Financial Services Authority Regulation Number 12/POJK.05/2014 Concerning Business Licensing and Institutional Aspects of Microfinance Institutions

FINANCIAL SERVICES AUTHORITY
REPUBLIC OF INDONESIA
COPY
FINANCIAL SERVICES AUTHORITY REGULATION
NUMBER 12 / POJK.05/2014
CONCERNING
BUSINESS LICENSING AND INSTITUTIONAL ASPECTS OF MICROFINANCE INSTITUTIONS BY THE GRACE OF GOD THE ALMIGHTY, THE COMMISSIONERS OF THE FINANCIAL SERVICES AUTHORITY, Considering: that in order to implement the provisions of Article 7 paragraph (2), Article 10, Article 22 paragraph (2), Article 23 paragraph (3), Article 27, and Article 33 paragraph (3) of Law Number 1 of 2013 concerning Microfinance Institutions, it is necessary to establish a Financial Services Authority Regulation concerning Business Licensing and Institutional Aspects of Microfinance Institutions; Recalling: 1. Law Number 21 of 2011 concerning the Financial Services Authority (State Gazette of the Republic of Indonesia Year 2011 Number 111, Supplement to the State Gazette of the Republic of Indonesia Number 5253);
2. Law Number 1 of 2013 concerning Microfinance Institutions (State Gazette of the Republic of Indonesia Year 2013 Number 12, Supplement to the State Gazette of the Republic of Indonesia Number 5394);
3. Government Regulation Number 89 of 2014 concerning Loan Interest Rates or Financing Returns and the Scope of Business Areas of Microfinance Institutions) (State Gazette of the Republic of Indonesia Year 2014 Number 321, Supplement to the State Gazette of the Republic of Indonesia Number 5616);
DECIDING:
Establishing: A FINANCIAL SERVICES AUTHORITY REGULATION CONCERNING BUSINESS LICENSING AND INSTITUTIONAL ASPECTS OF MICROFINANCE INSTITUTIONS.

CHAPTER I
GENERAL PROVISIONS
Article 1
In this Financial Services Authority Regulation, the following terms are defined as:

1. Microfinance Institutions, hereinafter abbreviated as MFI, are financial institutions specifically established to provide business development services and community empowerment, either through loans or financing in micro-scale businesses to members and the public, savings management, or the provision of business development consulting services, which are not solely profit-oriented.
2. Loan is the provision of funds by an MFI to the public that must be repaid according to the agreement.
3. Financing is the provision of funds by an MFI to the public that must be repaid according to the agreement based on Sharia principles.
4. Savings are funds entrusted by the public to an MFI in the form of savings and/or deposits based on a fund storage agreement.
5. Depositor is the party that places its funds with an MFI based on an agreement.
6. Sharia Principles are Islamic legal provisions based on fatwas or statements of Sharia compliance from the National Sharia Council of the Indonesian Ulema Council (DSN MUI).
7. Board of Directors:
   a. for MFIs in the form of a Limited Liability Company, are the board of directors as referred to in legislation concerning limited liability companies; b. for MFIs in the form of a Cooperative legal entity, are the managers as referred to in legislation concerning cooperatives.
8. Board of Commissioners:
   a. for MFIs in the form of a Limited Liability Company, are the board of commissioners as referred to in legislation concerning limited liability companies; b. for MFIs in the form of a Cooperative legal entity, are the supervisors as referred to in legislation concerning cooperatives.
9. Sharia Supervisory Board, hereinafter abbreviated as DPS, is a part of the MFI organ that conducts business activities based on Sharia Principles.
10. Financial Services Authority, hereinafter abbreviated as OJK, is an independent institution free from the interference of other parties that has the function, duties, and authority for regulation, supervision, examination, and investigation as referred to in the Law concerning the OJK.

CHAPTER II
LEGAL ENTITY FORM, OWNERSHIP, BUSINESS LICENSING, AND CAPITAL First Section Legal Entity Form and Ownership
Article 2
(1) The legal entity form of an MFI is:
a. a cooperative; or b. a limited liability company.
(2) The limited liability company as referred to in paragraph (1) letter b, at least 60% (sixty percent) of its shares must be owned by the District/City Regional Government or village/village enterprise legal entities. (3) The remaining share ownership of the limited liability company as referred to in paragraph (2) may be owned by:
a. Indonesian citizens; and/or b. cooperatives.
(4) Ownership of each Indonesian citizen over the shares of the limited liability company as referred to in paragraph (3) letter a is prohibited from exceeding 20% (twenty percent).
Article 3
While still observing the provisions as referred to in Article 2 of this OJK Regulation, an MFI may only be owned by:
a. Indonesian citizens; b. village/village enterprise legal entities;
c. District/City Regional Governments; and/or
d. cooperatives.
Article 4
MFIs are prohibited from being owned, either directly or indirectly, by foreign citizens and/or business entities that are partially or wholly owned by foreign citizens or foreign business entities.

Second Section
Business Licensing
Article 5
(1) An MFI may conduct business activities conventionally or based on Sharia Principles.
(2) Before conducting business activities, an MFI must have a business license from the OJK.
(3) To obtain the business license as referred to in paragraph (2), the MFI's Board of Directors submits a business license application to the OJK according to the format in Appendix I which is an integral part of this OJK Regulation and must be accompanied by:
a. the deed of establishment of the legal entity including the articles of association and any amendments (if any) that have been approved/agreed upon by the competent authority or notified to the competent authority, which at least contains:

1. name and domicile;
2. business activities as a conventional MFI or based on Sharia Principles;
3. capital;
4. ownership; and
5. authority, responsibility, and term of office of the Board of Directors, Board of Commissioners, and DPS;
   b. data on the Board of Directors, Board of Commissioners, and DPS including:
6. 1 (one) latest 4 x 6 cm passport photo;
7. photocopy of a valid identification card (KTP);
8. curriculum vitae;
9. a stamped declaration letter from the Board of Directors, Board of Commissioners, and DPS for MFIs conducting business activities based on Sharia Principles:
   a) not recorded in the list of non-performing loans in the financial services sector; b) never sentenced for committing criminal offenses in the field of financial services business and/or the economy based on a court decision that has acquired permanent legal force; c) never sentenced for committing criminal offenses based on a court decision that has acquired permanent legal force in the last 5 (five) years; d) never declared bankrupt or caused a business entity to be declared bankrupt based on a court decision that has acquired permanent legal force in the last 5 (five) years; e) not holding concurrent positions as Directors in other MFIs for Directors; f) not holding concurrent positions as Board of Commissioners in more than 2 (two) other MFIs for Directors; and g) not holding concurrent positions as Board of Commissioners in more than 3 (three) other MFIs for Board of Commissioners;
10. a certificate or written proof of having operational experience in the field of microfinance institutions or other financial services institutions for at least 1 (one) year for one of the Directors; and
11. a certificate or written proof of having operational experience in the field of microfinance institutions conducting business activities based on Sharia Principles or other Sharia financial services institutions for at least 1 (one) year for one of the Directors, for MFIs conducting business activities based on Sharia Principles;
    c. data on shareholders or members:
12. in the event that shareholders or members are individuals, the documents attached are the documents as referred to in letter b numbers 1), 2), and 3) and a stamped declaration letter that the capital deposit:
    a) does not originate from loans; and b) does not originate from and for money laundering criminal acts;
13. in the event that shareholders or members are village/village enterprise legal entities and/or cooperatives, the documents attached are:
    a) the deed of establishment including the articles of association and any amendments (if any) that have been approved/agreed upon by the competent authority or notified to the competent authority, or proof of establishment of village/village enterprise legal entities; b) financial reports that have been audited by a public accountant or the latest financial report or latest financial bookkeeping; c) documents as referred to in letter b numbers 1), 2), and 3) for the Directors or managers of village/village enterprise legal entities and/or cooperatives; and d) a stamped declaration letter that the capital deposit:
    i. does not originate from loans; and
    ii. does not originate from and for money laundering criminal acts;
14. In the event that shareholders are District/City Regional Governments, the documents attached are decisions or District/City Regional Regulations regarding capital participation in the MFI;
    d. a recommendation letter for the appointment of DPS from DSN MUI for MFIs conducting business activities based on Sharia Principles; e. organizational structure and management which at least has credit decision-making, collection, and administration functions; f. MFI work systems and procedures, at least including:
15. provision of Loans or Financing;
16. acceptance of Savings;
17. collection from borrowers or parties receiving Financing;
18. procedures for resolving non-performing receivables; and
19. procedures for closing Savings;
    g. work plan for the first 2 (two) years which at least contains:
20. data regarding the number of other microfinance institutions in the business area of the relevant MFI;
21. MFI business activity plan containing projections of Savings and disbursement of Loans or Financing as well as steps to be taken to realize the aforementioned plan;
22. description of economic potential in the business area of the relevant MFI;
23. projections of financial position reports and financial performance reports every 4 (four) months starting from when the MFI begins operational activities; and
24. projections of financial position reports and financial performance reports as referred to in number 4) refer to regulations concerning MFI financial reports;
    h. photocopy of proof of paid-up capital or principal savings, mandatory savings, and grants in the form of fixed-term deposits that are still valid in the name of the relevant MFI at one of the banks in Indonesia or one of the Sharia banks or Sharia business units in Indonesia for MFIs conducting business activities based on Sharia Principles; and
    i. proof of operational readiness including among others:
25. list of fixed assets (if any) and inventory;
26. proof of ownership or control of the office; and
27. example forms to be used for MFI operations.
    (4) Documents in the form of declaration letters and proof of capital deposits as referred to in paragraph (3) letter c number 1) letter a) and b), letter c number 2) letter d), and letter h do not apply to MFIs that were already operating at the time Law Number 1 of 2013 concerning Microfinance Institutions was promulgated.
    Article 6
    (1) The OJK provides approval or rejection of the business license application within a maximum period of 40 (forty) working days since the business license application was received completely and correctly. (2) In order to provide approval or rejection of the business license application, the OJK conducts:
    a. examination of document completeness; b. feasibility analysis of the work plan; and
    c. analysis of compliance with regulations in the field of MFIs.
    (3) In the event that the submitted business license application is incomplete and/or incorrect, the OJK issues a notification letter containing unfulfilled requirements to the applicant, at the latest 20 (twenty) working days after the application is received. (4) Rejection of the business license application is accompanied by the reasons for rejection. (5) In the event that the business license application is approved, the OJK establishes the business license as an MFI for the applicant.
    Article 7
    (1) An MFI that has received a business license from the OJK must conduct business activities at the latest 4 (four) months after the date the business license is established. (2) The report on the implementation of business activities as referred to in paragraph (1) must be submitted by the MFI's Board of Directors to the OJK accompanied by photocopies of proof of implementation of Savings management and/or disbursement of Loans or Financing at the latest 20 (twenty) working days after the date operational activities begin according to the format in Appendix II which is an integral part of this OJK Regulation. (3) If after the period as referred to in paragraph (1) the MFI has not conducted business activities, the OJK revokes the business license that has been issued.
    Article 8
    The name of the MFI must be clearly stated in the articles of association as referred to in Article 5 paragraph (3) letter a number 1) starting with the legal entity form followed by the phrase:
    a. "Microfinance Institution" or abbreviated as "MFI" and the name of the MFI for MFIs conducting business activities conventionally; b. "Sharia Microfinance Institution" or abbreviated as "LKMS" and the name of the MFI for MFIs conducting business activities based on Sharia Principles.

