company ensured that the foreign workers to be employed are not:
a. Board of Directors; b. Board of Commissioners;
c. experts; or
d. consultants.
Has the Company met the requirement that the Board of Directors and/or Board of Commissioners have knowledge about Indonesia, particularly regarding the economy, culture, and Indonesian language?
Has the Company met the requirement that the Board of Directors and/or Board of Commissioners have met the provisions of legislation in the field of labor, including immigration?
Does a Company using foreign workers employed as Board of Directors members require at least 50% (fifty percent) of the Board of Directors members to be Indonesian Citizens (WNI)?
Does a Company using foreign workers employed as Board of Commissioners members require at least 50% (fifty percent) of the Board of Commissioners members to be Indonesian Citizens (WNI)?
Does the Company ensure that foreign workers employed as experts and/or consultants handle functions:
a. information technology; b. risk management; and
c. other functions based on OJK approval?
Does the Company ensure that foreign workers employed as experts and/or consultants have expertise corresponding to the field of responsibility?
Does the Company ensure that foreign workers employed as experts and/or consultants meet the usage period of each foreign worker for a maximum of 3 (three) years, and can be extended once for a maximum of 1 (one) year?
Does the Company ensure that foreign workers employed as experts and/or consultants hold positions that cannot yet be filled by Indonesian workers?
Does the Company ensure that foreign workers employed as experts and/or consultants meet the provisions of legislation in the field of labor, including immigration?
Other documents (if any, specify)

Jakarta,
Board of Directors PT signature
(Clear Name)

FORM 12: SELF-ASSESSMENT APPLICATION FOR APPROVAL TO CLOSE UUS (Sharia Financing Business Unit)

SELF-ASSESSMENT APPLICATION FORM FOR APPROVAL TO CLOSE UUS

Company Name :
Request Letter Number :
Request Letter Date :
Brief Description of Business Activities Conducted : Contact Person (Name, Phone/Email) : Article 37 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies

NO. DESCRIPTION NOTES
Description Yes No Legal Basis Notes

Is the report letter signed by the Board of Directors?
Has the request included proof of notification of the plan to close the UUS to debtors and creditors?
Article 37 POJK Number 47/POJK.05/2020
Can be in the form of an announcement posted, notification letter, etc.
Has the request included procedures for settling the rights and obligations of debtors and creditors?
Have the procedures for settling the rights and obligations of debtors and creditors complied with legislation and considered the interests of the parties and other stakeholders?
Has the implementation of settling the rights and obligations of debtors and creditors complied with legislation and considered the interests of debtors and creditors?
Has the request included proof of the settlement of objections from debtors and creditors, if there are objections from debtors and creditors based on legislation?
Has the request included proof of the settlement of UUS rights and obligations owned based on legislation?
Has the approval included documents of the draft minutes of the General Meeting of Shareholders (GMS) approving the cessation of Sharia Financing activities?
Has the approval included documents stating the reasons for closing the UUS?
Has the approval included documents consisting of a list of Sharia Financing disbursements made, accompanied by information on Debtor names, nominal amounts of Sharia Financing received, and Sharia Financing duration?
Other documents (if any, specify)

Jakarta,
Board of Directors PT signature
(Clear Name)

FORM 13: SELF-ASSESSMENT APPLICATION FOR APPROVAL TO SEPARATE UUS INTO A SHARIA FINANCING COMPANY

SELF-ASSESSMENT APPLICATION FORM FOR APPROVAL TO SEPARATE UUS INTO A SHARIA FINANCING COMPANY

Company Name :
Request Letter Number :
Request Letter Date :
Brief Description of Business Activities Conducted : Contact Person (Name, Phone/Email) : Article 43 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies

NO. DESCRIPTION NOTES
Description Yes No Legal Basis Notes

Is the request letter signed by the Board of Directors?
Does the Company meet a minimum health level of PK-2?
Has the Company ensured that the separation of UUS does not harm the interests of debtors and creditors?
Has the request included photocopies of proof of Paid-up Capital repayment in the form of:
a. fixed-term deposits in the name of the Sharia Financing Company at one of the Sharia commercial banks or Sharia business units of commercial banks in Indonesia; and/or b. other forms permitted based on legislation and in accordance with Sharia financial accounting standards, and legalized by the receiving bank which remains valid during the business license application process.
Has the request included:
a. draft UUS Separation deed; b. draft deed establishing the new Sharia Financing Company;
c. plan for settling the rights and obligations of UUS Debtors and creditors;
d. plan for a list of shareholders including details of each share ownership up to the last shareholder and/or beneficial owner, as well as a list of other companies owned by the shareholders of the new Sharia Financing Company? e. data of shareholders other than Sharia Financing Companies (PSP) as referred to in Article 12 paragraph (2) letter d of the Financial Services Authority Regulation Number 47/POJK.05/2020 from the new Sharia Financing Company? f. statement letter from shareholders of the new Sharia Financing Company stating that:
1) the source of funds for capital contribution does not come from money laundering, terrorism financing, and other financial crimes; and
2) the source of funds for capital contribution does not come from loans?
g. business plan to be conducted for the first 3 (three) years after obtaining the business license of the Sharia Financing Company, at least containing:
1) vision, mission, and business strategy;
2) feasibility study of market opportunities and economic potential;
3) policies and management plans, including:
a) business activity plans; b) business activity development or expansion plans; c) capital plans; d) financing plans; e) office network or distribution channel development and/or change plans; f) organization, human resources, and/or information technology development plans; and g) activities to increase financial literacy and inclusion plans;
4) monthly projections of:
a) financial position reports; b) comprehensive income statements; and c) cash flow reports, along with assumptions used;
5) projections of ratios and certain items;
h. certification proof for the Board of Directors, Board of Commissioners, and officials one level below the Board of Directors according to the organizational structure at the time of the business license application;
i. organizational structure completed with descriptions of duties, authorities, responsibilities, and work procedures as referred to in Article 11 paragraph (1) and (2) of the Financial Services Authority Regulation Number 47/POJK.05/2020, for the new Sharia Financing Company resulting from UUS Separation.
Has the UUS Separation approval request been submitted simultaneously with the request for the assessment of competence and propriety for prospective members of the Board of Directors, Board of Commissioners, Sharia Financing Companies (PSP), and/or Sharia Supervisory Board (DPS) of the new Sharia Financing Company?
Other documents (if any, specify)

Jakarta,
Board of Directors PT signature
(Clear Name)

FORM 14: SELF-ASSESSMENT APPLICATION FOR APPROVAL OF OWNERSHIP CHANGES

SELF-ASSESSMENT APPLICATION FORM FOR APPROVAL OF OWNERSHIP CHANGES

I. Company Data
Company Name :
Request Letter Number :
Request Letter Date :
Brief Description of the Background of Ownership Changes : Contact Person (Name, Phone/Email) : Article 73 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies

II. Substance of the Planned Ownership Changes of the Financing Company
Old New
Basic Capital
Paid-up Capital with the following shareholder composition:
Before Changes After Changes
Shareholder Name Nominal (Rp) % Shareholder Name Nominal (Rp) % Total Total

III. Completeness of Documents for Approval Request
Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies

Is the request letter signed by the Board of Directors that has obtained OJK approval?
Signatory Name: …..
OJK approval decision number and date as the main party: …..
Has the ownership change obtained approval in the GMS and been notarized, and has it received confirmation from the Ministry of Law and Human Rights?
If yes, please state the reasons why the ownership change was realized before OJK approval? In the event that ownership changes are realized before obtaining OJK approval, the Company will be subject to an administrative sanction of IDR 100,000,000.00.
Is the planned ownership change included in the company's business plan?
Business Plan Year ….
Include descriptions regarding capital projections and capital change plans
Is the shareholder composition and share composition listed in the table before changes consistent with what is recorded in the Financial Services Institution Licensing Information System (SIJINGGA)?
OJK letter number and date of paid-up capital recording: …..
In the event that the shareholder composition and share composition listed in the table before changes are not consistent with what is recorded in SIJINGGA, a report on ownership changes for shareholder compositions and share compositions that have not yet been recorded in SIJINGGA must also be submitted.
In the event that ownership changes are caused by an increase in paid-up capital, is the increase in paid-up capital in the form of:
a. cash deposits; b. conversion of profit balances;
c. conversion of loans; and/or
d. stock dividends.
Specify the form of increase in paid-up capital, whether in the form of cash deposits/conversion of profit balances/conversion of loans/stock dividends
In the event that ownership changes are conducted through takeover/addition of new PSP (other than those resulting from inheritance), does the planned ownership change include plans to adjust paid-up capital to a minimum of IDR 250,000,000,000.00?
Adjustment of paid-up capital to a minimum of IDR 250,000,000,000.00 must be conducted simultaneously with the realization of ownership changes through takeover/addition of new PSP.
In the event that ownership changes are conducted through takeover/addition of new PSP (other than those resulting from inheritance), does the planned ownership change include a statement letter from the new PSP signed on stamp paper stating that it will not sell its shares in the Financing Company for a minimum period of 5 years?
Has the request included a list of shareholders including details of each share ownership up to the last shareholder and/or beneficial owner?
If there is no information up to the last shareholder, please explain the reasons.
Has the request included a list of other companies owned by the shareholders?
Has the request included a statement letter from the financing company's Board of Directors signed on stamp paper stating who the beneficial owner of the financing company is?
Based on Presidential Regulation Number 13 of 2018 concerning the Implementation of Beneficial Owner Principles in Preventing and Eradicating Money Laundering and Terrorism Financing Crimes, every corporation is required to submit beneficial owner/ Beneficial Owner (BO) data to the General Legal Administration System (AHU) online managed by the Ministry of Law and Human Rights. Information regarding the beneficial owner/BO of the financing company is taken from reports submitted to the AHU online system. Describe the brief profile of the beneficial owner/BO and the form of control by the beneficial owner/BO over the financing company.
Has the request included the draft minutes of the GMS approving the ownership change?
Draft minutes of the GMS of PT … approving ….
Does the draft minutes of the GMS include the share ownership proportion after the ownership change, based on the calculation of share nominal value (not share certificates)?
Has the request included the draft deed of transfer of share rights (if there are transfers of share rights other than due to sales)?
Examples of transfer of share rights include gifts and inheritance. The draft deed of transfer of share rights submitted consists of draft gift deeds and draft inheritance deeds.
Has the request included the draft deed of sale and purchase of shares (if there is a sale and purchase of shares among shareholders)?
Draft deed of sale and purchase of … shares with a nominal value of Rp... from … to …, at a price of Rp…
In the event of a sale and purchase of shares among shareholders, has a down payment (DP) been made by the buyer to the seller?
If a down payment (DP) has been made by the buyer to the seller, please attach proof of payment.
Does the ownership change result in new shareholders who are not PSP/ whose shares are less than 25% and do not exercise control?
None / There are new shareholders who are not PSP, namely: …
If the ownership change results in new shareholders who are not PSP, has the request included data for the new shareholders who are not PSP as referred to in Article 12 paragraph (2) letter d of POJK Number 47/POJK.05/2020?
a. individuals:
1) photocopy of identification cards, either resident identity cards or valid passports;
2) photocopy of tax identification numbers;
3) curriculum vitae completed with the latest 4 x 6 cm color photos; and
4) statement letter from the concerned party stating that:
a) does not have non-performing loans and/or financing; b) is not included in the list of parties prohibited from becoming shareholders or parties managing, supervising, and/or having significant influence on financial service institutions; c) has never been convicted of criminal offenses based on court decisions that have acquired permanent legal force within the last 5 (five) years; d) has never been declared bankrupt or guilty causing a company or corporation to be declared bankrupt based on court decisions that have acquired permanent legal force within the last 5 (five) years; and e) has never been a PSP, Board of Directors member, Board of Commissioners member, or

Members of the Board of Commissioners (DPS) at financial service companies whose business licenses have been revoked due to violations within the last 5 (five) years;
b. Legal entities:
1) A copy of the establishment deed of the legal entity, including the articles of association along with any amendments regarding business activities, capital, shareholder structure, and management, accompanied by proof of approval, consent, registration, and/or a letter of acceptance of notification from the competent authority;
2) A photocopy of the tax identification number (NPWP); and
3) Data on the Board of Directors of the legal entity from shareholders other than PSP, including:
a) A photocopy of identification in the form of a resident identity card (KTP) or valid passport; b) A photocopy of the tax identification number (NPWP); c) A curriculum vitae completed with the latest 4 x 6 cm color photo; and d) A statement letter from the Board of Directors or equivalent from the aforementioned legal entity stating that:
(1) Shareholders do not have outstanding loans and/or financing; (2) Shareholders are not included in the list of parties prohibited from becoming shareholders or parties that manage, supervise, and/or have significant influence on financial service institutions; (3) Shareholders have never been convicted for criminal offenses in the field of financial service business and/or the economy based on court decisions that have acquired permanent legal force within the last 5 (five) years; (4) Shareholders have never been declared bankrupt or guilty, causing a corporation or company to be declared bankrupt based on court decisions that have acquired permanent legal force within the last 5 (five) years; and (5) Shareholders have never served as PSP at financial service companies whose business licenses were revoked due to violations within the last 5 (five) years.

Has the application included a statement letter from prospective shareholders signed on stamped paper, stating that:
a. The source of funds for capital participation does not originate from money laundering, terrorism financing, and other financial crimes; and This statement letter is only valid for shareholders who will conduct ownership change transactions, whether through capital increase mechanisms or through share purchase mechanisms. In the event that the shareholder is a legal entity, the statement letter must be signed by one of the Directors of the aforementioned shareholder.

b. The source of funds for capital participation does not originate from loans;

In the event that ownership change is conducted through:
a. Capital increase with cash payments by existing shareholders or new shareholders; and/or b. Share purchases by existing shareholders or new shareholders, has the application included proof of fund placement in an escrow account and/or time deposits in the name of the shareholder? Provide an explanation regarding the flow of fund sources and supporting documents, including the prospective shareholder's bank statements for 1 month prior to placing the funds.

