Financial Services Authority Circular No. 16/SEOJK.05/2013 Regarding Monthly Reports of PT Jasa Raharja (Persero)

To:
PT Jasa Raharja (Persero)
At Location

COPY
FINANCIAL SERVICES AUTHORITY CIRCULAR NUMBER 16/SEOJK.05/2013 REGARDING MONTHLY REPORTS OF PT JASA RAHARJA (PERSERO)

In connection with Financial Services Authority Regulation Number 3/POJK.05/2013 dated September 12, 2013 regarding Monthly Reports of Non-Bank Financial Service Institutions (State Gazette of the Republic of Indonesia Year 2013 Number 150, Supplement to the State Gazette of the Republic of Indonesia Number 5443), it is necessary to regulate implementation provisions regarding the monthly reports of PT Jasa Raharja (Persero) in this Financial Services Authority Circular as follows:

I. GENERAL PROVISIONS

1. The Financial Services Authority, hereinafter abbreviated as OJK, is an independent institution free from the interference of other parties, which has the functions, duties, and authorities for regulation, supervision, examination, and investigation, as referred to in Law Number 21 of 2011 concerning the Financial Services Authority.

2. Monthly Report is a financial report prepared by non-bank financial service institutions for the benefit of OJK, covering the period from the 1st to the end of the current month and submitted according to the format and procedures determined by OJK.

II. FORM AND STRUCTURE OF MONTHLY REPORTS

The form and structure of the Monthly Report for PT Jasa Raharja (Persero) are as stated in the Appendix, which is an integral part of this OJK Circular.

III. TIME SUBMISSION OF MONTHLY REPORTS

1. PT Jasa Raharja (Persero) is obligated to submit the Monthly Report to OJK no later than the 10th of the following month.

2. In the event that the 10th date referred to in item 1 falls on a holiday, the Monthly Report must be submitted on the next working day.

IV. SUBMISSION PROCEDURES

1. Submission of the Monthly Report is conducted online through OJK's data communication network system.

2. In the event that OJK's data communication network system is not available, the Monthly Report is submitted online via the company's official email by attaching a softcopy of the Monthly Report in spreadsheet format to LB.ASOS@ojk.go.id.

3. In the event that the Monthly Report is submitted offline, submission is conducted via a letter signed by at least one member of the Board of Directors and addressed to:
   Financial Services Authority u.p. Director of Insurance Supervision Sumitro Djojohadikusumo Building, 14th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710

4. Submission of the Monthly Report offline as referred to in item 3 may be done in one of the following ways:
   a. handed in directly to the OJK office; b. sent via registered postal service; or
   c. sent via a courier/consignment service company.

5. PT Jasa Raharja (Persero) is deemed to have submitted the Monthly Report with the following provisions:
   a. for online submission via email, evidenced by an acknowledgment email from OJK, b. for offline submission, evidenced by:
   1) an acknowledgment letter from OJK, if the report is handed in directly to the OJK office; or
   2) a shipping receipt from the post office or courier/consignment service company, if the report is sent via the post office or courier/consignment service company.

6. In the event of changes to the OJK email address as referred to in item 2 and/or changes to the OJK office address as referred to in item 3, OJK will communicate the address changes via letter or announcement.

V. SANCTION PROVISIONS

1. OJK imposes administrative sanctions in the form of a first written warning as regulated in Article 6 paragraph (3) of OJK Regulation Number 3/POJK.05/2013 regarding Monthly Reports of Non-Bank Financial Service Institutions, with a compliance period for submitting the Monthly Report of no longer than 30 (thirty) days from the imposition of the administrative sanction in the form of a first written warning.

2. If within the time period referred to in item 1 the obligation to submit the Monthly Report is not fulfilled, OJK imposes administrative sanctions in the form of a second written warning as regulated in Article 6 paragraph (4) of OJK Regulation Number 3/POJK.05/2013 regarding Monthly Reports of Non-Bank Financial Service Institutions, with a compliance period for submitting the Monthly Report of no longer than 30 (thirty) days from the imposition of the administrative sanction in the form of a second written warning.

3. If within the time period referred to in item 2 the obligation to submit the Monthly Report is not fulfilled, OJK imposes administrative sanctions in the form of a third written warning as regulated in Article 6 paragraph (4) of OJK Regulation Number 3/POJK.05/2013 regarding Monthly Reports of Non-Bank Financial Service Institutions, with a compliance period for submitting the Monthly Report of no longer than 30 (thirty) days from the imposition of the administrative sanction in the form of a third written warning.