Third Section
Capital
Article 9
(1) The paid-up capital or principal savings, mandatory savings, and grants of an MFI are determined based on the scope of the business area, namely village/village, sub-district, or district/city. (2) The amount of paid-up capital or principal savings, mandatory savings, and grants of an MFI is determined at least:
a. IDR 50,000,000.00 (fifty million rupiah), for village/village business area scope; b. IDR 100,000,000.00 (one hundred million rupiah), for sub-district business area scope; or
c. IDR 500,000,000.00 (five hundred million rupiah), for district/city business area scope.
(3) At least 50% (fifty percent) of the paid-up capital or principal savings, mandatory savings, and grants must be used for working capital. (4) The MFI capital deposits as referred to in paragraph (2) must meet the requirements:
a. do not originate from loans; and b. do not originate from and for money laundering criminal acts.

CHAPTER III
MANAGEMENT AND SUPERVISION
First Section
Board of Directors and Board of Commissioners
Article 10
The Board of Directors and Board of Commissioners of an MFI must meet the requirements:
a. not recorded in the list of non-performing loans in the financial services sector; b. never sentenced for committing criminal offenses in the field of financial services business and/or the economy based on a court decision that has acquired permanent legal force;
c. never sentenced for committing criminal offenses based on a court decision that has acquired permanent legal force in the last 5 (five) years;
d. never declared bankrupt or caused a business entity to be declared bankrupt based on a court decision that has acquired permanent legal force in the last 5 (five) years; e. one of the Directors must have operational experience in the field of microfinance institutions or other financial services institutions for at least 1 (one) year; and f. one of the Directors must have operational experience in the field of Sharia microfinance institutions or other Sharia financial services institutions for MFIs conducting business activities based on Sharia Principles for at least 1 (one) year.
Article 11
(1) The Board of Directors of an MFI is prohibited from holding concurrent positions as Directors in other MFIs.
(2) The Board of Directors of an MFI may hold concurrent positions as Board of Commissioners in at most 2 (two) other MFIs. (3) The Board of Commissioners of an MFI may hold concurrent positions as Board of Commissioners in at most 3 (three) other MFIs.

Second Section
Sharia Supervisory Board
Article 12
(1) An MFI conducting business activities based on Sharia Principles is required to form a DPS.
(2) The DPS as referred to in paragraph (1) is appointed in the general meeting of shareholders or members meeting based on a recommendation from DSN MUI. (3) The formation of the DPS as referred to in paragraph (1) can be carried out by 1 (one) or several MFIs together. (4) The DPS as referred to in paragraph (1) carries out supervision duties and provides advice to the Board of Directors so that its business activities are in accordance with Sharia Principles. (5) The supervision and advice duties as referred to in paragraph (4) are carried out in the form of:
a. ensuring and supervising the compliance of MFI operational activities with fatwas established by DSN MUI; b. assessing the Sharia aspects of operational guidelines and products issued by the MFI;
c. studying new products and services that do not yet have fatwas to request fatwas from DSN MUI.
(6) Provisions regarding the requirements for the Board of Directors and Board of Commissioners of an MFI as referred to in Article 10 except for letter e and f, mutatis mutandis apply to the DPS.

CHAPTER IV
REPORTING
First Section
Changes in Shareholders, Board of Directors, Board of Commissioners, Sharia Supervisory Board, and Capital
Article 13
(1) The Board of Directors of an MFI in the form of a limited liability company legal entity is required to report every change in shareholders, Board of Directors, Board of Commissioners, DPS, and capital to the OJK at the latest 20 (twenty) working days after the date of receiving the approval or recording of the said changes from the competent authority. (2) The Board of Directors of an MFI in the form of a cooperative legal entity is required to report every change in the Board of Directors, Board of Commissioners, and DPS to the OJK at the latest 20 (twenty) working days after the date of the change as recorded in the minutes of the members' meeting. (3) The reports as referred to in paragraph (1) are submitted according to the format in Appendix III, Appendix IV, or Appendix V which are integral parts of this OJK Regulation, accompanied by:
a. proof of change as referred to in paragraph (1) that has been approved or recorded by the competent authority; b. documents of the Board of Directors and/or Board of Commissioners and/or data on shareholders and/or DPS as referred to in Article 5 paragraph (3) letter b and/or letter c and/or letter d. (4) The reports as referred to in paragraph (2) are submitted according to the format in Appendix IV which is an integral part of this OJK Regulation, accompanied by:
a. minutes of the general meeting of shareholders or members' meeting; and b. documents of the Board of Directors and/or Board of Commissioners and/or DPS as referred to in Article 5 paragraph (3) letter b and/or letter d.

Second Section
Name Change
Article 14
(1) The Board of Directors is required to report changes in the name of the MFI to the OJK at the latest 20 (twenty) working days after obtaining the letter of approval for the name change from the competent authority, using the format in Appendix VI which is an integral part of this OJK Regulation, accompanied by documents:
a. minutes of the general meeting of shareholders or members' meeting regarding the change of the MFI name; b. proof of change of articles of association regarding the name change that has been approved by the competent authority for MFIs in the form of a limited liability company legal entity; and
c. proof of announcement of the name change through a local daily newspaper or notice board at the MFI office that is easily accessible to the public.
(2) Based on the report as referred to in paragraph (1), the OJK records the change of the MFI name within a maximum period of 20 (twenty) working days calculated from the date the report is received completely and correctly.

CHAPTER V
MERGER AND CONSOLIDATION
Article 15
(1) An MFI may conduct a merger with one or more MFIs by maintaining the existence of one of the MFIs and dissolving the other MFIs without prior liquidation. (2) An MFI may conduct a consolidation with one or more MFIs by establishing a new MFI and dissolving the MFIs that are consolidating. (3) Merger or Consolidation is conducted by MFIs with the same legal entity form. (4) The merger or consolidation process of MFIs must obtain prior approval from the OJK. (5) Merger or Consolidation can only be conducted between MFIs located within 1 (one) District/City area. (6) Merger or Consolidation must observe the capital provisions as referred to in Article 9 of this OJK Regulation.
Article 16
(1) To obtain approval for merger or consolidation as referred to in Article 15 paragraph (4), the Board of Directors of the MFI to receive the merger or the Board of Directors of one of the MFIs to conduct the consolidation must submit an application to the OJK according to the format in Appendix VII or Appendix VIII which are integral parts of this OJK Regulation. (2) The application as referred to in paragraph (1) must be accompanied by a draft of merger or consolidation which at least contains:
a. minutes of the general meeting of shareholders or members' meeting of the MFIs conducting the merger or consolidation; b. draft amendment of articles of association of the MFI receiving the merger (if any) or draft articles of association of the MFI resulting from the consolidation;
c. plan for settling the rights and obligations of the MFIs to be merged or consolidated without reducing the rights of Depositors and borrowing customers; and
d. projections of financial position reports and financial performance reports of the MFI to receive the merger or the result of consolidation for 2 (two) years. (3) The OJK provides approval or rejection of the application as referred to in paragraph (1) within a maximum period of 20 (twenty) working days since the application is received completely and correctly. (4) In order to provide approval for the application as referred to in paragraph (1), the OJK conducts:
a. examination of document completeness; and b. analysis of compliance with regulations in the field of MFIs.
(5) In the event that the submitted application for approval of merger or consolidation is incomplete, the OJK issues a notification letter containing unfulfilled requirements to the applicant at the latest 10 (ten) working days after the application is received. (6) In the event that the OJK approves the application as referred to in paragraph (1), the OJK issues the said approval in writing to the MFI to conduct the merger or consolidation. (7) Rights and obligations arising after conducting merger or consolidation become the responsibility of the MFI to receive the merger or the result of consolidation.
Article 17
(1) An MFI receiving a merger is required to report the results of the merger implementation to the OJK according to the format in Appendix IX which is an integral part of this OJK Regulation and must be accompanied by documents:
a. photocopy of the amendment of articles of association of the MFI receiving the merger that has been approved, agreed upon, or recorded by the competent authority; b. organizational structure and management of the MFI, data on the Board of Directors, Board of Commissioners, and DPS as referred to in Article 5 paragraph (3) letter b as well as data on shareholders or members of the MFI receiving the merger;
c. financial position report and financial performance report of the MFI receiving the merger; and
d. complete address of the MFI receiving the merger.
(2) The MFI resulting from consolidation is required to report the results of the consolidation implementation to the OJK according to the format in Appendix...