Case Example:
On April 1, 2022, Financing Company PT X Finance submitted an approval request to OJK regarding a planned ownership change targeted to be completed in June 2022. This ownership change is planned to be conducted through a capital increase mechanism by existing shareholders, namely Mr. Boni, with a capital increase value of IDR 1 billion. For the purpose of this capital increase, Mr. Boni has placed funds in a time deposit at Bank DEF in his name worth IDR 1 billion on March 15, 2022 (automatic renewal/ARO). Subsequently, regarding the approval request for the planned ownership change, PT X Finance is required to attach documents including:
3. A photocopy of the valid time deposit certificate in Mr. Boni's name at Bank DEF showing the availability of funds worth at least IDR 1 billion. Funds stored in the escrow account and/or time deposits cannot be withdrawn before OJK approval.
4. A photocopy of Mr. Boni's bank statement at Bank DEF (i.e., the account used to place funds in deposit item 1) for the period of February 15 - March 15, 2022 (1 month before placing funds in the deposit).
5. If the photocopy of Mr. Boni's bank statement shows incoming fund flows before the deposit placement transaction, an explanation regarding the source of these incoming funds must also be attached, along with supporting documents. For example, before Mr. Boni placed funds in the deposit on March 15, 2022, worth IDR 1 billion, there were incoming funds to Mr. Boni's account on March 13, 2022, worth IDR 3 billion, originating from the sale of land in Bali owned by Mr. Boni. Therefore, PT X Finance must also submit proof or supporting documents related to Mr. Boni's land sale transaction, including a notarial sales deed.

Notes:

In the event that the ownership change results in a mandatory adjustment of paid-up capital to a minimum of IDR 250,000,000,000 (as explained in letter e), the funds placed in the deposit are also included in the funds that shareholders will use to adjust the paid-up capital to a minimum of IDR 250,000,000,000.
To facilitate companies and/or shareholders in explaining the flow and source of funding, it is recommended that capital payments be made through inter-bank transfers (not cash).
OJK will trace the source of funds through several layers of ownership if necessary.

In the event that ownership change is caused by capital participation (whether through capital increase or share purchase) by individual shareholders, has the application included photocopies of the tax notification letter (SPT) for the last 2 (two) years prior to the capital participation and other documents demonstrating the financial capacity and source of funds for the prospective individual shareholder?
Photocopy of SPT for Year ... and Year ... in the name of Mr./Ms. ... (SPT photocopy must be submitted in full, including asset and liability attachments). Provide an explanation regarding which assets listed in the SPT are used as the source of funds for capital participation.

Case Example:
From the case example in letter r, PT X Finance needs to submit photocopies of Mr. Boni's SPT for 2020 and 2021, complete with asset and liability attachments. Furthermore, since the source of funds Mr. Boni will use to increase capital in PT X Finance comes from the sale of land in Bali, PT X Finance must also attach an explanation that the land asset in Bali is listed in the SPT attachments for 2020 and 2021 belonging to Mr. Boni. However, if it turns out that the SPT attachments for 2020 and 2021 belonging to Mr. Boni do not list ownership of land in Bali, PT X Finance is required to submit a detailed explanation regarding the absence of this asset in Mr. Boni's SPT.

Note:
OJK will investigate the financial capacity and source of funds through several layers of ownership if necessary.

In the event that ownership change is caused by capital participation (whether through capital increase or share purchase) by legal entity shareholders, has the application included shareholder data consisting of:
a. Consolidated and non-consolidated financial reports audited by public accountants; b. The latest monthly financial report signed by the Board of Directors, for the period prior to the capital participation and other documents demonstrating the financial capacity and source of funds for the prospective shareholder? Provide an explanation regarding which assets listed in the latest monthly financial report are used as the source of funds for capital participation.

Case Example:
On April 1, 2022, Financing Company PT X Finance submitted an approval request to OJK regarding a planned ownership change targeted to be completed in June 2022. This ownership change is planned to be conducted through a capital increase mechanism by existing shareholders, namely PT ABC, with a capital increase value of IDR 1 billion. For the purpose of this capital increase, PT ABC has placed funds in a time deposit at Bank XYZ in its name worth IDR 1 billion on March 15, 2022 (automatic renewal/ARO). Subsequently, regarding the approval request for the planned ownership change, in addition to submitting photocopies of time deposit certificates and bank statements as explained in the case example in letter r, PT X Finance is also required to attach documents including:
4. Consolidated and non-consolidated financial reports of PT ABC for the year 2021, audited by public accountants;
5. Financial reports of PT ABC as of February 2022, signed by the Board of Directors (period prior to placing funds in the deposit);
6. An explanation regarding which assets in PT ABC's February 2022 financial report are used as the source of funds for placing deposits on March 15, 2022. For example, if the source of funds used by PT ABC comes from third-party receivables, PT X Finance must also attach an explanation that the third-party receivable asset is listed in PT ABC's February 2022 financial report. However, if it turns out that PT ABC's February 2022 financial report does not list ownership of third-party receivable assets, PT X Finance is required to submit a detailed explanation regarding the absence of this asset in PT ABC's financial report.

Note:
OJK will investigate the financial capacity and source of funds through several layers of ownership if necessary.

In the event that ownership change is caused by capital increase in the form of:
a. Conversion of retained earnings; b. Conversion of loans; and/or
c. Stock dividends, has the application included a photocopy of the Company's financial report audited by public accountants for the period prior to the capital increase?
Audited financial report of PT ... for Year ...
Provide information on retained earnings, loans, and/or retained earnings to be converted into paid-up capital.

Case Example 1:
On April 1, 2022, PT X Finance submitted an approval request to OJK regarding a planned ownership change targeted to be completed in June 2022. This ownership change is planned to be conducted through a capital increase originating from the conversion of retained earnings of PT X Finance for the 2021 fiscal year worth IDR 1 billion. Regarding this matter, PT X Finance needs to submit the audited financial report of PT X Finance as of December 31, 2021, showing retained earnings of at least IDR 1 billion.

Case Example 2:
On April 15, 2019, PT X Finance received a loan worth IDR 2 billion from PT ABC (shareholder of PT X Finance). Subsequently, on April 1, 2022, PT X Finance submitted an approval request to OJK regarding a planned ownership change targeted to be completed in June 2022. This ownership change is planned to be conducted through a capital increase originating from the conversion of loans received by PT X Finance from PT ABC on April 15, 2019. Regarding this matter, PT X Finance needs to submit the audited financial report of PT X Finance as of December 31, 2021, showing liabilities to PT ABC worth IDR 2 billion.

Case Example 3:
On April 1, 2022, PT X Finance submitted an approval request to OJK regarding a planned ownership change targeted to be completed in June 2022. This ownership change is planned to be conducted through a capital increase originating from stock dividends of PT X Finance for the 2021 fiscal year worth IDR 1 billion. Regarding this matter, PT X Finance needs to submit the audited financial report of PT X Finance as of December 31, 2021, showing net income of at least IDR 1 billion.

23. In the event that ownership change is caused by capital increase in the form of loan conversion, has the application included a photocopy of the Company's bank statement showing the receipt of loans?
Case Example:
From case example 2 letter t, PT X Finance needs to submit a photocopy of PT X Finance's bank statement showing that PT X Finance previously received a loan from PT ABC on April 15, 2019, worth IDR 2 billion.

24. In the event that ownership change is caused by capital increase in the form of loan conversion, has the application included supporting documents proving that the source of funds used by third parties to provide loans to the Company does not originate from loans?
Case Example:
From case example 2 letter t, PT X Finance needs to submit:
1. A photocopy of the loan agreement between PT ABC and PT X Finance serving as the basis for the loan provided by PT ABC to PT X Finance on April 15, 2019, worth IDR 2 billion.
2. A photocopy of PT ABC's bank statement for the period of March 15 - April 15, 2019 (1 month prior to the loan transaction to PT X Finance).
3. If the photocopy of PT ABC's bank statement shows incoming fund flows before the loan transaction to PT X Finance, an explanation regarding the source of these incoming funds must also be attached, along with supporting documents.

25. If ownership change is conducted through a reduction of paid-up capital, has the application submitted an explanation regarding the source of funds used by the Company to return capital payments to shareholders?

26. If ownership change is conducted through a reduction of paid-up capital, has the application included:
a. A photocopy of the Company's monthly financial reports for the period prior to the reduction of paid-up capital, signed by the Board of Directors? b. A prognosis of the Company's financial reports after the reduction of paid-up capital, signed by the Board of Directors? OJK may request the Company's latest financial reports and financial prognosis reports, with periods close to the date of OJK approval.

27. Has the application included a photocopy of the cooperation agreement between foreign legal entity shareholders and Indonesian shareholders as referred to in Article 12 paragraph (2) letter l of POJK Number 47/POJK.05/2020 (for approval requests for ownership changes involving new foreign legal entity shareholders)?

28. Does the total foreign ownership, both direct and indirect, after the ownership change, meet the provisions of Article 9 paragraph (1) of POJK Number 47/POJK.05/2020?
Foreign Ownership:
Before Change (%)
After Change (%)
Direct
Indirect

29. In the event that after the ownership change there is an exceedance of foreign ownership limits, does the exceedance meet the criteria regulated in Article 9 paragraph (3) of POJK Number 47/POJK.05/2020?
If the exceedance meets the criteria regulated in Article 9 paragraph (3) of POJK Number 47/POJK.05/2020, specify:

The Company's capital adequacy ratio:
The Company's equity value:
An explanation of the liquidity problems faced by the company;

30. In the event that there is an exceedance of foreign ownership limits, has the application included a plan to adjust foreign ownership limits approved by the Financial Services Authority (OJK) as referred to in Article 9 paragraph (4) of POJK Number 47/POJK.05/2020?
In the event that there is an exceedance of foreign ownership limits, before the Company submits an approval request for the planned ownership change, the Company must first submit an approval request for the plan to adjust foreign ownership limits to the Directorate of Supervision of Financing Institutions (DPLP). After the plan is approved, the Company is required to attach the approval letter from DPLP to the documents for the approval request for the planned ownership change.

31. In the event that ownership change is conducted through a takeover, has the new prospective PSP (through the Company) submitted an explanation of the Company's future business plan?
Explain the future business plan of the company prepared by the new prospective PSP.

32. In the event that ownership change is conducted through a takeover, has the Company submitted a request for the assessment of competence and propriety for the new prospective PSP?

33. In the event that ownership change is conducted through a takeover, has the new prospective PSP, if a legal entity, operated for at least 2 (two) years prior to making capital participation in the Company?
Attach the establishment deed of the new PSP.

34. Does the amount of capital participation by legal entity shareholders meet the provisions of Article 4 paragraph (4) or paragraph (7) of POJK Number 47/POJK.05/2020?
Shareholder A:
Total participation worth IDR...
Equity as of ... worth IDR...

35. Other documents (if any, specify)
Additional notes: (if any)

We, the undersigned, hereby declare that the above entries are consistent with the actual conditions. The application and documents uploaded to the application are identical to the originals, and the original documents are kept by the Company. In the event that OJK subsequently requires the original documents kept by the Company, we are willing to submit said documents to OJK. Jakarta, ………………………. Board of Directors of PT …. signature (Name)

FORM 15: SELF-ASSESSMENT FORM FOR MERGER OR CONSOLIDATION APPROVAL REQUEST
I. MERGER
SELF-ASSESSMENT FORM FOR MERGER OR CONSOLIDATION APPROVAL REQUEST Name of the Company Receiving the Merger:
Name of the Company Merging:
Number and Date of Request Letter:
Profile of the Company Receiving the Merger:
Number and Date of Business License (including any amendments if any):
Address of the Company:
Composition of the Board of Directors and Commissioners:
Composition of Shareholders:
Profile of the Company Merging:
Number and Date of Business License (including any amendments if any):
Address of the Company:
Composition of the Board of Directors and Commissioners:
Composition of Shareholders:
Brief description of the background of the merger:
Contact Person
(Name, Tel/E-mail):
Article 78 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Structure of Financing Companies and Sharia Financing Companies
Substance of the Merger:
No.
Before Change
No.
After Change
Shareholder Name
Nominal (Rp)
(%)
Shareholder Name
Nominal (Rp)
(%)

PT Financing A 1. PT Financing A/B
Shareholder 00000 00 Shareholder 00000 00
Shareholder 00000 00 Shareholder 00000 00
Total 00000 00
PT Financing B
Shareholder 00000 00
Shareholder 00000 00
Total 00000 00 Total 00000 00
Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Structure of Financing Companies and Sharia Financing Companies

NO. DESCRIPTION YES NO NOTES
1. Is the request letter signed by the Board of Directors registered with OJK?
Name of the signatory: …..
Number and date of approval decision as the main party from OJK: …..
Number and date of registration letter from OJK: …..
2. Is the Company's Merger Plan included in the Company's business plan?
Business Plan Year …
Include the content of the business plan regarding the merger plan:
3. Can the Company ensure that the Merger does not reduce Debtor rights?
4. Does the financial condition of the Company resulting from the Merger meet the health level requirements with a minimum composite rating of 2?
Include the self-assessment of the financial health level of the Company resulting from the Merger, stating the composite rating.
5. Has the application included the documents:
a. Implementation work plan for the Merger, containing at least:
1. Implementation steps
2. Implementation timeframe for the Merger
3. Notification plan to Debtors, Creditors, and other stakeholders;
Notification plan to Debtors, Creditors, and other stakeholders includes information regarding:
a. Details of the number of Debtors and outstanding debtor receivables; b. Timeline regarding the notification plan to Debtors;
c. Mechanism for the transfer of Debtor rights and obligations;
d. Mechanism for the transfer of Fiducia e. Mechanism for the transfer of Insurance f. Details of the number of Creditors and outstanding liabilities to Creditors g. Timeline regarding the notification plan to Creditors h. Mechanism for the transfer of payment of liabilities to Creditors
i. Steps to be taken if there are Creditors who object to the transfer of debt
j. Data of third parties/partners cooperating and the mechanism for the transfer of rights and obligations with third parties k. Timeline regarding the notification plan to third parties Attach a draft notification letter to Debtors, Creditors, and third parties containing information regarding the planned merger of companies and contact person. b. draft minutes of the General Meeting of Shareholders (GMS) approving the Merger Attach the draft minutes of the GMS for the Company merging and the draft minutes of the GMS for the Company receiving the Merger.
c. draft Merger deed
d. list of shareholders including details of each ownership share up to the last shareholder and/or beneficial owner, as well as a list of other companies owned by shareholders of the resulting Company from the Merger e. Has the application included a statement letter from the Board of Directors of the resulting Company from the Merger, signed on stamped paper, stating who the beneficial owners are of the resulting Company from the Merger? Based on Presidential Regulation Number 13 of 2018 concerning the Implementation of Beneficial Owner Principles in the Framework of Prevention and Eradication of Money Laundering and Terrorism Financing Crimes, every corporation is required to submit beneficial owner/ Beneficial Owner (BO) data to the Online General Legal Administration System (AHU) managed by the Ministry of Law and Human Rights. Information regarding the beneficial owners/BO of financing companies is taken from reports submitted to the online AHU System. Provide a brief profile of the beneficial owners/BO and the form of control by the beneficial owners/BO over the resulting Company from the Merger. f. proforma (audited) financial reports of the resulting Company from the Merger; Including projections of the financial ratios of the resulting Company from the Merger g. business plan for the first 3 (three) years of the resulting Company from the Merger as referred to in Article 12 paragraph (2)