VI. TRANSITIONAL PROVISIONS

1. PT Jasa Raharja (Persero) is obligated to submit the Monthly Report to OJK for the reporting period of September 2013 through the reporting period of August 2014 no later than the end of the following month.

2. In the event that the end of the following month referred to in item 1 falls on a holiday, the Monthly Report must be submitted on the next working day.

3. During the reporting period of September 2013 through the reporting period of August 2014, PT Jasa Raharja (Persero) is not required to submit reports for September 2013, December 2013, March 2014, and June 2014.

VII. CLOSING

This Financial Services Authority Circular takes effect on the date of issuance.

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

Established in Jakarta on November 25, 2013 EXECUTIVE HEAD OF IKNB SUPERVISOR FINANCIAL SERVICES AUTHORITY, Signed, FIRDAUS DJAELANI

Copy matches the original
Head of Legal Assistance Division
Legal Directorate
Signed,
Mufli Asmawidjaja

APPENDIX
FINANCIAL SERVICES AUTHORITY CIRCULAR NUMBER 16/SEOJK.05/2013 REGARDING MONTHLY REPORTS OF PT JASA RAHARJA (PERSERO)

To:
Financial Services Authority
Up. Director of Insurance Supervision Sumitro Djojohadikusumo Building, 14th Floor Jl. Lapangan Banteng Timur 1 - 4 Jakarta - 10710

MONTHLY REPORT
PT JASA RAHARJA (PERSERO)
Period …………./ Month ………. Year ………..
(Company Address)

(in millions of rupiah)

Description	Balance SAK	Balance SAP
ASSETS
Investments
Time Deposits and Certificates of Deposit	-	-
Stocks	-	-
Corporate Bonds and Corporate Sukuk	-	-
Securities Issued by the Indonesian State	-	-
Securities Issued by States Other than the Indonesian State	-	-
Securities Issued by Bank Indonesia	-	-
Securities Issued by Multinational Institutions	-	-
Mutual Funds	-	-
Asset-Backed Securities Collective Investment Contracts	-	-
Real Estate Investment Funds	-	-
Direct Investments	-	-
Buildings with Strata Rights or Land with Buildings for Investment	-	-
Purchase of Receivables for Financing Companies and/or Banks	-	-
Pure Gold	-	-
Loans Secured by Mortgage Rights	-	-
Other Investments	-	-
Total Investments	-	-
Non-Investments
Cash and Banks	-	-
Direct Underwriting Premium Receivables	-	-
Coinsurance Claim Receivables	-	-
Reinsurance Receivables	-	-
Investment Receivables	-	-
Investment Income Receivables	-	-
Buildings with Strata Rights or Land with Buildings for Own Use	-	-
Other Fixed Assets	-	-
Other Assets	-	-
Total Non-Investments	-	-
TOTAL ASSETS	-	-
LIABILITIES AND EQUITY
Liabilities
Debts
Claim Debts	-	-
Coinsurance Debts	-	-
Reinsurance Debts	-	-
Commission Debts	-	-
Tax Debts	-	-
Accrued Expenses	-	-
Other Debts	-	-
Total Debts	-	-
Technical Reserves
Premium Reserves	-	-
Reserves for Premiums Not Yet Earned Revenue	-	-
Claim Reserves	-	-
Total Technical Reserves	-	-
Total Liabilities	-	-
Subordinated Loans	-	-
Equity
Paid-in Capital	-	-
Share Premium	-	-
Retained Earnings Balance	-	-
Other Equity Components	-	-
Difference in Valuation Based on SAK and SAP	-	-
Assets Not Included in AYD	-	-
Total Equity	-	-
TOTAL LIABILITIES AND EQUITY	-	-

Month … Year …
PT JASA RAHARJA (PERSERO)
FINANCIAL POSITION REPORT
Non-Consolidated
Period ….

(in millions of rupiah)

Description	Month …	Year …
UNDERWRITING INCOME
Gross Premiums
a. Direct Underwriting Premiums
b. Indirect Underwriting Premiums
c. Paid Commissions
Total Gross Premiums	-
Reinsurance Premiums
a. Paid Reinsurance Premiums
b. Received Reinsurance Commissions
Total Reinsurance Premiums	-
Net Premiums	-
Decrease (Increase) in Premium Reserves and CAPYBMP
a. Decrease (Increase) in Premium Reserves
b. Decrease (Increase) in CAPYBMP
Decrease (Increase) in Premium Reserves and CAPYBMP	-
Total Net Premium Income	-
Other Net Underwriting Income
UNDERWRITING INCOME	-
UNDERWRITING EXPENSES
Claim Expenses
a. Gross Claims
b. Reinsurance Claims
c. Increase (Decrease) in Claim Reserves
Total Net Claim Expenses	-
Other Net Underwriting Expenses
TOTAL UNDERWRITING EXPENSES	-
UNDERWRITING RESULT	-
Investment Result
Business Expenses:
a. Marketing Expenses
b. General and Administrative Expenses:
- Employee and Executive Expenses
- Education and Training Expenses
- Other General and Administrative Expenses
Total Business Expenses	-
INSURANCE OPERATING PROFIT (LOSS)	-
Other Income (Expenses)
PROFIT (LOSS) BEFORE TAX	-
Income Tax
PROFIT AFTER TAX	-
Other Comprehensive Income
TOTAL COMPREHENSIVE PROFIT (LOSS)	-