Appendix X, which is an integral part of this OJK Regulation and must be accompanied by documents:
a. a photocopy of the articles of association of the MFI resulting from the merger, which has been approved by the competent authority; b. the organizational structure and management of the MFI resulting from the merger, data of the Board of Directors, Board of Commissioners, and Sharia Supervisory Board (DPS) as referred to in Article 5 paragraph (3) letter b, as well as data of shareholders or members of the MFI resulting from the merger;
c. the financial position report and financial performance report of the MFI resulting from the merger; and
d. the complete address of the MFI resulting from the merger.
(3) Reports as referred to in paragraph (1) and paragraph (2) must be submitted no later than 20 (twenty) working days after the date of receipt of the approval, consent, or recording of the amendment to the articles of association from the competent authority. (4) Based on the report as referred to in paragraph (1), OJK revokes the business license of the MFI that merges. (5) Based on the report as referred to in paragraph (2), OJK revokes the business license of the MFI that undergoes the merger and issues a business license for the MFI resulting from the merger.

Article 18
(1) The headquarters and branches of MFIs that merge may be used as branches of the MFI resulting from the merger.
(2) One of the headquarters of the MFIs that merge may be used as the headquarters of the MFI resulting from the merger. (3) The headquarters and branches of the MFIs that merge may be used as branches of the MFI resulting from the merger.

Article 19
(1) MFIs conducting business activities based on Sharia Principles may only merge or consolidate with one or more MFIs conducting business activities based on Sharia Principles. (2) Provisions regarding merger or consolidation as referred to in Article 15, Article 16, Article 17, and Article 18 apply mutatis mutandis to MFIs conducting business activities based on Sharia Principles.

Article 20
Mergers and consolidations of MFIs are carried out in accordance with applicable legislation.

CHAPTER VI
BRANCH OFFICES

Article 21
(1) An MFI whose business coverage area is within a district/city may open branch offices within its business coverage area by meeting the minimum solvency and liquidity ratio requirements as regulated in the OJK Regulation regarding the conduct of MFI business. (2) The opening of branch offices as referred to in paragraph (1) must be reported to OJK no later than 20 (twenty) working days from the date of the implementation of the branch office opening, according to the format in Appendix XI, which is an integral part of this OJK Regulation. (3) The report on the opening of branch offices as referred to in paragraph (2) must be accompanied by:
a. a photocopy of proof of the implementation of Savings management and/or Loan/Financing disbursement; b. proof of office control; and
c. the organizational structure and personnel of the branch office.

Article 22
(1) The closure of an MFI branch office must be reported to OJK.
(2) The report on the closure of branch offices as referred to in paragraph (1) must be submitted according to the format in Appendix XII, which is an integral part of this OJK Regulation, no later than 20 (twenty) working days after the closure of the branch office is implemented, accompanied by:
a. the reason for closure; and b. proof of the settlement of the rights and obligations of the MFI branch office to Depositors, borrowing customers, and/or other parties.

CHAPTER VII
OFFICE ADDRESS TRANSFER

Article 23
(1) Plans to transfer the office address must be announced in advance to the public through a local daily newspaper or a notice board at the MFI office, in a place easily accessible to the public, no later than 20 (twenty) working days before the transfer of the office address. (2) The transfer of the office address must be reported by the Board of Directors to OJK no later than 20 (twenty) working days after the date of the implementation of the change, according to the format in Appendix XIII, which is an integral part of this OJK Regulation. (3) The report as referred to in paragraph (2) must be accompanied by:
a. proof of announcement to the public regarding the transfer of the office address through a local daily newspaper or a notice board at the old MFI office, in a place easily accessible to the public; and b. proof of office control. (4) The transfer of the office address as referred to in paragraph (2) must be carried out within the same business coverage area.

CHAPTER VIII
CHANGE OF COVERAGE AREA DUE TO TERRITORIAL EXPANSION

Article 24
(1) MFIs whose domicile and business coverage area experience changes as a result of territorial expansion must submit a report to OJK regarding the territorial expansion, accompanied by information on Loans/Financing and/or Savings, within a maximum period of 20 (twenty) working days from the effective date of the territorial expansion, according to the format in Appendix XIV, which is an integral part of this OJK Regulation. (2) In the event of territorial expansion:
a. Loans or Financing already disbursed by the MFI outside its business coverage area may continue until the repayment period of the Loan or Financing ends; and b. Savings already received by the MFI from Depositors outside its business coverage area may continue until the closure of the Savings.

CHAPTER IX
LIQUIDATION OF MFIs

Article 25
(1) In the event that rehabilitation efforts for an MFI fail to overcome liquidity and solvency difficulties as referred to in the OJK Regulation regarding the conduct of MFI business, OJK revokes the business license of the relevant MFI and orders the Board of Directors of the MFI to immediately convene a General Meeting of Shareholders or a Meeting of Members to dissolve the legal entity of the MFI and form a liquidation team. (2) The liquidation team is tasked with settling all rights and obligations owned by the MFI. (3) The dissolution of the MFI legal entity, the formation of the liquidation team, and the settlement of rights and obligations are carried out in accordance with applicable legislation. (4) The Liquidation Team submits a report on the progress of the liquidation implementation to OJK at least once every 6 (six) months. (5) The Liquidation Team reports the implementation of the liquidation to shareholders or members, and OJK, no later than 3 (three) months from the date the liquidation implementation is completed.

CHAPTER X
TRANSFORMATION OF MFIs

Article 26
(1) MFIs must transform into rural banks or Islamic rural banks if:
a. they conduct business activities exceeding 1 (one) district/city area where the MFI is domiciled; or b. the MFI has:

1. equity of at least 5 (five) times the minimum paid-up capital requirement for rural banks or Islamic rural banks in accordance with applicable legislation; and
2. the amount of third-party funds in the form of Savings collected in the last 1 (one) year of at least 25 (twenty-five) times the minimum paid-up capital requirement for rural banks or Islamic rural banks in accordance with applicable legislation.
   (2) MFIs as referred to in paragraph (1) must submit an application for a business license as a rural bank or Islamic rural bank within a maximum period of 3 (three) years from the date of notification from OJK. (3) In the event that the MFI as referred to in paragraph (2) has not obtained a business license as a rural bank or Islamic rural bank, the MFI is prohibited from disbursing Loans or Financing outside its business coverage area. (4) The procedure for the transformation of MFIs into rural banks or Islamic rural banks is carried out in accordance with the provisions of applicable legislation regulating rural banks or Islamic rural banks. (5) In the event that the application as referred to in paragraph (2) is rejected, the relevant MFI may still conduct its business activities.

CHAPTER XI
SANCTIONS

Article 27
(1) MFIs that do not comply with the provisions in Article 2 paragraph (2), Article 2 paragraph (4), Article 3, Article 4, Article 7 paragraph (2), Article 12 paragraph (1), Article 13 paragraph (1), Article 13 paragraph (2), Article 14 paragraph (1), Article 17 paragraph (1), Article 17 paragraph (2), Article 17 paragraph (3), Article 21 paragraph (2), Article 22 paragraph (1), Article 23 paragraph (2), Article 24 paragraph (1), Article 26 paragraph (1), Article 26 paragraph (2), and Article 26 paragraph (3) of this OJK Regulation are subject to administrative sanctions in the form of written warnings. (2) Written warning sanctions as referred to in paragraph (1) are given in writing for a maximum of 3 (three) consecutive times, with each having a validity period of 40 (forty) working days. (3) In the event that before the validity period of the written warning sanction as referred to in paragraph (2) expires, the MFI has complied with the provisions as referred to in paragraph (1), OJK or the local district/city government or other parties appointed by OJK revoke the written warning sanction. (4) In the event that the validity period of the third written warning as referred to in paragraph (2) expires and the MFI still does not comply with the provisions as referred to in paragraph (1), OJK requests shareholders or the meeting of members to replace the Board of Directors of the MFI within a maximum period of 6 (six) months from the notification from OJK. (5) In the event that the time period as referred to in paragraph (4) expires and the General Meeting of Shareholders or Meeting of Members does not replace the Board of Directors as referred to, OJK dismisses the Board of Directors of the MFI and subsequently appoints and appoints a temporary replacement until the General Meeting of Shareholders or Meeting of Members appoints a permanent replacement with OJK's approval.