letter k, which must contain at least:
1) vision, mission, and business strategy;
2) policies and management plans, including:
a) business activity plans; b) plans for development or expansion of business activities; c) capitalization plans; d) financing plans; e) plans for the development and/or change of office networks or distribution channels; f) organizational, human resource, and/or information technology development plans; and g) activities to increase financial literacy and inclusion;
3) initial financial position report;
4) monthly projections for:
a) financial position reports; b) comprehensive income statements; and c) cash flow statements, along with the assumptions used;
5) projections of ratios and specific items
h. organizational structure of the Company resulting from the Merger
6. Has the amount of capital participation of shareholders in the form of legal entities met the provisions of Article 4 paragraph (4) or Article 4 paragraph (7) of POJK Number 47/POJK.05/2020?
7. Has the Company submitted a request for the assessment of competence and propriety for the key parties of the Company resulting from the Merger?
8. In the event of foreign ownership, has the total foreign ownership, both direct and indirect, in the Company resulting from the Merger met the provisions of Article 9 of POJK No. 47/POJK.05/2020? Foreign ownership in the Company resulting from the merger, both direct and indirect, is prohibited from exceeding 85% (eighty-five percent) of the Company's paid-up capital.
9. Has the application attached a plan for the settlement of tax debts for the Company merging itself?
10. Has the application submitted a plan for the settlement of OJK levies for the Company merging itself?
11. Does the Company merging itself have Branch Offices? If yes, please state the number and location of such Branch Offices?
12. Will the Branch Offices apply for permission to open Branch Offices to the OJK as Branch Offices of the Company receiving the Merger?
13. Other documents (if any, specify)
We, the undersigned, hereby declare that the above entries are in accordance with the actual conditions. The applications and documents uploaded to the application are identical to the originals, and the original documents are kept by the Company. In the event that the OJK later requires the original documents kept by the Company, we are willing to submit said documents to the OJK. Jakarta, Directorate (PT A) Directorate (PT B) signature signature (Clear Name) (Clear Name)

II. MERGER
SELF-ASSESSMENT FORM FOR APPLICATION FOR APPROVAL OF COMPANY MERGER Name of the Company merging itself 1. 2. Name of the New Company Resulting from Merger Number and Date of Application Letter Brief description of the background of the merger Contact Person (Phone/Email)
Article 78 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning
Business Licensing and Institutionalization of Financing Companies and Sharia Financing Companies Substance of the Merger :
No.
Before Change
No.
After Change
Name of Shareholder
Nominal
(Rp)
(%)
Name of Shareholder
Nominal
(Rp)
(%)
1. PT Financing A 1. PT Financing C
Shareholder 00000 00 Shareholder 00000 00
Shareholder 00000 00 Shareholder 00000 00
Total 00000 00
2. PT Financing B
Shareholder 00000 00
Shareholder 00000 00
Total 00000 00 Total 00000 00
Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutionalization of Financing Companies and Sharia Financing Companies:
NO. DESCRIPTION YES NO NOTES
1. Is the application letter
signed by the Directorate recorded by the OJK?
Name of the signatory of the letter: …..
Number and date of approval decision as the key party from the OJK: …..
Number and date of the recording letter from the OJK: ….

2. Has the Merger plan
been included in the business plan of the Company?
Business Plan Year
…
Include the content of the business plan related to the merger plan:
3. Can the Company ensure
that the Merger does not reduce the rights of Debtors?
4. Does the financial condition of the Company
resulting from the Merger meet the provisions on health level with a minimum composite rating of 2? Attach self-assessment of the financial health level of the Company resulting from the Merger, stating the composite rating of the health level.
5. Has the application attached
the implementation work plan for the Merger, at least containing:
a) implementation steps; b) implementation period of the Merger; and c) notification plan to Debtors, creditors, and other stakeholders; Notification plan to Debtors, Creditors, and other stakeholders among others contains information regarding:
a. Details of the number of Debtors and outstanding receivables of Debtors; b. Timeline regarding the notification plan to Debtors;
c. Mechanism
for the transfer of rights and obligations of Debtors;. d. Mechanism for the transfer of Fiducia e. Mechanism for the transfer of Insurance f. Details of the number of Creditors and outstanding debts to Creditors g. Timeline regarding the notification plan to Creditors h. Mechanism for the transfer of payment of debt obligations to Creditors

i. Steps that
will be taken if there are Creditors who object to the transfer of debt j. Data of third parties/partners who collaborate and the mechanism for the transfer of rights and obligations with third parties k. Timeline regarding the notification plan to third parties Attach the draft letter of notification to Debtors, Creditors, and third parties containing information regarding the merger plan of the company and contact person.
6. Has the application attached
the draft minutes of the GMS approving the Merger; Draft minutes of the GMS of PT …. approving ….
7. Has the application attached
the draft deed of Merger;
Draft deed of
Merger of PT …. approving ….
8. Has the application attached
the draft deed of establishment of the Company resulting from the Merger; Draft deed of establishment of PT …. approving ….
9. Has the application attached
the list of shareholders along with details of the size of each share ownership up to the last shareholder and/or beneficial owner as well as the list of other companies owned by the shareholders of the Company resulting from the Merger
10. Has the application attached
the statement letter of the Directorate of the Company resulting from the Merger signed on stamped paper stating who the beneficial owner party is for the Company resulting from the Merger? Based on Presidential Regulation Number 13 of 2018 concerning the Implementation of the Principle of Knowing the Beneficial Owner in the Framework of Prevention and Eradication of Money Laundering Crimes and

Terrorism Financing Crimes, every corporation is required to submit beneficial owner/ Beneficial Owner (BO) data to the General Legal Administration System (AHU) online managed by the Ministry of Law and Human Rights. Information regarding the beneficial owner/BO of the financing company is taken from reports that have been submitted to the AHU online System thereof. Describe the brief profile of the beneficial owner/BO and the form of control by the beneficial owner/BO against the Company resulting from the Merger.
11. Has the application attached
the proforma financial report from the
Company resulting from the Merger?
Including projections of the financial ratios of the Company resulting from the Merger
12. Has the application attached
the business plan for 3 (three) years from the first year of the Company resulting from the Merger, at least containing:
a. vision, mission, and business strategy; b. policies and management plans, including:
1) business activity plans;
2) plans for the development or
expansion of business activities;
3) capitalization plans;
4) financing plans;
5) plans for the development and/or
change of office networks or distribution channels;
6) organizational development
plans, human resources, and/or information technology; and
7) activities to
increase financial literacy and inclusion;
c. initial financial position reports;

d. monthly projections for:
1) financial position reports;
2) comprehensive income statements;
and
3) cash flow statements, along with assumptions
used; e. projections of ratios and specific items;
13. Has the application attached
the organizational structure of the Company resulting from the Merger?
14. Has the Company
submitted a request for the assessment of competence and propriety for the key parties of the Company resulting from the Merger?
15. In the event of foreign ownership,
has the total foreign ownership, both direct and indirect, in the resulting merger company met the provisions of Article 9 paragraph (1) of POJK Number 47/POJK.05/2020?
16. Has the amount of capital participation of the
shareholders in the form of legal entities met the provisions of Article 4 paragraph (4) or Article 4 paragraph (7) of POJK Number 47/POJK.05/2020? For shareholders in the form of legal entities
17. Has the application attached
the plan for the settlement of tax debts for the Company conducting the merger?
18. Has the application
submitted the plan for the settlement of OJK levies for the Company conducting the merger?
19. Does the Company conducting
the merger have Branch Offices? If yes, please state the number and location of the Branch Offices?
20. Will the Branch Offices
apply for permission to open Branch
Offices to the OJK as Branch Offices of the Company resulting from the Merger?
21. Other documents (if any,
specify)
We, the undersigned, hereby declare that the above entries are in accordance with the actual conditions. The applications and documents uploaded to the application are identical to the originals, and the original documents are kept by PT ....
In the event that the OJK later requires the original documents kept by PT ...., we are willing to submit said documents to the OJK.

Jakarta,
Directorate (PT A) Directorate (PT B) signature signature (Clear Name) (Clear Name)

FORM 16: SELF-ASSESSMENT FORM FOR APPLICATION FOR APPROVAL OF CONVERSION OF FINANCING COMPANY TO SHARIA FINANCING COMPANY SELF-ASSESSMENT FORM FOR APPROVAL OF CONVERSION OF FINANCING COMPANY TO SHARIA FINANCING COMPANY Company Name :
Approval Letter Number :
Date of Approval Letter :
Contact Person (Name,
Phone/Email)
:
Article 89 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing
and Institutionalization of Financing Companies and Sharia Financing Companies NO. DESCRIPTION YES NO NOTES

Is the reporting letter
signed by the Directorate recorded at the OJK?
Name of the signatory of the letter: …..
Number and date of the approval decision as the key party from the OJK: …..
Number and date of the recording letter from the OJK: ….
Does the company
submit the draft minutes of the GMS approving the conversion into Sharia Financing Company?
Does the company
submit the draft amendment of the articles of association containing:
a. name of the Sharia
Financing Company; b. purpose and objective of the Sharia Financing Company to conduct business activities Sharia Financing; and
c. authority and
responsibility of the DPS
Does the company
submit the latest financial report that has been audited?
Does the company have
submitted the list of offices outside the head office owned by the Sharia Financing Company and/or UUS?
Do the Directorate, Board of Commissioners, and officials
one level below the Directorate according to the organizational structure at the time of submitting the application for approval of conversion have proof of certification?
Does the organizational structure
complete with the structure of personnel, job descriptions, authority, and responsibility?
Has the company
attached the plan for the settlement of rights and obligations of Debtors and creditors?
Has the company
attached the projection of the initial financial report of the business activities of the Sharia Financing Company resulting from the conversion?
Has the company
attached the work plan related to business activities Sharia Financing to be conducted for 3 (three) years from the first year after obtaining the business license as a Company Sharia Financing, at least containing:
a. work systems and procedures; b. examples of Sharia Financing agreements;
c. feasibility studies
of market opportunities and economic potential; d. plans for the distribution of Sharia Financing and steps taken to realize the intended plan; and e. monthly projections for:
1) financial position
reports;
2) comprehensive income/statements;
and

3) cash flow statements,
as well as assumptions used.
11. Is the application
submitted simultaneously with the application for the assessment of competence and propriety for the candidate members of the Directorate, members of the Board of Commissioners, PSP, and members of the DPS of the Sharia Financing Company?
12. Other documents (if any
specify)
We, the undersigned, hereby declare that the above entries are in accordance with the actual conditions. The reports and documents uploaded to the application are identical to the originals, and the original documents are kept by the Company. In the event that the OJK later requires the original documents kept by the Company, we are willing to submit said documents to the OJK. Jakarta, Directorate PT signature (Clear Name)

FORM 17: SELF-ASSESSMENT FORM FOR APPLICATION FOR APPROVAL OF CESSATION OF BUSINESS ACTIVITIES SO THAT NO LONGER BECOMES A COMPANY SELF-ASSESSMENT FORM FOR APPLICATION FOR CESSATION OF BUSINESS ACTIVITIES SO THAT NO LONGER BECOMES A COMPANY Company Name :
Application Letter Number
:
Company Profile : Business License Number and Date (including any changes if any):
Company Address:
Composition of Directorate and Commissioners:
Composition of Shareholders:
Brief Description
Regarding Reasons for Cessation of Business
Activities So That No Longer Becomes a Company :
Contact Person (Name,
Phone/Email)
:
Article 98 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing
and Institutionalization of Financing Companies and Sharia Financing Companies NO. DESCRIPTION NOTES Description Yes No Notes

Is the application letter
signed by the Directorate recorded at the OJK?
Name of the signatory of the letter: …..
Number and date of the approval decision as the key party from the OJK: …..
Number and date of the OJK recording letter:
Is the Financing Company currently
subject to sanctions of suspension of business activities?
Does the application for approval
of cessation of business activities attach documents regarding explanations of reasons for cessation of business activities?
Does the application for approval
of cessation of business activities attach the draft deed of articles of association containing the following matters:

a. Changes in business activities b. Changes in purpose and objective
c. Changes in Company Name
so that it does not use the word finance/ financing;
5. Has the company
submitted the draft letter of notification of cessation of business activities of the company to debtors and creditors? Draft letter of notification of cessation of business activities of the company to debtors and creditors, must contain information regarding the plan for the settlement of rights and obligations as well as the contact person of the company that can be contacted after the company no longer becomes a Financing Company.
6. Does the application for approval
of cessation of business activities attach the following matters:
a. Description regarding the condition of the company before the cessation of business activities b. Data regarding outstanding amounts of financing for debtors.
c. Data regarding
outstanding amounts of obligations to creditors. d. Data regarding outstanding amounts of obligations to third parties.
7. Does the application for approval
of cessation of business activities attach the plan for the settlement of rights and obligations related to the business activities of the Company's Financing? Attach documents:
1. Timeplan for the settlement of rights and obligations
of debtors and creditors
2. Description regarding the following matters:
a. Steps for the settlement of obligations to debtors b. steps for the settlement of obligations to creditors
c. steps for the settlement of obligations
to third parties

8. Does the application for approval
of cessation of business activities attach a copy of the Business License of the Company (and any changes if any)?
9. Does the application for approval
of cessation of business activities attach an explanation regarding the plan for the settlement of tax obligations?
10. Does the application for approval
of cessation of business activities attach proof of settlement of OJK Levy obligations as well as administrative fines owed?
11. Does the application for approval
of cessation of business activities attach an explanation regarding the plan for the settlement of obligations of the company to employees?
12. Does the application for approval
of cessation of business activities attach documents regarding the plan for the settlement of Legal Cases Facing (if any)? Specify the Title of the Case, Legal Status, and Brief Description

We, the undersigned, hereby declare that the above entries are in accordance with the actual conditions. The applications and documents uploaded to the application are identical to the originals, and the original documents are kept by the Company. In the event that the OJK later requires the original documents kept by the Company, we are willing to submit said documents to the OJK. Jakarta, Directorate PT signature (Clear Name)