PT JASA RAHARJA (PERSERO)
COMPREHENSIVE INCOME/LOSS REPORT
Period ….

(in millions of rupiah)

Description	Month …	Year …
CASH AND BANK BALANCE BEGINNING
CASH FLOWS FROM OPERATING ACTIVITIES
Cash Inflows
a. Premiums
b. Coinsurance Claims
c. Reinsurance Claims
d. Commissions
e. Receivables
f. Others
Total Cash Inflows	-
Cash Outflows
a. Reinsurance Premiums
b. Claims
c. Commissions
d. Expenses
e. Others
Total Cash Outflows	-
TOTAL CASH FLOWS FROM OPERATING ACTIVITIES	-
CASH FLOWS FROM INVESTMENT ACTIVITIES
Cash Inflows
a. Investment Income Receipts
b. Investment Withdrawals
c. Sale of Fixed Assets
d. Others
Total Cash Inflows	-
Cash Outflows
a. Investment Placements
b. Purchase of Fixed Assets
c. Others
Total Cash Outflows	-
TOTAL CASH FLOWS FROM INVESTMENT ACTIVITIES	-
CASH FLOWS FROM FINANCING ACTIVITIES
Cash Inflows
a. Subordinated Loans
b. Capital Contributions
c. Others
Total Cash Inflows	-
Cash Outflows
a. Dividend Payments
b. Subordinated Loan Payments
c. Others
Total Cash Outflows	-
TOTAL CASH FLOWS FROM FINANCING ACTIVITIES	-
CASH AND BANK BALANCE ENDING	-

PT JASA RAHARJA (PERSERO)
CASH FLOW REPORT
Period ….

(in millions of rupiah)

Description	Month …	Year …
Solvency Ratio
Permitted Assets	-
Liabilities (excluding Subordinated Loans)	-
Total Solvency Ratio	-
Minimum Risk-Based Capital (MRCB)
Schedule A
Schedule B
Schedule C
Schedule D
Schedule E
Schedule F
Schedule G
Total MRCB	-
Excess (Deficiency) of Solvency Ratio Limit	-
Solvency Achievement Ratio (in %) 1)	#DIV/0!
1) Total Solvency Ratio divided by Total MRCB
In the event the Company experiences a solvency deficiency, the amount of funds needed to reach a 100.00% RBC ratio
120.00%

PT JASA RAHARJA (PERSERO)
SOLVENCY LEVEL REPORT
Solvency Achievement Ratio
Period ….

Rupiah 3)	Valas 3)	Total	Rupiah 3)	Valas 3)	Total	Rupiah 3)	Valas 3)	Total
≤ 1 year	#DIV/0!	#DIV/0!	#DIV/0!
1 year < age ≤ 5 years	#DIV/0!	#DIV/0!	#DIV/0!
5 years < age ≤ 10 years	#DIV/0!	#DIV/0!	#DIV/0!
> 10 years	#DIV/0!	#DIV/0!	#DIV/0!
Total	#DIV/0!

Rupiah 2)	Valas 2)	Total 2)

Notes:
1) In millions of rupiah
2) In percentage
3) Already converted to Indonesian Rupiah currency

Current assets/liabilities are assets/liabilities with an age of less than 1 year up to 1 year. Non-current assets/liabilities are assets/liabilities with an age of more than 1 year.

Signed,

Description	Asset Ratio Against Liabilities 2)
Asset Age 1)	Liabilities 1)
Current Asset Ratio Against Non-Current Assets
Current Liability Ratio Against Non-Current Liabilities

PT JASA RAHARJA (PERSERO)
ASSET AND LIABILITY MATCHING ANALYSIS REPORT Period … / Month … Year …

Mufli Asmawidjaja
Established in Jakarta on November 25, 2013 EXECUTIVE HEAD OF IKNB SUPERVISOR FINANCIAL SERVICES AUTHORITY Head of Legal Assistance Division Signed, FIRDAUS DJAELANI Copy matches the original Legal Directorate