Article 28
(1) In the event that an MFI cannot comply with the provisions in Article 9 paragraph (3), Article 11, Article 15 paragraph (4), and Article 21 paragraph (1) of this OJK Regulation, OJK issues a written notification to the MFI to comply with the provisions within a maximum period of 40 (forty) working days from the notification from OJK. (2) If the time period as referred to in paragraph (1) has expired and the MFI cannot comply with the provisions as referred to in Article 9 paragraph (3), Article 11, Article 15 paragraph (4), and Article 21 paragraph (1) of this OJK Regulation, the relevant MFI is subject to administrative sanctions as referred to in Article 27 of this OJK Regulation.

CHAPTER XII
TRANSITIONAL PROVISIONS

Article 29
(1) Village Banks, Village Granaries, Market Banks, Employee Banks, Village Credit Institutions (BKD), District Credit Institutions (BKK), Small Business Credit (KURK), District Credit Institutions (LPK), Village Production Credit Regional Banks (BKPD), Rural Credit Business Enterprises (BUKP), Baitul Maal wa Tamwil (BMT), Baitul Tamwil Muhammadiyah (BTM), and/or other institutions deemed equivalent that have been established and have operated before the enactment of Law Number 1 of 2013 concerning Microfinance Institutions, and have not obtained business licenses based on applicable legislation, must obtain business licenses through ratification as MFIs to OJK no later than January 8, 2016. (2) Applications for business licenses through ratification as MFIs as referred to in paragraph (1) must be submitted to OJK, according to the format in Appendix XV, which is an integral part of this OJK Regulation, accompanied by:
a. the deed of establishment of the legal entity including the articles of association and any amendments as referred to in Article 5 paragraph (3) letter a; b. projected financial position reports and financial performance reports for 4 (four) months starting from when the MFI begins operational activities for the first 2 (two) years as referred to in Article 5 paragraph (3) letter g number 5);
c. annual financial reports consisting of at least financial position reports and financial performance reports for the last 2 (two) years;
d. closing financial position reports and opening financial position reports of the MFI to be ratified; e. MFI financing performance for the last 2 (two) years; and f. data of the Board of Directors, Board of Commissioners, DPS, shareholders or members, as referred to in Article 5 paragraph (3) letter b and c, except for statements regarding capital deposits. (3) Compliance with paid-up capital or principal savings, mandatory savings, and grants for business license applications through ratification as MFIs as referred to in paragraph (1) is calculated based on equity in the opening financial position report as referred to in paragraph (2) letter d. (4) In the event that the application for a business license through ratification as an MFI submitted is incomplete and/or incorrect, OJK notifies the applicant to fulfill the requirements within a maximum of 20 (twenty) working days after the application is received. (5) OJK grants approval for business license applications through ratification as MFIs within a maximum period of 40 (forty) working days from the receipt of the complete and correct application.

Article 30
Village Banks, Village Granaries, Market Banks, Employee Banks, Village Credit Institutions (BKD), District Credit Institutions (BKK), Small Business Credit (KURK), District Credit Institutions (LPK), Village Production Credit Regional Banks (BKPD), Rural Credit Business Enterprises (BUKP), Baitul Maal wa Tamwil (BMT), Baitul Tamwil Muhammadiyah (BTM), and/or other institutions deemed equivalent that have been ratified as MFIs as referred to in Article 29 of this OJK Regulation, must comply with the provisions as referred to in Article 2 paragraph (2), Article 2 paragraph (3), Article 2 paragraph (4), Article 3, and Article 4 of this OJK Regulation within a maximum period of 5 (five) years from the date of ratification as MFIs by OJK.

CHAPTER XIII
CLOSING PROVISIONS

Article 31
This OJK Regulation takes effect on January 8, 2015.

To ensure that everyone knows it, it is ordered to promulgate this OJK Regulation by placing it in the State Gazette of the Republic of Indonesia.

Established in Jakarta on October 31, 2014
CHAIRMAN OF THE BOARD OF COMMISSIONERS
FINANCIAL SERVICES AUTHORITY,
Signed,
MULIAMAN D. HADAD

Promulgated in Jakarta on November 11, 2014
MINISTER OF LAW AND HUMAN RIGHTS
REPUBLIC OF INDONESIA,
Signed,
YASONNA H. LAOLY

STATE GAZETTE OF THE REPUBLIC OF INDONESIA YEAR 2014 NUMBER 342 A copy in accordance with the original Director of Law 1 Ministry of Law, Signed, Tini Kustini

EXPLANATION
OF
FINANCIAL SERVICES AUTHORITY REGULATION
NUMBER 12 /POJK.05/2014
CONCERNING
BUSINESS LICENSING AND INSTITUTIONAL FRAMEWORK FOR MICROFINANCE INSTITUTIONS

I. GENERAL
The financial services sector is a sector that is interconnected with almost all sectors in the national economy. Although the performance of the financial sector in Indonesia in recent years has shown significant growth, equitable growth has not yet been achieved because, in reality, the accessibility of low-income communities and micro entrepreneurs to financing facilities, especially from banks, remains very low. Limited access to the banking sector can become an entry point for informal creditors who apply high interest rates. Thus, to meet the need for affordable financial services, especially for low-income communities and micro business actors, the existence of financial institutions that specialize in empowering low-income communities and micro business actors is very important.

The Government has established Law Number 1 of 2013 concerning Microfinance Institutions (MFIs) on January 8, 2013. The Law on MFIs mandates several further technical regulatory matters related to business licensing, MFI institutional framework, and requirements related to the transformation of MFIs into Rural Banks in the form of a Financial Services Authority Regulation. This is because, based on the mandate of the Law on MFIs which states that the Financial Services Authority is the authority that supervises, regulates, and oversees MFIs. Thus, with the existence of MFIs operating with licenses and institutional frameworks regulated by OJK, it is hoped that these MFIs can continue to contribute to empowering low-income communities and micro business actors while still paying attention to prudential aspects and protection for customers.

In relation to this, the Financial Services Authority establishes the Financial Services Authority Regulation concerning Business Licensing and Institutional Framework for Microfinance Institutions.

II. ARTICLE BY ARTICLE
Article 1
Clearly stated

Article 2
Paragraph (1)
Letter a
The term "cooperative" refers to service cooperatives.
Letter b
Clearly stated

Paragraph (2)
Clearly stated

Paragraph (3)
Clearly stated

Paragraph (4)
Clearly stated

Article 3
Clearly stated

Article 4
Clearly stated

Article 5
Paragraph (1)
Clearly stated

Paragraph (2)
Clearly stated

Paragraph (3)
Letter a
Clearly stated

Letter b
Number 1)
Clearly stated

Number 2)
Clearly stated

Number 3)
Clearly stated

Number 4)
Clearly stated

Number 5)
The term operational experience refers to experience in the fields of funding, lending, marketing, collection, and/or accounting/bookkeeping.

Number 6)
Clearly stated

Letter c
Number 1)
Clearly stated

Number 2)
Letter a)
Clearly stated

Letter b)
The term latest financial report or latest financial bookkeeping refers to the period of the financial report or financial bookkeeping no later than 4 (four) months before the date of submitting the MFI business license application.

Letter c)
Clearly stated

Letter d)
Clearly stated

Number 3)
Clearly stated

Letter d
Clearly stated

Letter e
Clearly stated

Letter f
Clearly stated

Letter g
The financial position report is part of the financial report of an entity generated during an accounting period that shows the financial position of the entity at the end of that period (formerly the balance sheet). Meanwhile, the financial performance report is part of the financial report of an entity generated during an accounting period that shows the elements of company income and expenses (formerly the income statement).

Letter h
Clearly stated

Letter i
The term form to be used for MFI operations, for example, the Savings opening form, the Savings withdrawal form.

Paragraph (4)
Clearly stated

Article 6
Clearly stated

Article 7
Clearly stated

Article 8
The name of the MFI in the articles of association can be listed as follows: PT Microfinance Institution Bakti Makmur or PT MFI Bakti Makmur, Sharia Microfinance Institution Cooperative Sugih Waras or Sharia MFC Cooperative Sugih Waras. For MFIs resulting from ratification, the type of previous MFI can also be listed, for example: District Credit Regional Enterprise (PDPK) becomes PT Microfinance Institution PDPK Sentosa or PT MFI PDPK Sentosa, Sharia Microfinance Institution Cooperative PDPK Sentosa or Sharia MFC Cooperative PDPK Sentosa.

Article 9
Clearly stated

Article 10
Clearly stated

Article 11
Clearly stated

Article 12
Clearly stated

Article 13
Clearly stated

Article 14
Clearly stated

Article 15
Clearly stated

Article 16
Clearly stated

Article 17
Paragraph (1)
The financial position report is part of the financial report of an entity generated during an accounting period that shows the financial position of the entity at the end of that period (formerly the balance sheet). Meanwhile, the financial performance report is part of the financial report of an entity generated during an accounting period that shows the elements of company income and expenses (formerly the income statement).