FORM 18: SELF-ASSESSMENT FORM FOR APPLICATION FOR APPROVAL OF DISSOLUTION OF THE COMPANY DUE TO GMS DECISION SELF-ASSESSMENT FORM FOR APPROVAL OF DISSOLUTION OF THE COMPANY DUE TO GMS DECISION Company Name :
Application Letter Number
:
Company Profile : Business License Number and Date (including any changes if any):
Company Address:
Composition of Directorate and Commissioners:
Composition of Shareholders:
Brief Description
Regarding Reasons for Dissolution
:
Contact Person (Name,
Phone/Email)
:
Article 106 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning
Business Licensing and Institutionalization of Financing Companies and Sharia Financing Companies NO. DESCRIPTION NOTES Description Yes No Notes
1. Is the application letter
signed by the Directorate recorded at the OJK?
Name of the signatory of the letter: …..
Number and date of the approval decision as the key party from the OJK: …..
Number and date of the OJK recording letter:
2.
Is the Financing Company Currently subject to sanctions of suspension of business activities?
3. Does the application for approval
of dissolution attach the draft deed of approval of dissolution?
4. Does the application for approval
of dissolution attach the plan for the settlement of rights and obligations of Debtors and Creditors? Attach documents:
a. Timeplan for the settlement of rights and obligations. of debtors and creditors. b. Description regarding the following matters:
1) condition of the Company before the implementation of
dissolution
2) data regarding outstanding amounts of
financing for debtors and steps for the settlement of obligations to debtors
3) data regarding outstanding amounts of obligations
to creditors and steps for the settlement of obligations to creditors

4) data regarding outstanding amounts of obligations
to third parties and steps for the settlement of obligations to third parties
5. Has the company
submitted the draft letter of notification of the plan for the dissolution of the company to debtors and creditors? Draft letter of notification of the plan for the dissolution of the company to debtors and creditors, must contain information regarding the plan for the settlement of rights and obligations.
6. Does the application for approval
of dissolution attach a copy of the Business License of the Company (and any changes if any)?
7. Does the application for approval
of dissolution attach an explanation regarding the plan for the settlement of tax obligations?
8. Does the application for approval
of dissolution attach an explanation regarding the plan for the settlement of OJK Levies as well as administrative fines owed?
9. Does the application for approval
of dissolution attach an explanation regarding the plan for the settlement of obligations of the company to employees? We, the undersigned, hereby declare that the above entries are in accordance with the actual conditions. The applications and documents uploaded to the application are identical to the originals, and the original documents are kept by the Company. In the event that the OJK later requires the original documents kept by the Company, we are willing to submit said documents to the OJK.

Jakarta,
Directorate PT signature
(Clear Name)

FORM 19: SELF-ASSESSMENT FORM FOR APPLICATION FOR APPROVAL OF COMPANIES THAT WILL CONDUCT INTEGRATION SELF-ASSESSMENT FORM FOR APPLICATION FOR APPROVAL OF COMPANIES THAT WILL CONDUCT INTEGRATION Name of the Company conducting integration :
Name of the Company receiving integration
:
Business activities of the Company conducting integration :
No. Name of Company Type of Business
Activities
1. PT …..
2. PT …...
Number and Date of
Application Letter
:
Brief description of the background of integration :
Contact Person
(Phone/Email)
:
Article 113 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning
Business Licensing and Institutionalization of Financing Companies and Sharia Financing Companies
1. Is the application letter
signed by the Directorate that has been recorded at the OJK?
Name of the signatory of the letter: …..
Number and date of the approval decision as the key party from the OJK: …..
Number and date of the recording letter from the OJK: ….
2. Has the application attached
the action plan related to integration that will be conducted?
3. Has the application attached
the statement of willingness from the Company that will receive integration?
4. Has the application attached
the financial report of the Company that will conduct and receive integration?
Financial Report
of PT .... period ....
5. Has the application attached
the proforma financial report of the Company

that will conduct and receive integration?
6. Has the application attached
the approval from creditors in the event that the integrated item is liabilities?
7. Has the company conducted
integration before obtaining approval from the Financial Services Authority?
8. Other documents (if any,
specify)
We, the undersigned, hereby declare that the above entries are in accordance with the actual conditions. The applications and documents uploaded to the application are identical to the originals, and the original documents are kept by the Company. In the event that the OJK later requires the original documents kept by the Company, we are willing to submit said documents to the OJK. Jakarta, Directorate (PT A) Directorate (PT B) signature signature (Clear Name) (Clear Name)

FORM 20: SELF-ASSESSMENT FORM FOR REPORTING CHANGES IN UUS LEADERSHIP SELF-ASSESSMENT FORM FOR REPORTING CHANGES IN UUS LEADERSHIP Company Name :
Application Letter Number :
Date of Application Letter :
Brief Description Regarding
Type of Business Activities Conducted
:
Contact Person (Name,
Phone/Email)
:
Article 36 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing
and Institutionalization of Financing Companies and Sharia Financing Companies NO. DESCRIPTION NOTES Description Yes No Legal Basis Notes

Is the reporting letter
signed by the Directorate?
Does the company
report changes in
UUS leadership in accordance with the time specified?
Article 36 paragraph 1 of POJK
Number
47/POJK.05/2020 at the latest 15 (fifteen) calendar days from the date of appointment
Has the reporting been
attached with documents of UUS leadership data, including:
Article 31 paragraph 2 letter
d and Article 36 paragraph
2 of POJK Number
47/POJK.05/2020 a. photocopy of valid ID card or passport b. photocopy of tax identification number
c. curriculum vitae completed with
a recent color passport-sized photo of 4 x 6 cm d. proof of appointment as UUS leadership e. statement letter that states:
1) does not have non-performing loans
and/or financing; and
2) does not hold dual positions
in other functions within

Same Financing Company f. proof of expertise, training, and/or experience in the field of Sharia finance
4. Other documents (if any, specify)
We, the undersigned, hereby declare that the above entries are in accordance with the actual situation. The reports and documents uploaded to the application are the same as the originals, and the original documents are kept by the Company. In the event that OJK requires the original documents kept by the Company at a later date, we are willing to submit said documents to OJK. Jakarta, Board of Directors PT signature (Clear Name)

FORM 21: SELF-ASSESSMENT REPORTING OF CESSATION OF BUSINESS ACTIVITIES UUS SELF-ASSESSMENT FORM FOR REPORTING CESSATION OF UUS BUSINESS ACTIVITIES Company Name :
Request Letter Number :
Company Profile : UUS License Number and Date (including amendments, if any):
UUS Office Address:
Composition of Board of Directors and Board of Commissioners:
Composition of Shareholders:
Brief Description
Regarding Reasons for Cessation of UUS
Activities :
Still Required
Contact Person (Name,
Phone/Email)
: Article 40 of Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Structure of Financing Companies and Sharia Financing Companies NO. DESCRIPTION DETAILS Description Yes No Details

Is the reporting letter
signed by the
Directors registered with
OJK?
Name of signatory: …..
Number and date of approval decision as the main party from OJK: …..
Number and date of OJK recording letter:
Does the Financing
Company report the cessation of UUS business activities within a maximum period of 15 (fifteen) working days after all rights and obligations of the UUS are settled?
Does the reporting of
UUS cessation include attaching documents:
a. copy of the decision regarding the granting of the license for the establishment of the UUS b. UUS financial position report last
c. proof of execution
of the announcement of the plan to cease
UUS business activities and the plan to settle UUS obligations in a daily newspaper with national circulation within a maximum of 15 (fifteen) working days from the date of the letter of approval for the UUS closure plan; d. proof of settlement of all rights and obligations of the UUS Maximum 1 (one) year from the date of the letter of approval for the UUS closure plan e. statement letter from the Board of Directors of the Financing Company stating that all obligations of the UUS have been settled and if there are lawsuits and complaints at a later date, they become the responsibility of the Financing Company
Has the request for
approval of the cessation of business activities attached the document of the plan to settle legal cases faced (if any)? Specify Case Title, Legal Status, and Brief Description We, the undersigned, hereby declare that the above entries are in accordance with the actual situation. The requests and documents uploaded to the application are the same as the originals, and the original documents are kept by the Company. In the event that OJK requires the original documents kept by the Company at a later date, we are willing to submit said documents to OJK. Jakarta, Board of Directors PT signature (Clear Name)

FORM 22: SELF-ASSESSMENT REPORTING ON THE IMPLEMENTATION OF A GENERAL MEETING OF SHAREHOLDERS APPROVING THE SEPARATION OF A UUS SELF-ASSESSMENT FORM FOR REPORTING THE IMPLEMENTATION OF A GENERAL MEETING OF SHAREHOLDERS APPROVING THE SEPARATION OF A UUS Company Name :
Reporting Letter Number :
Date of Reporting Letter :
Effective Date of UUS
Separation
: Number & Date of OJK Letter of Approval for
UUS separation
: Contact Person (Name,
Phone/Email)
: Article 46 of Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Structure of Financing Companies and Sharia Financing Companies:
NO. DESCRIPTION YES NO DETAILS

Is the reporting letter
signed by the Directors registered with OJK?
Name of signatory: …..
Number and date of approval decision as the main party from OJK: …..
Number and date of recording letter from
OJK: …..
Was the General Meeting of Shareholders
approving the UUS separation implemented within a maximum of 60 (sixty) working days calculated from the date of the OJK approval letter? Date of GMS: ….. Date of OJK approval letter: …..
Has the submission
of the report been in accordance with the established time limit, namely a maximum of 15 (fifteen) working days calculated from the date of the GMS? Date of GMS:
Date of Reporting Letter:
Does the report on the
implementation of the GMS approving the UUS separation include a copy of the minutes of the GMS approving the UUS Separation? Title of Deed: ….. Deed Number: ….. Date of Deed: ….. Name and Position of Notary Making the Deed: ….. Content of Deed: …..
Does the report on the
implementation of the GMS approving the merger include a copy of the deed of UUS Separation? Title of Deed: ….. Deed Number: ….. Date of Deed: ….. Name and Position of Notary Making the Deed: ….. Content of Deed: …..
Does the report on the
implementation of the GMS approving the UUS separation include a copy of the deed of establishment of the Company resulting from the UUS Separation?
Does the report on the
implementation of the GMS approving the UUS separation include documents stating that the Company conducting the UUS separation has no tax debts to the competent authority? The document can be a letter of certification from the Directorate General of Taxes stating that the company has completed all tax obligations
Does the report on the
implementation of the GMS approving the UUS separation include documents regarding the settlement of payments of OJK levies for UUS Separation?
Does the report on the
implementation of the GMS approving the separation include a copy of the business license decision of the company conducting the UUS separation (if any)?
Other documents (if any,
specify)
We, the undersigned, hereby declare that the above entries are in accordance with the actual situation. The reports and documents uploaded to the application are the same as the originals, and the original documents are kept by the Company. In the event that OJK requires the original documents kept by the Company at a later date, we are willing to submit said documents to OJK. Jakarta, Board of Directors PT signature (Clear Name)

FORM 23: SELF-ASSESSMENT REPORTING ON THE IMPLEMENTATION OF UUS SEPARATION SELF-ASSESSMENT FORM FOR REPORTING THE IMPLEMENTATION OF UUS SEPARATION Company Name :
Reporting Letter Number :
Date of Reporting Letter :
Effective Date of UUS
Separation
: Number & Date of OJK Letter of Approval for the merger plan : Contact Person (Name, Phone/Email) : Article 47 of Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Structure of Financing Companies and Sharia Financing Companies NO. DESCRIPTION YES NO DETAILS
1. Is the reporting letter
signed by the
Directors registered with
OJK?
Name of signatory: …..
Number and date of approval decision as the main party from OJK: …..
Number and date of recording letter from
OJK: …..
2. Has the submission
of the report been in accordance with the established time limit, namely a maximum of 15 (fifteen) working days calculated from the date of the articles of association were approved by or notified to the competent authority? Date of approval by the competent authority:
Date of reporting letter:
3.
Does the report on the implementation of the UUS separation include the articles of association accompanied by a letter of acceptance of notification from the competent authority. Title of Deed:
Deed Number:
Date of Deed:
Name and Position of Notary Making the Deed:
Content of Deed:
Ministry of Law and Human Rights Approval Number:
Date of Ministry of Law and Human Rights Approval:
4. Other documents (if any,
specify)
We, the undersigned, hereby declare that the above entries are in accordance with the actual situation. The reports and documents uploaded to the application are the same as the originals, and the original documents are kept by the Company. In the event that OJK requires the original documents kept by the Company at a later date, we are willing to submit said documents to OJK.

Jakarta,
Board of Directors PT signature
(Clear Name)

FORM 24: SELF-ASSESSMENT REPORTING ON THE CLOSURE OF BRANCH OFFICES SELF-ASSESSMENT FORM FOR REPORTING THE CLOSURE OF BRANCH OFFICES Company Name :
Reporting Letter Number :
Date of Reporting Letter :
Name of Branch Office
(according to Branch Office License SK)
: Number & Date of Branch Office License and Address according to SK : Number & Date of Last Address Change Recording Letter (if any) and Address according to the last recording letter : Effective date of Branch Office closure : Brief Description Regarding Background of Branch Office Closure : Contact Person (Name, Phone/Email) : Article 54 of Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Structure of Financing Companies and Sharia Financing Companies NO. DESCRIPTION YES NO DETAILS

Is the reporting letter
signed by the
Directors who have been recorded by OJK?
Name of signatory: …..
Number and date of approval decision as the main party from OJK: …..
Number and date of recording letter from OJK:
….
Has the company notified
the Debtors regarding:
a. the plan to close the branch office; b. procedures for the transfer or settlement of rights and obligations. Provide an explanation regarding the submission of the plan to close the branch office and how the procedure for settling the rights and obligations of debtors is handled.
Has the submission
of the report been in accordance with the established time limit, namely a maximum of 15 (fifteen) working days calculated from the date of the Branch Office closure? Date of Branch Office Closure:
Date of Reporting Letter:
Has the report
attached proof of notification of the plan to close the branch office?
Proof of notification of the plan to close the branch office can be in the form of a photo of the announcement posted in front of the branch office, a letter of notification sent to the customer's address.
Has the report
attached proof of notification of the procedure for settling the rights and obligations of debtors? Proof of notification of the procedure for settling the rights and obligations of debtors in the letter of notification/announcement which among others contains:

Information on the branch office/head office that
receives the transfer, including address and contact information that can be reached
Payment Method
for Installments/Debtor Obligations
Method of Claim Submission
Method of Taking BPKB,
etc

Has the report
attached proof of the transfer of services of the closed Branch Office to the head office or another Branch Office? Proof of transfer or settlement of rights and obligations of Debtors:
In the event that there are still outstanding amounts, it can be accompanied by:
system screenshot showing the transfer of outstanding amounts from the closed branch office to the branch office receiving the transfer and customer data accompanied by the remaining outstanding amount. In the event that there are no remaining outstanding amounts, it can be accompanied by: system screenshot showing outstanding = 0.
Has the branch office
receiving the transfer of receivables obtained OJK approval?
Name of Branch Office:
License Number:
Date of license:
Address:
Other documents (if any,
specify)
We, the undersigned, hereby declare that the above entries are in accordance with the actual situation. The reports and documents uploaded to the application are the same as the originals, and the original documents are kept by the Company. In the event that OJK requires the original documents kept by the Company at a later date, we are willing to submit said documents to OJK. Jakarta, Board of Directors PT signature (Clear Name)

FORM 25: SELF-ASSESSMENT REPORTING ON THE CLOSURE OF UUS BRANCH OFFICES SELF-ASSESSMENT FORM FOR REPORTING THE CLOSURE OF UUS BRANCH OFFICES Company Name :
Request Letter Number :
Date of Request Letter :
Brief Description Regarding
Type of Business Activities
Conducted
: Contact Person (Name,
Phone/Email)
: Article 65 of Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Structure of Financing Companies and Sharia Financing Companies NO. DESCRIPTION DETAILS Description Yes No Legal Basis Details

Is the reporting letter
signed by the
Directors?
Has the reporting letter
been submitted in accordance with the specified time limit?
POJK Number
47/POJK.05/2020 maximum 15
(Fifteen) calendar days before the closure is carried out
Has the request
attached proof of notification of the plan to close the UUS Branch Office to the debtor?
Can be in the form of an announcement posted, notification letter, etc.
Has the request
attached the procedure for settling the rights and obligations of debtors?
Has the procedure
for settling the rights and obligations of debtors been in accordance with legislation and considered the interests of the debtor?
Has the Company
attached the documents:
a. proof of notification of the plan to close the UUS Branch Office which contains the procedure for the transfer or settlement of rights and obligations of Debtors

b. proof of transfer or settlement of rights and obligations of Debtors
c. proof of transfer or
transfer of services of the closed UUS Branch Office to the head office or another UUS Branch Office.
7. Other documents (if any,
specify)
We, the undersigned, hereby declare that the above entries are in accordance with the actual situation. The reports and documents uploaded to the application are the same as the originals, and the original documents are kept by the Company. In the event that OJK requires the original documents kept by the Company at a later date, we are willing to submit said documents to OJK. Jakarta, Board of Directors PT signature (Clear Name)

FORM 26: SELF-ASSESSMENT REPORTING ON THE IMPLEMENTATION OF OWNERSHIP CHANGES SELF-ASSESSMENT FORM FOR REPORTING THE IMPLEMENTATION OF OWNERSHIP CHANGES
I. Company Data
Name of Financing
Company
: Request Letter Number :
Date of Request Letter :
Brief description of the background of ownership changes : Contact Person (Phone/Email) : Article 76 of Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Structure of Financing Companies and Sharia Financing Companies
II. Substance of the Plan for Ownership Changes of Financing Companies
Old New
Basic Capital
Paid-up Capital with the following composition of shareholders:
Before Change After Change
Name of Shareholder
Nominal (Rp) % Name of Shareholder
Nominal (Rp) %
Total Total
III. Completeness of Documents for Request for Approval
Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Structure of Financing Companies and Sharia Financing Companies

Is the reporting letter
signed by the Directors who have obtained OJK approval?
Name of signatory: …..
Number and date of approval decision as the main party from OJK: …..
Has the ownership change
obtained approval in the GMS and been notarized in the form of a notarial deed and has obtained approval from the Ministry of Law and Human Rights? If yes, specify the reason why the ownership change has been realized before OJK approval? In the event that the ownership change has been realized before obtaining approval from OJK, the Company will be subject to an administrative sanction of Rp100,000,000.00.
Is the composition of shareholders
and share composition listed in the table before the change in accordance with what is recorded in the Financial Services Institution Licensing Information System (SIJINGGA)? In the event that the composition of shareholders and share composition listed in the table before the change is not in accordance with what is recorded in SIJINGGA, then it is necessary to submit also a report on ownership changes for the composition of shareholders and share composition that has not yet been recorded in SIJINGGA.
In the event that the ownership change
is caused by an increase in paid-up capital, has the increase in paid-up capital been carried out in the form of:
a. cash deposits; b. conversion of profit balances;
c. conversion of loans; and/or
d. stock dividends?
Specify the form of increase in paid-up capital, whether in the form of cash deposits/conversion of profit balances/conversion of loans/stock dividends
Has the request
attached a list of shareholders along with details of the size of each ownership of shares down to the last shareholder and/or beneficial owner? If there is no information down to the last shareholder, describe the reason.
Has the request
attached a list of other companies owned by the shareholders?
Has the request
attached a statement letter from the Board of Directors of the financing company signed on stamped paper stating who the beneficial owner of the financing company is? Based on Presidential Regulation Number 13 of 2018 concerning the Implementation of the Principle of Knowing the Beneficial Owner in the Context of Prevention and Eradication of Money Laundering and Terrorism Financing Crimes, every corporation is required to submit beneficial owner/ Beneficial Owner (BO) data to the General Legal Administration System (AHU) online managed by the Ministry of Law and Human Rights. Information regarding the beneficial owner/BO of the financing company is taken from the reports that have been submitted to the AHU online System. Describe a brief profile of the beneficial owner/BO and the form of control by the beneficial owner/BO over the financing company.
Has the request
attached a draft of the
Draft minutes of the GMS of PT … which approves ….
Does the draft minutes of the GMS
state the share ownership proportion after the ownership change, with reference to the calculation of the nominal value of shares (not share units)?
Has the request
attached a draft of the deed of transfer of rights over shares (if there is a transfer of rights over shares other than due to sale and purchase)? Examples of transfer of rights over shares are gifts and inheritance. The draft deed of transfer of rights over shares submitted is in the form of a draft deed gift and a draft deed of inheritance.
Has the request
attached a draft of the deed of sale and purchase of shares (if a sale and purchase of shares occurs between the shareholders)? Draft deed of sale and purchase of … shares with a nominal value of Rp... from … to …, with a price of Rp…
In the event that there is a sale and purchase of shares
among the shareholders, has a down payment (DP) been made by the buyer to the seller?
If a down payment (DP) has already been made by the buyer to the seller, attach proof of payment.
Does the ownership change
result in the existence of new shareholders who are not PSP/ whose shares are less than 25% (twenty-five percent) and do not exercise control? None / There are new shareholders who are not PSP, namely: …
If the ownership change
results in the existence of new shareholders who are not PSP, has the request attached data on the prospective new shareholders who are not PSP as referred to in Article 12 paragraph (2) letter d of POJK Number 47/POJK.05/2020? a. individuals:
1) photocopy of identification
in the form of an identity card or passport that is still valid;
2) photocopy of the tax identification number;
3) curriculum vitae with a completed color photo
of the latest size 4 x 6 cm; and
4) a statement letter from the
person concerned stating that:
a) does not have non-performing loans and/or financing; b) is not included in the list of parties prohibited from becoming shareholders or parties that manage, supervise, and/or have significant influence on financial services institutions; c) has never been sentenced for committing criminal offenses based on court decisions that have final legal force within 5 (five) years; d) has never been declared bankrupt or guilty that causes a company or company to be declared bankrupt based on court decisions that have final legal force within 5 (five) years; and e) has never been a PSP, member of the Board of Directors, member of the Board of Commissioners, or member of the DPS at a financial services company whose business license was revoked due to violations within 5 (five) years; b. legal entities:
1) copy of the deed of establishment
of the legal entity, including the articles of association along with amendments to the articles of association regarding business activities, capital, structure of shareholders, and management that are the latest, accompanied by proof of approval, approval, recording, and/or letter of acceptance of notification from the competent authority;
2) photocopy of the tax identification number; and
3) data on the directors of the legal entity
from shareholders other than
PSP, including:
a) photocopy of identification in the form of an identity card or passport that is still valid; b) photocopy of the tax identification number; c) curriculum vitae with a completed color photo of the latest size 4 x 6 cm; and d) a statement letter from the director or equivalent from the legal entity concerned stating that:
(1) the shareholder does not have non-performing loans and/or financing; (2) the shareholder is not included in the list of parties prohibited from becoming shareholders or parties that manage, supervise, and/or have significant influence on financial services institutions; (3) the shareholder has never been sentenced for committing criminal offenses in the field of financial services and/or the economy based on court decisions that have final legal force within 5 (five) years; (4) the shareholder has never been declared bankrupt or

liable that causes a company or company to be declared bankrupt based on court decisions that have final legal force within 5 (five) years; and (5) the shareholder has never been a PSP at a financial services company whose business license was revoked due to violations within 5 (five) years
15. Has the request
attached a statement letter from the prospective shareholder signed on stamped paper, stating that:
a. the source of funds for the capital contribution is not derived from money laundering, terrorism financing, and other financial crimes; and b. the source of funds for the capital contribution is not derived from loans; This statement letter is only valid for shareholders who will carry out ownership change transactions either through the mechanism of capital increase or through the mechanism of share purchase. In the event that the shareholder is a legal entity, the statement letter is signed by one of the Directors of the shareholder concerned.
16. In the event that the ownership change
is carried out through:
a. increase in paid-up capital with cash deposits by existing shareholders or new shareholders; and/or b. share purchase by existing shareholders or new shareholders, has the request attached proof of fund placement in an escrow account and/or fixed deposit in the name of the shareholder? Provide an explanation regarding the flow of funding sources and supporting evidence, including the bank statement of the prospective shareholder who will make the capital contribution for a period of 1 month before placing the funds. Case Example:
On April 1, 2022, PT X Finance Financing Company submitted a request for approval to OJK regarding the plan for ownership changes that were targeted to be completed in June
2022. The ownership change was planned to be carried out through
the mechanism of increasing paid-up capital by existing shareholders , namely Mr. Boni, with a value of increased paid-up capital of Rp1 billion. For the purpose of increasing the paid-up capital for this

Sdr. Boni has placed funds in a bank deposit at DEF Bank in his name worth Rp1 billion on March 15, 2022 (automatic renewal/ARO). Subsequently, regarding the request for approval of the ownership change plan, PT X Finance is required to attach documents including but not limited to:

A photocopy of the valid time deposit certificate in the name of Sdr. Boni at DEF Bank showing the availability of funds worth at least Rp1 billion. The funds stored in the escrow account and/or time deposit cannot be withdrawn before OJK approval.
A photocopy of Sdr. Boni’s bank statement at DEF Bank (i.e., the account used to place funds in deposit item 1) for the period of February 15 – March 15, 2022 (1 month prior to placing funds in the deposit).
If the photocopy of Sdr. Boni’s bank statement shows incoming fund flows prior to the deposit placement transaction, an explanation regarding the source of the incoming funds must also be attached, accompanied by supporting documents. For example, before Sdr. Boni placed funds in the deposit on March 15, 2022, worth Rp1 billion, there were incoming funds to Sdr. Boni’s account on March 13, 2022, worth Rp3 billion, originating from the sale of land in Bali owned by Sdr. Boni. In this case, PT X Finance must also submit proof or supporting documents related to the land sale transaction, including a notarial deed of sale.

Note:

In the event that the ownership change results in an obligation to adjust paid-in capital to a minimum of Rp250,000,000,000 (as explained in letter e), the funds placed in the deposit are also included as funds to be used by the shareholder to adjust paid-in capital to a minimum of Rp250,000,000,000.
To facilitate the company and/or shareholder in explaining the flow and source of funding, it is recommended that capital contributions be made via inter-bank transfer transactions (not cash).
OJK will trace the source of funds through several layers of ownership if necessary.

If the ownership change is caused by capital participation (whether through increasing paid-in capital or purchasing shares) by an individual shareholder, has the request attached a photocopy of the tax notification letter (SPT) for the 2 (two) years prior to the capital participation and other documents showing the financial capacity and source of funds of the prospective individual shareholder?
Photocopy of SPT for the year … and year … in the name of Mr./Ms. … (photocopy of SPT must be submitted completely, including asset and liability attachments) Provide an explanation regarding which assets listed in the SPT are used as the source of funds for capital participation.

Case Example:
From the case example in letter r, PT X Finance needs to submit a photocopy of Sdr. Boni’s SPT for 2020 and 2021, complete with asset and liability attachments. Furthermore, considering that the source of funds Sdr. Boni will use to increase paid-in capital in PT X Finance comes from the sale of land in Bali, PT X Finance must also attach an explanation that the land asset in Bali has been listed in the SPT attachments for 2020 and 2021 in Sdr. Boni’s name. However, if the SPT attachments for 2020 and 2021 in Sdr. Boni’s name do not list ownership of land in Bali, PT X Finance is required to submit a detailed explanation regarding why such assets are not listed in Sdr. Boni’s SPT.

Note:
OJK will investigate financial capacity and fund sources through several layers of ownership if necessary.

If the ownership change is caused by an increase in paid-in capital in the form of loan conversion, has the request attached a photocopy of the Company’s bank statement showing the receipt of the loan?

Case Example:
From case example 2 letter t, PT X Finance needs to submit a photocopy of PT X Finance’s bank statement showing that PT X Finance previously received a loan from PT ABC on April 15, 2019, worth Rp2 billion.

If the ownership change is caused by an increase in paid-in capital in the form of loan conversion, has the request attached supporting documents proving that the source of funds used by the third party to provide a loan to the Company does not come from a loan?

Case Example:
From case example 2 letter t, PT X Finance needs to submit:
1. A photocopy of the debt agreement between PT ABC and PT X Finance, which serves as the basis for the loan provided by PT ABC to PT X Finance on April 15, 2019, worth Rp2 billion.
2. A photocopy of PT ABC’s bank statement for the period of March 15 – April 15, 2019 (1 month prior to the loan transaction to PT X Finance).
3. If the photocopy of PT ABC’s bank statement shows incoming fund flows prior to the loan transaction to PT X Finance, an explanation regarding the source of the incoming funds must also be attached, accompanied by supporting documents.

20. If the ownership change is conducted through a reduction of paid-in capital, has the request submitted an explanation regarding the source of funds used by the Company to return capital contributions to shareholders?