Paragraph (2)
Clearly stated

Paragraph (3)
Clearly stated

Paragraph (4)
Clearly stated

Paragraph (5)
Clearly stated

Article 18
Clearly stated

Article 19
Clearly stated

Article 20
The term applicable legislation includes but is not limited to legislation regulating limited liability companies and cooperatives in relation to the merger and consolidation process.

Article 21
Clearly stated

Article 22
Clearly stated

Article 23
Clearly stated

Article 24
Clearly stated

Article 25
Clearly stated

Article 26
Clearly stated

Article 27
Clearly stated

Article 28
Clearly stated

Article 29
Paragraph (1)
Clearly stated

Paragraph (2)
Letter a
Clearly stated

Letter b
Clearly stated

Letter c
The financial position report is part of the financial report of an entity generated during an accounting period that shows the financial position of the entity at the end of that period (formerly the balance sheet). Meanwhile, the financial performance report is part of the financial report of an entity generated during an accounting period that shows the elements of company income and expenses (formerly the income statement).

Letter d
Clearly stated

Letter e
MFI Financing Performance is a document containing information regarding the quality of the MFI's Loan/Financing assets, consisting of at least data regarding current, less active, and non-performing receivables from MFI customers.

Letter f
Clearly stated

Paragraph (3)
The term equity refers to the excess of MFI assets after deducting all liabilities as stated in the financial position report, taking into account the provision for write-off of Loans or Financing. The financial position report is part of the financial report of an entity generated during an accounting period that shows the financial position of the entity at the end of that period (formerly the balance sheet).

Paragraph (4)
Clearly stated

Paragraph (5)
Clearly stated

Article 30
Clearly stated

Article 31
Clearly stated

SUPPLEMENTARY STATE GAZETTE OF THE REPUBLIC OF INDONESIA NUMBER 5621

FINANCIAL SERVICES AUTHORITY
REPUBLIC OF INDONESIA
APPENDIX I
FINANCIAL SERVICES AUTHORITY REGULATION
CONCERNING
BUSINESS LICENSING AND INSTITUTIONAL FRAMEWORK FOR MICROFINANCE INSTITUTIONS

EXAMPLE FORMAT FOR APPLICATION FOR MICROFINANCE INSTITUTION BUSINESS LICENSE

To the
Head of Executive Supervisor for Non-Bank Financial Institutions, Financial Services Authority through OJK Office ..….
Jl ………………..
………………..

Referring to Financial Services Authority Regulation Number........./POJK.05/2014 concerning Business Licensing and Institutional Framework for Microfinance Institutions, we hereby submit an application to obtain a business license as a Microfinance Institution (MFI):

Name : PT/Cooperative*) MFI/SMFI*) .....
Address : .....
District/City*) .....
Province .....
Business Coverage Area : Village/Sub-district*), District, District/City*) .....
Telephone/Fax No. : .....
Email : .....

To complete the aforementioned application, we hereby submit the following documents:

1. Deed of establishment of PT/Cooperative*) MFI/SMFI..... including articles of association and any amendments (if any) that have been approved/approved by the competent authority or notified to the competent authority.
2. List of the composition of the Board of Directors, Board of Commissioners, and Sharia Supervisory Board (DPS), accompanied by:
   a. 1 (one) recent 4x6 cm passport photo; b. photocopy of a valid identification card (KTP);
   c. curriculum vitae;
   d. a stamped statement letter from the Board of Directors, Board of Commissioners, and DPS for Sharia MFIs stating:

1. not listed in the non-performing loan list in the financial services sector;

2. never convicted for committing criminal offenses in the field of financial services business and/or the economy based on a court decision that has acquired permanent legal force;

3. never convicted for committing criminal offenses based on a court decision that has acquired permanent legal force in the last 5 (five) years;

4. never declared bankrupt or causing a business entity to be declared bankrupt based on a court decision that has acquired permanent legal force in the last 5 (five) years;

5. not holding concurrent positions as Directors in other MFIs for Directors;

6. does not hold concurrent positions as members of the Board of Commissioners for more than 2 (two) other MFIs for the Board of Directors; and

7. does not hold concurrent positions as members of the Board of Commissioners for more than 3 (three) other MFIs for the Board of Commissioners;
   e. a certificate or written proof of having operational experience in the field of microfinance institutions or other financial service institutions for at least 1 (one) year for one of the Directors; f. a certificate or written proof of having operational experience in the field of microfinance institutions conducting business activities based on Sharia Principles or other Sharia financial service institutions for at least 1 (one) year for one of the Directors, for MFIs conducting business activities based on Sharia Principles;

3. Data on shareholders along with details of share ownership/member data*)
4. A recommendation letter for the appointment of the Sharia Supervisory Board (DPS) from the National Sharia Council of the Indonesian Ulema Council (DSN MUI) for MFIs conducting business activities based on Sharia Principles;
5. Organizational structure and management, work systems and procedures of the MFI.
6. A work plan for the first 2 (two) years which must at least contain:
   a. data regarding the number of other microfinance institutions in the operational area of the relevant MFI; b. the MFI's business activity plan containing projections of Savings and the disbursement of Loans or Financing as well as steps to be taken to realize the aforementioned plan;
   c. an explanation of the economic potential in the operational area of the relevant MFI;
   d. projections of financial position reports and financial performance reports every 4 (four) months starting from when the MFI commences operational activities; and e. projections of financial position reports and financial performance reports as referred to in letter d referring to regulations regarding MFI financial reports.
7. A photocopy of proof of repayment of paid-up capital or principal savings, mandatory savings, and grants amounting to Rp ..... (.....) in the form of a valid time deposit in the name of PT/Cooperative*) MFI/Sharia MFI….. at one of the banks/Sharia banks/Sharia business units*) in Indonesia.
8. Proof of operational readiness, including but not limited to:
   a. a list of fixed assets (if any) and inventory; b. proof of ownership or control of the office; and
   c. examples of forms to be used for MFI operations.
9. A stamped declaration letter from shareholders stating that paid-up capital or principal savings, mandatory savings, and grants:
   a. do not originate from loans; and b. do not originate from and are not for money laundering criminal acts.

This is our application, and for your attention, Sir/Madam*), we express our gratitude.
........, date, month, year
Board of Directors
PT/Cooperative*) MFI/Sharia MFI*) .....
..............................
*) strike what is not needed
Established in Jakarta on 31 October 2013
CHAIRMAN OF THE COMMISSIONER BOARD
FINANCIAL SERVICES AUTHORITY,
Signed,
MULIAMAN D. HADAD
Copy matches the original
Legal Director 1
Legal Department,
Signed,
Tini Kustini

FINANCIAL SERVICES AUTHORITY
REPUBLIC OF INDONESIA
APPENDIX II
FINANCIAL SERVICES AUTHORITY REGULATION
ON
BUSINESS LICENSING AND INSTITUTIONAL FRAMEWORK FOR MICROFINANCE INSTITUTIONS

EXAMPLE FORMAT FOR REPORT ON THE IMPLEMENTATION OF BUSINESS ACTIVITIES MICROFINANCE INSTITUTION To the Head of Executive Supervisor for Non-Bank Financial Institutions, Financial Services Authority Through the OJK Office/Regent/Mayor/Other party designated by OJK*) Jl ……………….. ………………..
Referring to the Financial Services Authority Decision Letter Number .....
dated ..... month ..... year ...... regarding the issuance of a business license for Microfinance Institution/Sharia (MFI/Sharia MFI)) to PT/Cooperative) MFI/Sharia MFI*) ....., hereby we report that we have commenced
business activities as an MFI/Sharia MFI*) on date ..... month ..... year ......
As supporting data, we hereby submit a photocopy of proof of implementation of activities managing Savings and/or disbursement of Loans or Financing. This report is submitted, and for your attention, Sir/Madam*), we express our gratitude. ........, date, month, year Board of Directors
PT/Cooperative*) MFI/Sharia MFI*) .....
..............................
*) Strike what is not needed
Established in Jakarta on 31 October 2014
CHAIRMAN OF THE COMMISSIONER BOARD
FINANCIAL SERVICES AUTHORITY,
Signed,
MULIAMAN D. HADAD
Copy matches the original
Legal Director 1
Legal Department,
Signed,
Tini Kustini

FINANCIAL SERVICES AUTHORITY
REPUBLIC OF INDONESIA
APPENDIX III
FINANCIAL SERVICES AUTHORITY REGULATION
NUMBER 12 /POJK.05/2014
ON
BUSINESS LICENSING AND INSTITUTIONAL FRAMEWORK FOR MICROFINANCE INSTITUTIONS

EXAMPLE FORMAT FOR REPORT ON CHANGES IN SHAREHOLDERS To the Head of Executive Supervisor for Non-Bank Financial Institutions, Financial Services Authority Through the OJK Office/Regent/Mayor/Other party designated by OJK*)……… Jl ……………….. ……………….. Referring to the Financial Services Authority Regulation Number........./POJK.05/2014 on Business Licensing and Institutional Framework for Microfinance Institutions, hereby we report that in accordance with the General Meeting of Shareholders (GMS)/Cooperative Members Meeting (CMM) of PT MFI/Sharia MFI*) ...... dated ..... month .... year ..... changes in shareholders have been made, namely:
Old New
Name
Shareholder
Share Value Name
Shareholder
Share Value
Rp % Rp %
..... ..... ..... .....
..... ..... ..... .....
As supporting data, we hereby submit:

1. Proof of change in shareholders that has been approved or recorded by
   the competent authority;
2. Shareholder data:
   a. In the case of individuals, it is mandatory to attach:

1. 1 (one) latest passport photo size 4 x 6 cm;
2. photocopy of identification in the form of an Identity Card (KTP) that
   is still valid;
3. a curriculum vitae; and
4. a stamped declaration letter from the shareholder stating that the capital
   deposit does not originate from loans and does not originate from and is not for money laundering criminal acts. b. In the case of cooperatives or village/village-owned enterprises*) it is mandatory to attach:
5. deed of establishment including articles of association including amendments (if any) or proof of establishment of village/village-owned enterprise*);
6. financial reports audited by a public accountant or
   the latest financial report or latest financial bookkeeping;
7. documents for the Board of Directors or management of village/village-owned
   enterprise*) and/or cooperative in the form of:
   a) 1 (one) latest passport photo size 4 x 6 cm; b) photocopy of identification in the form of an Identity Card (KTP) that is still valid; and c) curriculum vitae.
8. a stamped declaration letter from the shareholder stating that the capital
   deposit does not originate from loans and does not originate from and is not for money laundering criminal acts.
   c. In the case where the shareholder is a District/City Government*), the documents to be attached are in the form of
   decisions or District/City Government*) Regulations regarding capital participation in the MFI.
   This report is submitted, and for your attention, Sir/Madam*), we express our gratitude.
   ........, date, month, year
   Board of Directors
   PT MFI/Sharia MFI*) .....
   ..............................
   *) Strike what is not needed
   Established in Jakarta on 31 October 2014
   CHAIRMAN OF THE COMMISSIONER BOARD
   FINANCIAL SERVICES AUTHORITY,
   Signed,
   Signed,
   MULIAMAN D. HADAD
   Copy matches the original
   Legal Director 1
   Legal Department,
   Signed,
   Tini Kustini

FINANCIAL SERVICES AUTHORITY
REPUBLIC OF INDONESIA
APPENDIX IV
FINANCIAL SERVICES AUTHORITY REGULATION
ON
BUSINESS LICENSING AND INSTITUTIONAL FRAMEWORK FOR MICROFINANCE INSTITUTIONS

EXAMPLE FORMAT FOR REPORT ON CHANGES IN BOARD OF DIRECTORS/BOARD OF COMMISSIONERS/SHARIA SUPERVISORY BOARD OF MICROFINANCE INSTITUTIONS To the Head of Executive Supervisor for Non-Bank Financial Institutions, Financial Services Authority Through the OJK Office/Regent/Mayor/Other party designated by OJK*)……… Jl ……………….. ……………….. Referring to the Financial Services Authority Regulation Number........./POJK.05/2014 on Business Licensing and Institutional Framework for Microfinance Institutions, hereby
we report that in accordance with the GMS/CMM*) of PT/Cooperative*) MFI/Sharia MFI*) ......
dated ..... month ..... year .... changes in the Board of Directors and/or Board of Commissioners or Sharia Supervisory Board*), namely:
Old New
Chief Commissioner ..... .....
Commissioner ..... .....
Chief Director ..... .....
Director ..... .....
Sharia Supervisory Board ..... .....
Sharia Supervisory Board ..... .....
..... ..... .....
As supporting data, we hereby submit:

1. Proof of changes in the Board of Directors and/or Board of Commissioners or Sharia Supervisory
   Board that has been approved or reported to the competent authority.
2. Minutes of the Members' Meeting (for MFIs in the form of a legal entity cooperative)
3. Data on the Board of Directors and/or Board of Commissioners: )
   a. 1 (one) latest passport photo size 4x6 cm; b. photocopy of identification in the form of an Identity Card (KTP) that is still valid;
   c. curriculum vitae;
   d. a stamped declaration letter from the Board of Directors and Board of Commissioners stating:

1. not recorded in the list of non-performing loans in the financial service sector;
2. never sentenced for committing criminal acts in the field of financial service business and/or the economy based on a court decision that has had permanent legal force;
3. never sentenced for committing criminal acts based on a court decision that has had permanent legal force in the last 5 (five) years;
4. never declared bankrupt or causing a business entity to be declared bankrupt based on a court decision that has had permanent legal force in the last 5 (five) years;
5. does not hold concurrent positions as Directors in other MFIs for Directors;
6. does not hold concurrent positions as Commissioners for more than 2 (two) other MFIs for Directors; and
7. does not hold concurrent positions as Commissioners for more than 3 (three) other MFIs for Commissioners;
   e. a certificate or written proof of having operational experience in the field of microfinance institutions or other financial service institutions for at least 1 (one) year for one of the Directors; f. a certificate or written proof of having operational experience in the field of microfinance institutions conducting business activities based on Sharia Principles or other Sharia financial service institutions for at least 1 (one) year for one of the Directors, for MFIs conducting business activities based on Sharia Principles;

4. Data on the Sharia Supervisory Board includes: )
   a. 1 (one) latest passport photo size 4x6 cm; b. photocopy of identification in the form of an Identity Card (KTP) that is still valid;
   c. curriculum vitae;
   d. a stamped declaration letter from the DPS stating:

1. not recorded in the list of non-performing loans in the financial service sector;
2. never sentenced for committing criminal acts in the field of
   financial service business and/or the economy based on a court decision that has had permanent legal force;
3. never sentenced for committing criminal acts based on a court decision that has had permanent legal force in the last 5 (five) years;
4. never declared bankrupt or causing a business entity to be declared bankrupt based on a court decision that has had permanent legal force in the last 5 (five) years;
   e. a recommendation letter for the appointment of the DPS from the National Sharia Council of the Indonesian Ulema Council (DSN MUI) for MFIs conducting business activities based on Sharia Principles; This report is submitted, and for your attention, Sir/Madam*), we express our gratitude. ........, date, month, year Board of Directors
   PT/Cooperative*) MFI/Sharia MFI*) .....
   ..............................
   *) Strike what is not needed
   ) choose one
   Established in Jakarta on 31 October 2014
   CHAIRMAN OF THE COMMISSIONER BOARD
   FINANCIAL SERVICES AUTHORITY,
   Signed,
   Signed,
   MULIAMAN D. HADAD
   Copy matches the original
   Legal Director 1
   Legal Department,
   Signed,
   Tini Kustini

FINANCIAL SERVICES AUTHORITY
REPUBLIC OF INDONESIA
APPENDIX V
FINANCIAL SERVICES AUTHORITY REGULATION
NUMBER 12 /POJK.05/2014
ON
BUSINESS LICENSING AND INSTITUTIONAL FRAMEWORK FOR MICROFINANCE INSTITUTIONS

EXAMPLE FORMAT FOR REPORT ON CHANGES IN CAPITAL OF MICROFINANCE INSTITUTIONS To the Head of Executive Supervisor for Non-Bank Financial Institutions, Financial Services Authority Through the OJK Office/Regent/Mayor/Other party designated by OJK*)……… Jl ……………….. ……………….. Referring to the Financial Services Authority Regulation Number........./POJK.05/2014 on Business Licensing and Institutional Framework for Microfinance Institutions, hereby we report that in accordance with the GMS of PT MFI/Sharia MFI*) dated ..... month ..... year ...... changes in capital have been made, namely:
Old New
Authorized Capital ..... .....
Paid-up Capital ..... .....
Old New
Name
Shareholder
Share Value Name
Shareholder
Share Value
Rp % Rp %
..... ..... ..... .....
..... ..... ..... .....
As supporting data, we hereby submit:

1. Proof of capital change that has been approved or reported to
   the competent authority;
2. Shareholder data:
   a. In the case of individuals, it is mandatory to attach:

1. 1 (one) latest passport photo size 4 x 6 cm;
2. photocopy of identification in the form of an Identity Card (KTP) that
   is still valid;
3. a curriculum vitae; and
4. a stamped declaration letter from the shareholder stating that the capital
   deposit does not originate from loans and does not originate from and is not for money laundering criminal acts. b. In the case of cooperatives or village/village-owned enterprises*) it is mandatory to attach:
5. deed of establishment including articles of association including amendments (if any) or proof of establishment of village/village-owned enterprise*);
6. financial reports audited by a public accountant or
   the latest financial report or latest financial bookkeeping;
7. documents for the Board of Directors or management of village/village-owned
   enterprise*) and/or cooperative in the form of:

1. 1 (one) latest passport photo size 4 x 6 cm;
2. photocopy of identification in the form of an Identity Card (KTP) that is
   still valid; and
3. curriculum vitae.