21. If the ownership change is conducted through a reduction of paid-in capital, has the request attached:
a. A photocopy of the Company’s monthly financial statements for the period prior to the reduction of paid-in capital, signed by the Board of Directors? b. A forecast of the Company’s financial statements after the reduction of paid-in capital, signed by the Board of Directors? OJK may request the Company’s latest financial statements and financial forecasts with periods close to the date of OJK approval.

22. Has the request attached a photocopy of the cooperation agreement between the shareholder in the form of a foreign legal entity and the Indonesian shareholder as referred to in Article 12 paragraph (2) letter l of POJK Number 47/POJK.05/2020 (for requests for approval of ownership changes involving new shareholders in the form of foreign legal entities)?

23. Has the total foreign ownership, both direct and indirect, after the ownership change has been completed, met the provisions of Article 9 paragraph (1) of POJK Number 47/POJK.05/2020?
Foreign Ownership:
Before Change (%)
After Change (%)
Direct
Indirect

24. In the event that after the ownership change there is an exceedance of foreign ownership limits, has such exceedance met the criteria regulated in Article 9 paragraph (3) of POJK Number 47/POJK.05/2020?
If such exceedance meets the criteria regulated in Article 9 paragraph (3) of POJK Number 47/POJK.05/2020, specify:

The Company’s capital adequacy ratio:
The Company’s equity value:
Description of the liquidity problems faced by the company;

25. In the event that there is an exceedance of foreign ownership limits, has the request attached a plan to adjust foreign ownership limits approved by the Financial Services Authority (OJK) as referred to in Article 9 paragraph (4) of POJK Number 47/POJK.05/2020?
In the event that there is an exceedance of foreign ownership limits, before the Company submits a request for approval of the ownership change plan, the Company must first submit a request for approval of the foreign ownership limit adjustment plan to the Directorate of Supervision of Financing Institutions (DPLP). After the plan is approved, the Company is required to attach the approval letter from DPLP to the documents for the request for approval of the ownership change plan.

26. In the event that the ownership change is conducted through an acquisition, has the new prospective shareholder (through the Company) submitted a description of the Company’s future business plan?
Describe the Company’s future business plan prepared by the new prospective shareholder.

27. In the event that the ownership change is conducted through an acquisition, has the Company submitted a request for the assessment of suitability and propriety for the new prospective shareholder?

28. In the event that the ownership change is conducted through an acquisition, has the new prospective shareholder in the form of a legal entity operated for at least 2 (two) years prior to making capital participation in the Company?
Attach the deed of establishment of the new prospective shareholder.

29. Has the total capital participation of shareholders in the form of legal entities met the provisions of Article 4 paragraph (4) or paragraph (7) of POJK Number 47/POJK.05/2020?
Shareholder A:
Total participation amounting to Rp…
Equity as of … amounting to Rp…

30. Other documents (if any, specify)
Additional information: (if any)
We, the undersigned, hereby declare that the above entries are consistent with the actual situation. The request and documents uploaded to the application are identical to the originals, and the original documents are kept by the Company. In the event that OJK subsequently requires the original documents kept by the Company, we are willing to submit said documents to OJK. Jakarta, ………………………. Board of Directors of PT …. signature (Name)

FORM 27: SELF-ASSESSMENT REPORT ON THE IMPLEMENTATION OF THE GENERAL MEETING OF SHAREHOLDERS (GMS) THAT APPROVED THE MERGER SELF-ASSESSMENT REPORT ON THE IMPLEMENTATION OF THE GMS THAT APPROVED THE MERGER Company Name :
Report Letter Number :
Report Letter Date :
Effective Date of Merger :
Number & Date of OJK Letter of Approval for Merger Plan :
Contact Person (Name, Tel/E-mail) :
Article 81 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies

NO. DESCRIPTION YES NO NOTES

Is the report letter signed by the Board of Directors recorded at OJK?
Name of signatory: …..
Number and date of approval decision as the main party from OJK: …..
Number and date of recording letter from OJK: ….
Was the GMS approving the Merger implemented within a maximum of 60 (sixty) working days calculated from the date of the OJK approval letter?
Date of GMS:
Date of OJK approval letter:
Was the submission of the report in accordance with the established time limit, namely a maximum of 15 (fifteen) working days calculated from the date of the GMS?
Date of GMS:
Date of report letter:
Difference … working days
Does the report on the implementation of the GMS approving the Merger attach a copy of the minutes of the GMS approving the Merger?
Title of Deed:
Number of Deed:
Date of Deed:
Name and Location of Notary Making the Deed:
Content of Deed:
Does the report on the implementation of the GMS approving the Merger attach a copy of the Merger Deed?
Title of Deed:
Number of Deed:
Date of Deed:
Name and Location of Notary Making the Deed:
Content of Deed:
Does the report on the implementation of the GMS approving the Merger attach documents stating that the Company merging does not have tax debts to the competent authority?
Documents can include a letter of confirmation from the Directorate General of Taxes stating that the Company has completed all tax obligations.
Does the report on the implementation of the GMS approving the Merger attach documents regarding the settlement of OJK fee payments for the Company merging?
Does the report on the implementation of the GMS approving the Merger attach a copy of the business license decision of the Company merging, including amendments (business license SK, if any)?
Other documents (if any, specify)

We, the undersigned, hereby declare that the above entries are consistent with the actual situation. The report and documents uploaded to the application are identical to the originals, and the original documents are kept by the Company. In the event that OJK subsequently requires the original documents kept by the Company, we are willing to submit said documents to OJK. Jakarta, Board of Directors of PT signature (Clear Name)

FORM 28: SELF-ASSESSMENT REPORT ON THE IMPLEMENTATION OF THE MERGER SELF-ASSESSMENT REPORT ON THE IMPLEMENTATION OF THE MERGER Company Name :
Report Letter Number :
Report Letter Date :
Effective Date of Merger :
Number & Date of OJK Letter of Approval for Merger Plan :
Contact Person (Name, Tel/E-mail) :
Article 84 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies

NO. DESCRIPTION YES NO NOTES

Is the report letter signed by the Board of Directors recorded at OJK?
Name of signatory: …..
Number and date of approval decision as the main party from OJK: …..
Number and date of recording letter from OJK: ….
Was the submission of the report in accordance with the established time limit, namely a maximum of 15 (fifteen) working days calculated from the date the articles of association were approved by or notified to the competent authority?
Date of approval by competent authority:
Date of report letter:
Does the report on the implementation of the merger attach the articles of association accompanied by a letter of receipt of notification from the competent authority?
Title of Deed:
Number of Deed:
Date of Deed:
Name and Location of Notary Making the Deed:
Content of Deed:
Number of Kemenkumham Approval:
Date of Kemenkumham Approval:
Other documents (if any, specify)

Jakarta,
Board of Directors of PT signature
(Clear Name)

FORM 29: SELF-ASSESSMENT REPORT ON THE IMPLEMENTATION OF THE GMS THAT APPROVED THE CONSOLIDATION SELF-ASSESSMENT REPORT ON THE IMPLEMENTATION OF THE GMS THAT APPROVED THE CONSOLIDATION Company Name :
Report Letter Number :
Report Letter Date :
Effective Date of Consolidation :
Number & Date of OJK Letter of Approval for Consolidation Plan :
Contact Person (Name, Tel/e mail) :
Article 85 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies:

NO. DESCRIPTION YES NO NOTES

Is the report letter signed by the Board of Directors recorded at OJK?
Name of signatory: …..
Number and date of approval decision as the main party from OJK: …..
Number and date of recording letter from OJK: ….
Was the GMS approving the Consolidation implemented within a maximum of 60 (sixty) working days calculated from the date of the OJK approval letter?
Date of GMS: ….
Date of OJK approval letter: ….
Was the submission of the report in accordance with the established time limit, namely a maximum of 15 (fifteen) working days calculated from the date of the GMS?
Date of GMS:
Date of Report Letter:
Does the report on the implementation of the GMS approving the Consolidation attach a copy of the minutes of the GMS approving the Consolidation?
Title of Deed: ….
Number of Deed: ….
Date of Deed: ….
Name and Location of Notary Making the Deed: ….
Content of Deed: ….
Does the report on the implementation of the GMS approving the Consolidation attach a copy of the Consolidation Deed?
Title of Deed: ….
Number of Deed: ….
Date of Deed: ….
Name and Location of Notary Making the Deed: ….
Content of Deed: ….
Does the report on the implementation of the GMS approving the Consolidation attach a copy of the deed of establishment of the Company resulting from the Consolidation?
Does the report on the implementation of the GMS approving the Consolidation attach documents stating that the Company consolidating does not have tax debts to the competent authority?
Documents can include a letter of confirmation from the Directorate General of Taxes stating that the Company has completed all tax obligations.
Does the report on the implementation of the GMS approving the Consolidation attach documents regarding the settlement of OJK fee payments for the Company consolidating?
Does the report on the implementation of the GMS approving the Consolidation attach a copy of the business license decision of the Company consolidating, including amendments (if any)?
Other documents (if any, specify)

FORM 30: SELF-ASSESSMENT REPORT ON THE IMPLEMENTATION OF THE CONSOLIDATION SELF-ASSESSMENT REPORT ON THE IMPLEMENTATION OF THE CONSOLIDATION Company Name :
Report Letter Number :
Report Letter Date :
Date of Kemenkumham Approval :
Number & Date of OJK Letter of Approval for Consolidation Plan :
Contact Person (Name, Tel/E-mail) :
Article 88 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies:

NO. DESCRIPTION YES NO NOTES

Is the report letter signed by the Board of Directors recorded at OJK?
Name of signatory: …..
Number and date of approval decision as the main party from OJK: …..
Number and date of recording letter from OJK: ….
Was the submission of the report in accordance with the established time limit, namely a maximum of 15 (fifteen) working days calculated from the date the articles of association were approved by or notified to the competent authority?
Date of Kemenkumham Approval:
Date of Company Letter:
Does the report on the implementation of the consolidation attach the articles of association approved by the competent authority?
Title of Deed: ….
Number of Deed:
Date of Deed:
Number of Kemenkumham Approval:
Date of Kemenkumham Approval:
Other documents (if any, specify)

Jakarta,
Board of Directors of PT signature
(Clear Name)

FORM 31: SELF-ASSESSMENT REPORT ON THE IMPLEMENTATION OF THE GMS THAT APPROVED THE CONVERSION TO A SHARIA FINANCING COMPANY SELF-ASSESSMENT REPORT ON THE IMPLEMENTATION OF THE GMS THAT APPROVED THE CONVERSION TO A SHARIA FINANCING COMPANY Company Name :
Report Letter Number :
Report Letter Date :
Effective Date of Approval for Conversion to Sharia Financing Company :
Number & Date of OJK Letter of Approval for Plan to Convert to Sharia Financing Company :
Contact Person (Name, Tel/E-mail) :
Article 92 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies:

NO. DESCRIPTION YES NO NOTES

Is the report letter signed by the Board of Directors recorded at OJK?
Name of signatory: …..
Number and date of approval decision as the main party from OJK: …..
Number and date of recording letter from OJK: ….
Was the GMS approving the Conversion to a Sharia Financing Company implemented within a maximum of 60 (sixty) working days calculated from the date of the OJK approval letter?
Date of GMS: ….
Date of OJK approval letter: ….
Was the submission of the report in accordance with the established time limit, namely a maximum of 15 (fifteen) working days calculated from the date of the GMS?
Date of GMS:
Date of Report Letter:
Does the report on the implementation of the GMS approving the conversion attach a copy of the minutes of the GMS approving the conversion to a Sharia Financing Company?
Title of Deed: ….
Number of Deed: ….
Date of Deed: ….
Name and Location of Notary Making the Deed: ….
Content of Deed: ….
Does the report on the implementation of the GMS approving the conversion attach a copy of the Deed of Conversion to a Sharia Financing Company?
Title of Deed: ….
Number of Deed: ….
Date of Deed: ….
Name and Location of Notary Making the Deed: ….
Content of Deed: ….
Does the report on the implementation of the GMS approving the conversion attach a copy of the deed of conversion to a Sharia Financing Company?
Does the report on the implementation of the GMS approving the conversion attach documents stating that the Company converting to a Sharia Financing Company does not have tax debts to the competent authority?
Documents can include a letter of confirmation from the Directorate General of Taxes stating that the Company has completed all tax obligations.
Does the report on the implementation of the GMS approving the conversion attach documents regarding the settlement of OJK fee payments for the conversion to a Sharia Financing Company?
Does the report on the implementation of the GMS approving the conversion attach a copy of the business license decision of the Company converting to a Sharia Financing Company (if any)?
Other documents (if any, specify)

Jakarta,
Board of Directors of PT signature
(Clear Name)

FORMULIR 32: SELF-ASSESSMENT REPORTING OF CONVERSION IMPLEMENTATION FORMULAR SELF-ASSESSMENT REPORT OF CONVERSION IMPLEMENTATION Company Name :
Reporting Letter Number :
Reporting Letter Date :
Effective Date of
Conversion
:
OJK Letter Number & Date of Approval for
Conversion Implementation Plan
:
Contact Person (Name,
Phone/Email)
:
Article 93 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies
NO. DESCRIPTION YES NO NOTES

Is the reporting letter signed by the Board of Directors registered with OJK?
Name of the signatory: …..
Number and date of approval decision as the main party from OJK: …..
Number and date of recording letter from OJK: ….
Has the report been submitted within the established time limit, namely at most (15 (fifteen) working days calculated from the date the articles of association are approved by or notified to the competent authority)?
Date of approval by competent authority:
Date of reporting letter:
Has the implementation report of the separation attached the articles of association accompanied by the letter of acceptance of notification from the competent authority.
Title of Deed:
Number of Deed:
Date of Deed:
Name and Position of Notary Making the Deed:
Content of Deed:
Number of Approval from Ministry of Law and Human Rights:
Date of Approval from Ministry of Law and Human Rights:
Other documents (if any, specify)
We who sign below, hereby declare that the above entries are in accordance with the actual situation. The reports and documents uploaded to the application are the same as the originals and the original documents are kept by the Company. In the event that OJK subsequently requires the original documents kept by the Company, we are willing to submit the said documents to OJK.

Jakarta,
Board of Directors PT signature
(Clear Name)

FORMULIR 33: SELF-ASSESSMENT REPORTING OF CHANGES TO THE PURPOSE AND OBJECTIVES AND BUSINESS ACTIVITIES OF THE COMPANY FORMULAR SELF-ASSESSMENT REPORTING OF CHANGES TO THE PURPOSE AND OBJECTIVES AND BUSINESS ACTIVITIES OF THE COMPANY Company Name :
Substance of Change :
Article Content Before
Change
Article Content After
Change
Reporting Letter Number :
Reporting Letter Date :
Contact Person (Name, Phone/email)
:
Article 95 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies
NO. DESCRIPTION YES NO NOTES

Is the reporting letter signed by the Board of Directors who has been registered with OJK?
Name of the signatory:
Number and date of approval decision as the main party from OJK:
Number and date of recording letter from OJK:
Has the report been submitted to OJK at most 15 working days from the date of approval from the competent authority?
Date of approval from competent authority:
Date of reporting letter:
Has the report attached the deed of amendment to the articles of association accompanied by proof of approval or receipt of notification letter from the competent authority?
Title of Deed:
Number of Deed:
Date of Deed:
Name and Position of Notary Making the Deed:
Number of proof of approval or letter of acceptance of notification from competent authority:
Date of proof of approval or letter of acceptance of notification from competent authority:
Has the substance of the amendment to the articles of association been in accordance with the purpose and objectives as well as business activities as stipulated in Article 2 of POJK Number 35/POJK.05/2018?
Has the company been/going to conduct part of its business activities using Sharia principles?
If yes, include the number and OJK letter regarding UUS approval.
In the event of changes in business activities:
In the event that new business activities to be conducted are included in other business activities with OJK approval or fee-based, then such documents do not need to be submitted. a. Has a sample financing agreement to be used been included? b. Has the sample financing agreement to be used been in accordance with the substance of the agreement as stipulated in Articles 33 and 34 of POJK Number 35/POJK.05/2018?
Has the report attached the previous deed of amendment to the articles of association containing the purpose and objectives as well as business activities?
Title of Deed:
Number of Deed:
Date of Deed:
Name and Position of Notary Making the Deed:
Number of proof of approval or letter of acceptance of notification from competent authority:
Date of proof of approval or letter of acceptance of notification from competent authority:
Other documents (if any, specify)
We who sign below, hereby declare that the above entries are in accordance with the actual situation. The reports and documents uploaded to the application are the same as the originals and the original documents are kept by the Company. In the event that OJK subsequently requires the original documents kept by the Company, we are willing to submit the said documents to OJK. , Board of Directors PT signature (Clear Name)

FORMULIR 34: SELF-ASSESSMENT REPORTING OF COMPANY NAME CHANGES FORMULAR SELF-ASSESSMENT REPORTING OF COMPANY NAME CHANGES Old Company Name :
Company Name After
Change
:
Reporting Letter Number :
Reporting Letter Date :
Brief Description of the
Background of Name Change
:
Contact Person (Name,
Phone/Email)
:
Article 95 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies
NO. DESCRIPTION YES NO NOTES

Is the reporting letter signed by the Board of Directors who has been registered with OJK?
Name of the signatory:
Number and date of approval decision as the main party from OJK:
Number and date of OJK recording letter:
Has the report been submitted to OJK at most 15 working days from the date of approval from the competent authority?
Date of approval from competent authority:
Date of reporting letter:
Has the report attached the deed of amendment to the articles of association accompanied by proof of approval from the competent authority?
Title of Deed:
No. Deed:
Date:
Name & Position of Notary Making the Deed:
Number of proof of approval or letter of acceptance of notification from competent authority:
Date of proof of approval or letter of acceptance of notification from competent authority:
Has the report attached the NPWP (Tax Identification Number) in the new name of the Company?
NPWP No.:
New company name:
Address:
Has the name on the new NPWP been in accordance with the name in the articles of association?
New company name on NPWP:
New company name in the articles of association:
Has the new company name met the provisions of Article 6 of POJK 47/2020?
New company name:
Has the report attached a copy of the business license of the Company along with its amendments (if any)?
Decision No.:
Date:
Other documents (if any, specify)
We who sign below, hereby declare that the above entries are in accordance with the actual situation. The reports and documents uploaded to the application are the same as the originals and the original documents are kept by the Company. In the event that OJK subsequently requires the original documents kept by the Company, we are willing to submit the said documents to OJK. Jakarta, Board of Directors PT signature (Clear Name)

FORMULIR 35: SELF-ASSESSMENT REPORTING OF CHANGES TO THE LOCATION OF THE COMPANY'S HEAD OFFICE FORMULAR SELF-ASSESSMENT REPORTING OF CHANGES TO THE LOCATION OF THE COMPANY'S HEAD OFFICE Company Name :
Reporting Letter Number :
Reporting Letter Date :
Substance of Change
Head Office Address
: Old Address New Address
Contact Person (Name,
Phone/Email)
:
Article 95 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies
NO. DESCRIPTION YES NO NOTES

Is the reporting letter signed by the Board of Directors registered with OJK?
Name of the signatory:
Number and date of approval decision as the main party from OJK:
Number and date of recording letter from OJK:
Has the submission of the report been in accordance with the established time limit? (15 working days from the approval from the competent authority)
Date of approval from competent authority:
Date of reporting letter:
Has the old address been in accordance with that recorded in the Financial Services Institution Licensing Information System (SIJINGGA)?
Number and date of address recording letter from OJK: ….
In the event that the old address is not in accordance with that recorded in SIJINGGA, an explanation regarding the reason for the data difference must be submitted.
Has the report attached the deed of amendment to the articles of association accompanied by proof of approval from the competent authority?
Title of Deed:
Number of Deed:
Date of Deed:
Name and Position of Notary Making the Deed:
Content of Deed:
Number of proof of approval from competent authority:
Date of proof of approval from competent authority:
Has the company submitted a report on the change of the head office address to OJK?
OJK recording number:
OJK recording date:
Has the report on the change of location attached proof of ownership or control of the new office building?
Type of ownership proof:
Number:
Date:
Has the report on the change of location attached a photocopy of the NPWP (Tax Identification Number) for the new address of the Company?
NPWP No.:
Address:
Has the address on the new NPWP been in accordance with the new address?
Address on reporting letter:
Address on NPWP:
Other documents (if any, specify)
We who sign below, hereby declare that the above entries are in accordance with the actual situation. The reports and documents uploaded to the application are the same as the originals and the original documents are kept by the Company. In the event that OJK subsequently requires the original documents kept by the Company, we are willing to submit the said documents to OJK. , Board of Directors PT signature (Clear Name)

FORMULIR 36: SELF-ASSESSMENT REPORTING OF CHANGES IN CLOSED COMPANY STATUS TO OPEN LIMITED LIABILITY COMPANY OR VICE VERSA FORMULAR SELF-ASSESSMENT REPORTING OF CHANGES IN CLOSED COMPANY STATUS TO OPEN LIMITED LIABILITY COMPANY OR VICE VERSA Company Name :
Substance of Change :
Article Content Before
Change
Article Content After
Change
Reporting Letter Number :
Reporting Letter Date :
Contact Person (Name,
Phone/Email)
:
Article 95 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies
NO. DESCRIPTION NOTES
Description Yes No Notes

Is the reporting letter signed by the Board of Directors registered with OJK?
Name of the signatory:
Number and date of approval decision as the main party from OJK:
Number and date of recording letter from OJK:
Has the submission of the report been in accordance with the established time limit? (15 working days from the approval or receipt of the notification letter from the competent authority)
Date of approval from competent authority:
Date of reporting letter:
Has the report attached the deed of amendment to the articles of association accompanied by proof of approval from the competent authority?
Title of Deed:
Number of Deed:
Date of Deed:
Name and Position of Notary Making the Deed:
Content of Deed:
Number of proof of approval from competent authority:
Date of proof of approval from competent authority:
Has the change of company status received approval from the OJK Capital Market?
Number of recording letter:
Date of recording letter
In the event of a change of status from a closed company to an open company, has the report attached a recording letter from the Directorate of Financing Institution Supervision regarding compliance with the provisions of Article 73 of POJK 35/POJK.05/2018?
Number of recording letter:
Date of recording letter:
Other documents (if any, specify)
We who sign below, hereby declare that the above entries are in accordance with the actual situation. The reports and documents uploaded to the application are the same as the originals and the original documents are kept by the Company. In the event that OJK subsequently requires the original documents kept by the Company, we are willing to submit the said documents to OJK. , Board of Directors PT signature (Clear Name)

FORMULIR 37: SELF-ASSESSMENT REPORTING OF CHANGES TO BOARD OF DIRECTORS MEMBERS, BOARD OF COMMISSIONERS MEMBERS, AND/OR DPS MEMBERS OF THE COMPANY FORMULAR SELF-ASSESSMENT REPORTING OF CHANGES TO BOARD OF DIRECTORS MEMBERS, BOARD OF COMMISSIONERS MEMBERS, AND/OR DPS MEMBERS OF THE COMPANY Company Name :
Request Letter Number :
Request Letter Date :
Brief Description of the
Type of Business Activities Conducted
:
Contact Person (Name,
Phone/Email)
:
Article 96 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies
NO. DESCRIPTION NOTES
Description Yes No Legal Basis Notes

Is the reporting letter signed by the Board of Directors?
Article 96 of POJK 47/POJK.05/2020
Has the reporting submitted a copy of the RUPS (General Meeting of Shareholders) deed regarding the appointment of Board of Directors members, Board of Commissioners members, and/or DPS members accompanied by proof of the letter of acceptance of notification from the competent authority?
Has the submission of the report been carried out within the determined deadline?
Article 96 paragraph 1 and POJK Number 47/POJK.05/2020
At most 15 calendar days after the change is approved or recorded by the competent authority
Other documents (if any, specify)
We who sign below, hereby declare that the above entries are in accordance with the actual situation. The reports and documents uploaded to the application are the same as the originals and the original documents are kept by the Company. In the event that OJK subsequently requires the original documents kept by the Company, we are willing to submit the said documents to OJK. Jakarta, Board of Directors PT signature (Clear Name)

FORMULIR 38: SELF-ASSESSMENT REPORTING OF CHANGES TO THE ADDRESS OF THE HEAD OFFICE, BRANCH OFFICE, AND UUS BRANCH OFFICE
I. HEAD OFFICE
FORMULAR SELF-ASSESSMENT REPORTING OF CHANGES TO THE ADDRESS OF THE HEAD OFFICE Company Name :
Reporting Letter Number :
Reporting Letter Date :
Number and Date of Business License
:
Brief Description of the
Background of Head Office Address Change
:
Substance of Change
Head Office Address
: Old Address New Address
Contact Person (Name,
Phone/email)
:
Article 97 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies
NO. DESCRIPTION YES NO NOTES

Has the reporting letter been signed by the Board of Directors registered with OJK?
Name of the signatory:
Number and date of approval decision as the main party from OJK:
Number and date of recording letter from OJK:
Has the submission of the report been in accordance with the established time limit? (15 working days from the date of implementation of the change)
Date of move:
Date of report:
Has the old address been in accordance with that recorded in the Financial Services Institution Licensing Information System (SIJINGGA)?
Number and date of address recording letter from OJK: ….
In the event that the old address is not in accordance with that recorded in SIJINGGA, an explanation regarding the reason for the data difference must be submitted.
Has the report on the change of address attached proof of ownership or control of the new office building?
Type of ownership proof:
Number:
Date:
Is the lessee/borrower/owner indicated on the proof of ownership or control of the new office building the Company represented by ... as ...
If the lessee/borrower/owner is an individual, then attach a letter of certification.

in the name of the financing company?
6. Has the head office address indicated on the reporting letter been in accordance with the head office address indicated on the proof of ownership or control of the new office building?
Address on the building control proof:
If not, then write the full address to be used.
7. Has the start date of lease/borrow indicated on the proof of ownership or control of the new office building been in accordance with the date of moving the head office?
If the difference between the start date of lease/borrow and the date of moving is more than 3 months, then include the reason.
8. In the event that the change of head office address is carried out in a different city, has the company made changes to the articles of association regarding the change of location and reported the amendment to the articles of association to OJK?
9. Has the report attached photos of the exterior of the building and photos of the interior as well as the room layout?
10. Other documents (if any, specify)
We who sign below, hereby declare that the above entries are in accordance with the actual situation. The reports and documents uploaded to the application are the same as the originals and the original documents are kept by the Company. In the event that OJK subsequently requires the original documents kept by the Company, we are willing to submit the said documents to OJK. Jakarta, Board of Directors PT signature (Clear Name)

II. BRANCH OFFICE
FORMULAR SELF-ASSESSMENT REPORTING OF CHANGES TO THE ADDRESS OF THE BRANCH OFFICE Company Name :
Reporting Letter Number :
Reporting Letter Date :
Number & Date of UUS Branch Office License
:
Brief Description of the
Background of UUS Branch Office Address Change :
Reason for change of address:
Old Address New Address
Contact Person (Name,
Phone/email)
:
Article 97 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies
NO. DESCRIPTION YES NO NOTES

Is the reporting letter signed by the Board of Directors registered with OJK?
Name of the signatory:
Number and date of approval decision as the main party from OJK:
Number and date of recording letter from OJK:
Has the change of branch office address been carried out within the same city/regency?
Old address:
Old City/Regency:
New address:
New City/Regency:
Has the submission of the report been in accordance with the established time limit? (15 working days from the date of implementation of the change)
Date of Move:
Date of Report:
Has the old address been in accordance with that recorded in the Financial Services Institution Licensing Information System (SIJINGGA)?
Number and date of address recording letter from OJK: ….
In the event that the old address is not in accordance with that recorded in SIJINGGA, an explanation regarding the reason for the data difference must be submitted.
Has the report on the change of address attached proof of ownership or control of the new office building?
Type of ownership proof:
Number:
Date:
Is the lessee/
borrower/owner indicated on the proof of ownership or control of the building the Company represented by ... as ... If the lessee/borrower/owner is an individual, then attach a letter of certification.

in the name of the financing company?
7. Has the UUS branch office address indicated on the reporting letter been in accordance with the UUS branch office address indicated on the proof of ownership or control of the new office building?
Address on the proof of ownership or control of the building:
If not, then write the full address to be used.
8. Has the start date of lease/borrow indicated on the proof of ownership or control of the building been in accordance with the date of moving the UUS branch office?
Date of move:
Start date of lease:
If the difference between the start date of lease/borrow and the date of moving is more than 3 months, then include the reason.
9. Has the report on the change of address attached photos of the exterior of the building and photos of the interior as well as the room layout?
10. Other documents (if any, specify)
We who sign below, hereby declare that the above entries are in accordance with the actual situation. The reports and documents uploaded to the application are the same as the originals and the original documents are kept by the Company. In the event that OJK subsequently requires the original documents kept by the Company, we are willing to submit the said documents to OJK. Jakarta, Board of Directors PT signature (Clear Name)

III. UUS BRANCH OFFICE
FORMULAR SELF-ASSESSMENT REPORTING OF CHANGES TO THE ADDRESS OF THE UUS BRANCH OFFICE Company Name :
Reporting Letter Number :
Reporting Letter Date :
Number & Date of Branch Office License
:
Brief Description of the
Background of Branch Office Address Change
:
Reason for change of address:
Old Address New Address
Contact Person (Name,
Phone/Email)
:
Article 97 of the Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Business Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies
NO. DESCRIPTION YES NO NOTES

Is the reporting letter signed by the Board of Directors registered with OJK?
Name of the signatory:
Number and date of approval decision as the main party from OJK:
Number and date of recording letter from OJK:
Has the change of UUS branch office address been carried out within the same city/regency?
Old address:
Old City/Regency:
New address:
New City/Regency:
Has the submission of the report been in accordance with the established time limit? (15 working days from the date of implementation of the change)
Date of Move:
Date of Report:
Has the old address been in accordance with that recorded in the Financial Services Institution Licensing Information System (SIJINGGA)?
Number and date of address recording letter from OJK: ….
In the event that the old address is not in accordance with that recorded in SIJINGGA, an explanation regarding the reason for the data difference must be submitted.
Has the report on the change of address attached proof of ownership or control of the new office building?
Type of ownership proof:
Number:
Date:
Is the lessee/
borrower/owner indicated on the proof of ownership or control of the building in the name of the UUS financing company? If the lessee/borrower/owner is an individual, then attach a letter of certification.
Has the branch office address indicated on the reporting letter been in accordance with the branch office address indicated on the proof of ownership or control of the new office building?
Address on the proof of ownership or control of the building:
If not, then write the full address to be used.
Has the start date of lease/borrow indicated on the proof of ownership or control of the building been in accordance with the date of moving the branch office?
Date of move:
Start date of lease:
If the difference between the start date of lease/borrow and the date of moving is more than 3 months, then include the reason.
Has the report on the change of address attached photos of the exterior of the building and photos of the interior as well as the room layout?
Other documents (if any, specify)
We who sign below, hereby declare that the above entries are in accordance with the actual situation. The reports and documents uploaded to the application are the same as the originals and the original documents are kept by the Company. In the event that OJK subsequently requires the original documents kept by the Company, we are willing to submit the said documents to OJK. Jakarta, Board of Directors PT signature (Clear Name)

FORM 39: SELF-ASSESSMENT REPORTING FOR IMPLEMENTATION OF BUSINESS CESSATION SELF-ASSESSMENT FORM FOR REPORT ON THE IMPLEMENTATION OF BUSINESS CESSATION Company Name :
Request Letter Number
:
Company Profile : Company Address:
Board of Directors and Board of Commissioners Structure:
Shareholder Structure:
Number and Date of Approval Letter for Business Cessation Plan So That It Is No Longer a Financing Company :
Contact Person (Name,
Phone/Email)
:
Article 101 of Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies
NO. DESCRIPTION DETAILS
Description Yes No Details

Is the report letter
signed by the
Directorate recorded at OJK?
Name of signatory: …..
Number and date of approval decision as principal party from OJK: …..
Number and date of OJK recording letter:
Has the Company
ceased all business activities?
Attach proof of implementation of business cessation in the form of a statement letter signed by the Directorate on stamped paper stating that the Company is not conducting financing operational activities, namely new financing issuance activities and funding acceptance activities from creditors.
Has the company
announced the plan to cease business activities and the plan to settle the Company's obligations in a daily newspaper with national circulation for 3 (three) consecutive days within a maximum of 15 (fifteen) working days from the date of the approval letter for the business cessation plan? Attach proof of announcement, and explanation regarding:
Newspaper Name:
Type of Newspaper Circulation:
Content of Announcement:
Date of Approval Letter for Business Cessation Plan:
Date of announcement in the newspaper:

(lima belas) hari kerja sejak tanggal surat persetujuan rencana penghentian kegiatan usaha?
4. Has the company
settled all rights and obligations of the
Company within a period of at most 6 (six) months from the date of the approval letter for the business cessation plan?
5. Has the Company
appointed a public accountant to conduct an audit of the final financial position report including verification to ensure the settlement of all rights and obligations of the Company regarding the report on the implementation of business cessation? Attach proof of appointment of a public accountant to conduct an audit of the final financial position report including verification to ensure the settlement of all rights and obligations of the Company
6. Has the submission
of the report on the implementation of business cessation been in accordance with the deadline, i.e., at the latest 20 (twenty) working days after:
a. all rights and obligations are settled; or b. the time limit as referred to in
Article 100 letter c,
whichever is earlier.
Date of Report Letter on Implementation of Business Cessation:
Date of settlement of all rights and obligations of the company:
7. Has the report on the
implementation of business cessation attached proof of settlement of rights and obligations? Attach documents regarding:

Sampling of notification letters to debtors and creditors

has attached proof of settlement of rights and obligations?
2. Outstanding value of debtor receivables and creditor/third-party debts.
3. Proof of debt repayment to creditors/third parties
4. Documents regarding the mechanism for settling debtor rights and obligations (e.g., agreement on sale of receivables with other financing companies)
5. Proof of settlement of obligations to employees (e.g., proof of transfer of severance pay that has been paid in full)
6. Proof of settlement of tax obligations, among others in the form of a certificate from the Director General of Taxes stating that the company has completed all tax obligations.
7. Proof of settlement of OJK levies
8. Has the report on the
implementation of business cessation attached documents in the form of a copy of the articles of association containing the new business activities accompanied by proof of approval from the competent authority? Title of Deed:
Number of Deed:
Date of Deed:
Name and Position of Notary Making the Deed:
Content of Deed:
Number of KUMHAM approval letter:
Date of KUMHAM approval letter:
9. Has the report on the
implementation of business cessation attached documents in the form of a closing financial position report that has been audited by a public accountant?
10. Has the report on the
implementation of business cessation attached a statement letter from the shareholders signed on stamped paper stating that all rights and obligations of the Company have been settled and if there are claims and lawsuits in the future become the responsibility of the shareholders?
11. Has the report on the
implementation of business cessation attached documents for settlement of SLIK Debtor data? We who sign below hereby declare that the entries above are in accordance with the actual situation. The reports and documents uploaded into the application are the same as the originals and the original documents are stored by the Company. In the event that OJK requires the original documents stored by the Company at a later date, we are willing to submit said documents to OJK. Jakarta, signature (Clear Name)

FORM 40: SELF-ASSESSMENT REPORTING FOR DEBT PAYMENT DEFERRAL PROCESS, EITHER UPON OWN REQUEST OR UPON CREDITOR'S REQUEST SELF-ASSESSMENT FORM FOR REPORTING COMPANIES IN THE PROCESS OF DEBT PAYMENT DEFERRAL, EITHER UPON OWN REQUEST OR UPON CREDITOR'S REQUEST Company Name :
Report Letter Number :
Date of Report Letter :
Contact Person (Name,
Phone/Email)
:
Article 103 of Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies
NO. DESCRIPTION YES NO DETAILS

Is the report letter
signed by the
Directorate recorded at
OJK?
Name of signatory: …..
Number and date of approval decision as principal party from OJK: …..
Number and date of recording letter from
OJK: …..
Does it contain
a description of the name of the party submitting the request for declaration of debt payment deferral obligation?
Does it contain
a description of the summary of the request for declaration of debt payment deferral obligation?
Does it contain
a description of the action plan that will be carried out by the Company to follow up on the process of debt payment deferral obligation?
Other documents (if
any, specify)
We who sign below hereby declare that the entries above are in accordance with the actual situation. The reports and documents uploaded into the application are the same as the originals and the original documents are stored by the Company. In the event that OJK requires the original documents stored by the Company at a later date, we are willing to submit said documents to OJK. Jakarta, Board of Directors PT

signature
(Clear Name)

FORM 41: SELF-ASSESSMENT REPORTING FOR BANKRUPTCY PROCESS, EITHER UPON OWN REQUEST OR UPON CREDITOR'S REQUEST SELF-ASSESSMENT FORM FOR REPORTING COMPANIES IN THE BANKRUPTCY PROCESS, EITHER UPON OWN REQUEST OR UPON CREDITOR'S REQUEST Company Name :
Report Letter Number :
Date of Report Letter :
Contact Person (Name,
Phone/Email)
:
Article 104 of Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies
NO. DESCRIPTION YES NO DETAILS

Is the report letter
signed by the
Directorate recorded at
OJK?
Name of signatory: …..
Number and date of approval decision as principal party from OJK: …..
Number and date of recording letter from
OJK: …..
Is the report submitted
at most 5
(five) working days since the existence of the request for declaration of bankruptcy?
Does the report contain
a description regarding the name of the party filing for bankruptcy?
Does the report contain
a description regarding the summary of the request for declaration of bankruptcy?
Does the report contain
a description regarding the action plan that will be carried out by the Company to follow up on the bankruptcy process?
Other documents (if
any, specify)
We who sign below hereby declare that the entries above are in accordance with the actual situation. The reports and documents uploaded into the application are the same as the originals and the original documents are stored by the Company. In the event that OJK requires the original documents stored by the Company at a later date, we are willing to submit said documents to OJK. Jakarta,

Board of Directors PT signature
(Clear Name)

FORM 42: SELF-ASSESSMENT REPORTING FOR DISSOLUTION IMPLEMENTATION
I. DISSOLUTION DUE TO RUPS DECISION
SELF-ASSESSMENT FORM FOR REPORTING ON THE IMPLEMENTATION OF DISSOLUTION DUE TO RUPS DECISION Company Name :
Request Letter Number
:
Company Profile : Company Address:
Board of Directors and Board of Commissioners Structure:
Shareholder Structure:
Number and Date of Approval Letter for Dissolution Plan :
Contact Person (Name,
Phone/Email)
:
Article 109 of Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies
NO. DESCRIPTION DETAILS
Description Yes No Details
1. Is the report letter
signed by the
Directorate recorded at OJK?
Name of signatory: …..
Number and date of approval decision as principal party from OJK: …..
Number and date of OJK recording letter:
2. Does the company
meet the requirement of not being subject to suspension of business activities sanctions?
3. Does the Company
obtain approval from the
Financial Services Authority?
4. Has the submission
of the report on the implementation of dissolution been in accordance with the time limit, i.e., at most 15 (fifteen) working days counted from the date the articles of association are approved, agreed upon by, or notified to the competent authority? Date of notification to KUMHAM:
Date of approval from KUMHAM:
5. Has the submission
of the report on the implementation of dissolution attached documents in the form of a dissolution deed that has been notified to the competent authority? Date of Deed:
Name and Position of Notary Making the Deed:
Content of Deed:
6. Has the submission
of the report on the implementation of dissolution attached a letter of approval from the competent authority? Number of KUMHAM approval letter:
Date of KUMHAM approval letter:
7. Has the submission
of the report on the implementation of dissolution attached document proof of announcement of dissolution in a daily newspaper with national circulation for 3 (three) consecutive days within a maximum of 15 (fifteen) working days since the date of the approval letter for the dissolution plan Newspaper Name:
Type of Newspaper Circulation:
Content of Announcement:
Date of Approval Letter for Dissolution Plan:
Date of announcement in the newspaper:
8. Has the submission
of the report on the implementation of dissolution attached document proof of settlement of rights and obligations Attach documents regarding:
1. Sampling of notification letters to debtors and
creditors
2. Outstanding value of debtor receivables and creditor/third-party debts
3. Proof of debt repayment to creditors/third
parties
4. Documents regarding the mechanism for settling debtor rights
and obligations (e.g., agreement on sale of receivables with other financing companies)
5. Proof of settlement of obligations to employees
(e.g., proof of transfer of severance pay that has been paid in full)
6. Proof of settlement of tax obligations, among others
in the form of a certificate from the Director General of Taxes that states that the company has completed all tax obligations.
7. Proof of settlement of OJK levies
9. Has the company
already submitted a copy of the decision regarding the granting of business license for the company?
10. Has the submission
of the report on the implementation of dissolution attached documents for the closing financial position report that has been audited?
11. Has the submission
of the report on the implementation of dissolution attached documents for settlement of SLIK Debtor data? We who sign below hereby declare that the entries above are in accordance with the actual situation. The reports and documents uploaded into the application are the same as the originals and the original documents are stored by the Company. In the event that OJK requires the original documents stored by the Company at a later date, we are willing to submit said documents to OJK. Jakarta, signature (Clear Name)

II. DISSOLUTION BASED ON COURT DECREE OR FOLLOW-UP TO BANKRUPTCY PROCESS
SELF-ASSESSMENT FORM FOR REPORT ON THE IMPLEMENTATION OF DISSOLUTION BASED ON COURT DECREE OR FOLLOW-UP TO BANKRUPTCY PROCESS Company Name :
Report Letter Number :
Date of Report Letter :
Contact Person (Name,
Phone/Email)
:
Article 110 of Financial Services Authority Regulation Number 47/POJK.05/2020 concerning Licensing and Institutional Aspects of Financing Companies and Sharia Financing Companies
NO. DESCRIPTION YES NO DETAILS

Is the report letter
signed by the
Directorate recorded at
OJK?
Name of signatory: …..
Number and date of approval decision as principal party from OJK: …..
Number and date of recording letter from
OJK: …..
Does the company
submit the report within the established timeframe? at most 15 working days since the court decision that has permanent legal force
Does the company
attach documents a copy of the decision regarding the granting of business license for the Company?
Does the company
attach documents of the court decision that has permanent legal force?
Other documents (if
any, specify)
We who sign below hereby declare that the entries above are in accordance with the actual situation. The reports and documents uploaded into the application are the same as the originals and the original documents are stored by the Company. In the event that OJK requires the original documents stored by the Company at a later date, we are willing to submit said documents to OJK.

Jakarta,
Board of Directors PT signature
(Clear Name)
Established in Jakarta on November 9, 2023
EXECUTIVE HEAD OF SUPERVISOR OF FINANCING INSTITUTIONS, VENTURE CAPITAL COMPANIES, MICROFINANCE INSTITUTIONS, AND OTHER FINANCIAL SERVICE INSTITUTIONS FINANCIAL SERVICES AUTHORITY REPUBLIC OF INDONESIA, AGUSMAN This copy is in accordance with the original Legal Director 1 Legal Department Mufli Asmawidjaja signed signed

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