4. a stamped declaration letter from the shareholder stating that the capital
   deposit does not originate from loans and does not originate from and is not for money laundering criminal acts.
   c. In the case where the shareholder is a District/City Government*), the documents to be attached are in the form of
   decisions or District/City Government*) Regulations regarding capital participation in the MFI.
   This report is submitted, and for your attention, Sir/Madam*), we express our gratitude.
   ........, date, month, year
   Board of Directors
   PT MFI/Sharia MFI*) .....
   ..............................
   *) Strike what is not needed
   Established in Jakarta on 31 October 2014
   CHAIRMAN OF THE COMMISSIONER BOARD
   FINANCIAL SERVICES AUTHORITY,
   Signed,
   Signed,
   MULIAMAN D. HADAD
   Copy matches the original
   Legal Director 1
   Legal Department,
   Signed,
   Tini Kustini

FINANCIAL SERVICES AUTHORITY
REPUBLIC OF INDONESIA
APPENDIX VI
FINANCIAL SERVICES AUTHORITY REGULATION
NUMBER 12 /POJK.05/2014
ON
BUSINESS LICENSING AND INSTITUTIONAL FRAMEWORK FOR MICROFINANCE INSTITUTIONS

EXAMPLE FORMAT FOR REPORT ON CHANGES IN NAME OF MICROFINANCE INSTITUTION To the Head of Executive Supervisor for Non-Bank Financial Institutions, Financial Services Authority Through the OJK Office/Regent/Mayor/Other party designated by OJK*)……… Jl ……………….. ……………….. Referring to the Financial Services Authority Regulation Number........./POJK.05/2014 on Business Licensing and Institutional Framework for Microfinance Institutions, hereby we report that in accordance with the GMS/CMM*) dated ..... month .... year .... the name of PT/Cooperative*) MFI/Sharia MFI*)
..... has changed to PT/Cooperative*) MFI/Sharia MFI*) .....
This name change has received approval from ............... with decision number ..... dated ..... month ..... year.....) As supporting data, we hereby submit:

1. minutes of the general meeting of shareholders or cooperative members meeting*)
   regarding the name change of the MFI;
2. proof of amendment to the articles of association regarding the name change that has been approved
   by the competent authority for MFIs in the form of a limited liability company;
3. proof of announcement of the name change through a local daily newspaper or
   announcement at the MFI office.
   This report is submitted, and for your attention, Sir/Madam*), we express our gratitude.
   ........, date, month, year
   Board of Directors
   PT/Cooperative*) MFI/Sharia MFI*) .....
   ..............................
   *) Strike what is not needed
   ) This sentence is used for MFIs with limited liability company legal entity status Established in Jakarta on 31 October 2014 CHAIRMAN OF THE COMMISSIONER BOARD FINANCIAL SERVICES AUTHORITY, Signed, MULIAMAN D. HADAD Copy matches the original Legal Director 1 Legal Department, Signed, Tini Kustini

FINANCIAL SERVICES AUTHORITY
REPUBLIC OF INDONESIA
APPENDIX VII
FINANCIAL SERVICES AUTHORITY REGULATION
NUMBER 12 /POJK.05/2014
ON
BUSINESS LICENSING AND INSTITUTIONAL FRAMEWORK FOR MICROFINANCE INSTITUTIONS

EXAMPLE FORMAT FOR APPLICATION FOR APPROVAL OF MERGER To the Head of Executive Supervisor for Non-Bank Financial Institutions, Financial Services Authority Through the OJK Office/Regional Office ………… Jl ……………….. ……………….. Referring to the Financial Services Authority Regulation Number........./POJK.05/2014 on Business Licensing and Institutional Framework for Microfinance Institutions, hereby we submit an application for approval to conduct a merger of PT/Cooperative*) MFI/Sharia MFI*). As supporting data, we hereby submit the following documents:

1. minutes of the general meeting of shareholders or members' meeting of the MFI/Sharia MFI*)
   conducting the merger;
2. draft amendment to the articles of association of the MFI receiving
   the merger);
3. plan for the settlement of rights and obligations of the MFI/Sharia MFI*) that will
   conduct the merger; and
4. projection of financial position reports and financial performance reports from
   the MFI/Sharia MFI*) receiving the merger for 2 (two) years.
   This application is submitted, and for your attention, Sir/Madam*), we express our gratitude.
   ........, date, month, year
   Board of Directors
   PT/Cooperative*) MFI/Sharia MFI*) .....
   ..............................
   *) Strike what is not needed
   ) If any
   Established in Jakarta on 31 October 2014
   CHAIRMAN OF THE COMMISSIONER BOARD
   FINANCIAL SERVICES AUTHORITY,
   Signed,
   Signed,
   MULIAMAN D. HADAD
   Copy matches the original
   Legal Director 1
   Legal Department,
   Signed,
   Tini Kustini

FINANCIAL SERVICES AUTHORITY
REPUBLIC OF INDONESIA
APPENDIX VIII
FINANCIAL SERVICES AUTHORITY REGULATION
NUMBER 12 /POJK.05/2014
ON
BUSINESS LICENSING AND INSTITUTIONAL FRAMEWORK FOR MICROFINANCE INSTITUTIONS

EXAMPLE FORMAT FOR APPLICATION FOR APPROVAL OF CONSOLIDATION To the Head of Executive Supervisor for Non-Bank Financial Institutions, Financial Services Authority Through the OJK Office/Regional Office ………… Jl ……………….. ……………….. Referring to the Financial Services Authority Regulation Number........./POJK.05/2014 on Business Licensing and Institutional Framework for Microfinance Institutions, hereby we submit an application for approval to conduct a consolidation of PT/Cooperative*) MFI/Sharia MFI*). As supporting data, we hereby submit the following documents:

1. minutes of the general meeting of shareholders or members' meeting of the MFI/Sharia MFI*)
   conducting the consolidation;
2. draft articles of association of the MFI/Sharia MFI*) resulting from the consolidation;
3. plan for the settlement of rights and obligations of the MFI/Sharia MFI*) conducting
   the consolidation; and
4. projection of financial position reports and financial performance reports from
   the MFI/Sharia MFI*) resulting from the consolidation for 2 (two) years.
   This application is submitted, and for your attention, Sir/Madam*), we express our gratitude.
   ........, date, month, year
   Board of Directors
   PT/Cooperative*) MFI/Sharia MFI*) .....
   ..............................
   *) Strike what is not needed
   Established in Jakarta on 31 October 2014
   CHAIRMAN OF THE COMMISSIONER BOARD
   FINANCIAL SERVICES AUTHORITY,
   Signed,
   Signed,
   MULIAMAN D. HADAD
   Copy matches the original
   Legal Director 1
   Legal Department,
   Signed,
   Tini Kustini

FINANCIAL SERVICES AUTHORITY
REPUBLIC OF INDONESIA
APPENDIX IX
FINANCIAL SERVICES AUTHORITY REGULATION
ON
BUSINESS LICENSING AND INSTITUTIONAL FRAMEWORK FOR MICROFINANCE INSTITUTIONS

EXAMPLE FORMAT FOR REPORT ON THE IMPLEMENTATION OF MERGER To the Head of Executive Supervisor for Non-Bank Financial Institutions, Financial Services Authority Through the OJK Office/Regent/Mayor/Other party designated by OJK*)……… Jl ……………….. ………………..
In accordance with the merger approval as per OJK Letter Number .....
dated ..... month.... year ......, hereby we report that in accordance with the GMS/CMM*) dated ..... month .... year .... a merger has been conducted between PT/Cooperative*) MFI/Sharia MFI*) ..... and PT/Cooperative*)
MFI/Sharia MFI*) .....
As supporting data, we hereby submit the following documents:

1. photocopy of the amendment to the articles of association of the MFI/Sharia MFI*) receiving
   the merger that has been ratified, approved, or recorded by the competent authority;
2. organizational structure and management of the MFI, data on the Board of
   Directors, Board of Commissioners, and DPS as well as data on shareholders or members of the MFI receiving the merger;
3. financial position reports and financial performance reports of the MFI receiving
   the merger; and
4. full address of the MFI receiving the merger.
   This report is submitted, and for your attention, Sir/Madam*), we express our gratitude.
   ........, date, month, year
   Board of Directors
   PT/Cooperative*) MFI/Sharia MFI*) .....
   ..............................
   *) Strike what is not needed
   Established in Jakarta on 31 October 2014
   CHAIRMAN OF THE COMMISSIONER BOARD
   FINANCIAL SERVICES AUTHORITY,
   Signed,
   MULIAMAN D. HADAD
   Copy matches the original
   Legal Director 1
   Legal Department,
   Signed,
   Tini Kustini

FINANCIAL SERVICES AUTHORITY
REPUBLIC OF INDONESIA
APPENDIX X
FINANCIAL SERVICES AUTHORITY REGULATION
NUMBER 12 /POJK.05/2014
ON
BUSINESS LICENSING AND INSTITUTIONAL FRAMEWORK FOR MICROFINANCE INSTITUTIONS

EXAMPLE FORMAT FOR REPORT ON THE IMPLEMENTATION OF CONSOLIDATION To the Head of Executive Supervisor for Non-Bank Financial Institutions, Financial Services Authority Through the OJK Office/Regional Office ………… Jl ……………….. ……………….. Hereby we report that in accordance with the GMS/members' meeting*) dated ..... a consolidation has been conducted between PT/Cooperative*) MFI ..... and
PT/Cooperative*) MFI ..... into PT/Cooperative*) MFI .....
As consideration material, we hereby submit the following documents:

1. Photocopy of the articles of association of the MFI resulting from the consolidation that has been ratified by
   the competent authority;
2. organizational structure and management of the MFI resulting from the consolidation, data on the Board of Directors,
   Board of Commissioners, DPS as well as shareholders or members of the MFI resulting from the consolidation;
3. financial position reports and financial performance reports of the MFI resulting
   from the consolidation; and
4. full address of the MFI resulting from the consolidation.
   This report is submitted, and for your attention, Sir/Madam*), we express our gratitude.
   Board of Directors
   PT/Cooperative*)
   MFI ..................
   ......................................
   *) Strike what is not needed
   Established in Jakarta on 31 October 2014
   CHAIRMAN OF THE COMMISSIONER BOARD
   FINANCIAL SERVICES AUTHORITY,
   Signed,
   MULIAMAN D. HADAD
   Copy matches the original
   Legal Director 1
   Legal Department,
   Signed,
   Tini Kustini

FINANCIAL SERVICES AUTHORITY
REPUBLIC OF INDONESIA
APPENDIX XI
FINANCIAL SERVICES AUTHORITY REGULATION
ON
BUSINESS LICENSING AND INSTITUTIONAL FRAMEWORK FOR MICROFINANCE INSTITUTIONS

EXAMPLE FORMAT FOR REPORT ON THE IMPLEMENTATION OF OPENING OF MICROFINANCE INSTITUTION BRANCH OFFICE To the Head of Executive Supervisor for Non-Bank Financial Institutions, Financial Services Authority Through the OJK Office/Regent/Mayor/Other party designated by OJK*)……… Jl ……………….. ……………….. Referring to Article 21 of the Financial Services Authority Regulation Number........./POJK.05/2014 on Business Licensing and Institutional Framework for Microfinance Institutions, hereby we report that our branch office
with address ..... has commenced business activities since date ..... month ....
year .....
As supporting data, we hereby attach the following documents:

1. photocopy of proof of implementation of activities managing Savings and/or
   disbursement of Loans or Financing;
2. proof of control of the office; and
3. organizational structure and personnel of the branch office.
   This is submitted, and for your attention, Sir/Madam*), we express our gratitude.
   ........, date, month, year
   Board of Directors
   PT/Cooperative*) MFI/Sharia MFI*) .....
   ......................................
   *) Strike what is not needed
   Established in Jakarta on 31 October 2014
   CHAIRMAN OF THE COMMISSIONER BOARD
   FINANCIAL SERVICES AUTHORITY,
   Signed,
   Signed,
   MULIAMAN D. HADAD
   Copy matches the original
   Legal Director 1
   Legal Department,
   Signed,
   Tini Kustini

FINANCIAL SERVICES AUTHORITY
REPUBLIC OF INDONESIA
APPENDIX XII
FINANCIAL SERVICES AUTHORITY REGULATION
NUMBER 12 /POJK.05/2014
ON
BUSINESS LICENSING AND INSTITUTIONAL FRAMEWORK FOR MICROFINANCE INSTITUTIONS

EXAMPLE FORMAT FOR MICROFINANCE INSTITUTION BRANCH CLOSURE REPORT To:
Head of Executive Supervisor for IKNB, Financial Services Authority Through OJK Office/Regent/Mayor/Other parties designated by OJK*)……… Jl ……………….. ……………….. Referring to the Financial Services Authority Regulation
Number........./POJK.05/2014 concerning Business Licensing and Institutional Structure of Microfinance Institutions, we hereby report the closure of our branch office located at ..... since date .... month .... year .... with the reason .....
As supporting data, we attach proof of settlement of rights and obligations of the MFI branch ..... to Depositors, borrowing customers, and/or other parties. Thus this request is submitted, and for your attention, Sir/Madam*), we express our gratitude. ........, date, month, year Board of Directors
PT/Cooperative*) MFI/MFIS*) .....
......................................
*) Delete what is not needed
Established in Jakarta on October 31, 2014
CHAIRMAN OF THE COMMISSIONERS BOARD
FINANCIAL SERVICES AUTHORITY,
Signed,
Signed,
MULIAMAN D. HADAD
Copy matches the original
Legal Director 1
Legal Department,
Signed,
Tini Kustini

FINANCIAL SERVICES AUTHORITY
REPUBLIC OF INDONESIA
APPENDIX XIII
FINANCIAL SERVICES AUTHORITY REGULATION
NUMBER 12 /POJK.05/2014
CONCERNING
BUSINESS LICENSING AND INSTITUTIONAL STRUCTURE OF MICROFINANCE INSTITUTIONS

EXAMPLE FORMAT FOR MICROFINANCE INSTITUTION OFFICE ADDRESS CHANGE IMPLEMENTATION REPORT To:
Head of Executive Supervisor for IKNB, Financial Services Authority Through OJK Office/Regent/Mayor/Other parties designated by OJK*)……… Jl ……………….. ……………….. Referring to the Financial Services Authority Regulation Number........./POJK.05/2014 concerning Business Licensing and Institutional Structure of Microfinance Institutions, we hereby report the change of address of the Head Office/Branch*) as follows:
Old Address : .....
Telephone : .....
New Address : .....
Telephone : .....
Date of change : .....
As supporting data, we attach the following documents:

1. proof of announcement to the public regarding the relocation of the office address through a local daily newspaper or an announcement board at the old MFI office, which is easily accessible to the public; and
2. proof of office possession.
   Thus this report is submitted, and for your attention, Sir/Madam*), we express our gratitude.
   ........, date, month, year
   Board of Directors
   PT/Cooperative*) MFI/MFIS*) .....
   ......................................
   *) Delete what is not needed
   Established in Jakarta on October 31, 2014
   CHAIRMAN OF THE COMMISSIONERS BOARD
   FINANCIAL SERVICES AUTHORITY,
   Signed,
   MULIAMAN D. HADAD
   Copy matches the original
   Legal Director 1
   Legal Department,
   Signed,
   Tini Kustini

FINANCIAL SERVICES AUTHORITY
REPUBLIC OF INDONESIA
APPENDIX XIV
FINANCIAL SERVICES AUTHORITY REGULATION
CONCERNING
BUSINESS LICENSING AND INSTITUTIONAL STRUCTURE OF MICROFINANCE INSTITUTIONS

EXAMPLE FORMAT FOR REPORT ON CHANGE OF BUSINESS AREA SCOPE DUE TO AREA EXPANSION OF MICROFINANCE INSTITUTION To:
Head of Executive Supervisor for IKNB, Financial Services Authority Through OJK Office/Regional Office ………… Jl ………………..
………………..
In connection with the expansion of the area of Village/Sub-district or District or Regency/City or Province*) .............. we hereby report that the business area coverage of PT/Cooperative*) MFI/MFIS*)..... is as follows:
Business area coverage width : .........
Office address : Village/Sub-district ....., District .....
Regency/City .....
or
Street ......, Regency/City .....
Changes to:
Business area coverage width : .........
Office address : Village/Sub-district ....., District .....
Regency/City .....
or
Street ......, Regency/City .....
As supporting data, we submit information on borrowing customers/financing recipients and/or depositors located outside the business area coverage, as follows:
No. Name of Customer
Borrower/Financing Recipient
Loan/Financing Amount
Due Date

1. ... ... ...
2. ... ... ...
3. ... ... ...
   No. Name of Depositor Customer Deposit Amount
4. ... ...
5. ... ...
6. ... ...

Thus this report is submitted, and for your attention, Sir/Madam*), we express our gratitude.
........, date, month, year
Board of Directors
PT/Cooperative*) MFI/MFIS*) .....
......................................
*) Delete what is not needed
Established in Jakarta on October 31, 2014
CHAIRMAN OF THE COMMISSIONERS BOARD
FINANCIAL SERVICES AUTHORITY,
Signed,
Signed,
Copy matches the original MULIAMAN D. HADAD
Legal Director 1
Legal Department,
Signed,
Tini Kustini

FINANCIAL SERVICES AUTHORITY
REPUBLIC OF INDONESIA
APPENDIX XV
FINANCIAL SERVICES AUTHORITY REGULATION
CONCERNING
BUSINESS LICENSING AND INSTITUTIONAL STRUCTURE OF MICROFINANCE INSTITUTIONS

EXAMPLE FORMAT FOR APPLICATION FOR CONFIRMATION AS A MICROFINANCE INSTITUTION To:
Head of Executive Supervisor for IKNB, Financial Services Authority through OJK Office/Regional Office ………… Jl ………………..
………………..
Referring to the Financial Services Authority Regulation Number........./POJK.05/2014 concerning Business Licensing and Institutional Structure of Microfinance Institutions, we hereby submit an application for confirmation as a Microfinance Institution (MFI):
Name : PT/Cooperative*) MFI/MFIS*) .....
Address : Village/Sub-district..., District...
Regency/City... or
Street ...... Regency/City...
Business Area Coverage Width : Village/Sub-district, District, Regency/City*) …..
Telephone/fax No. : …..
Email : …..
So far, there has been no/has been*) financing/loans outside the aforementioned business area coverage.
To complete the aforementioned application, we submit the following documents:

1. Deed of establishment of PT/Cooperative*) MFI/MFIS ..... including the articles of association and any amendments thereto, which have been approved by the competent authority or reported to the competent authority.
2. List of composition of the Board of Directors, Board of Commissioners, and Sharia Supervisory Board (DPS), accompanied by:
   a. 1 (one) sheet of the latest 4x6 cm passport-sized photo; b. photocopy of an identification card, namely a Citizen Identity Card (KTP) that is still valid;
   c. curriculum vitae;
   d. stamped declaration letter from the Board of Directors, Board of Commissioners, and DPS stating:

1. not recorded in the list of non-performing loans in the financial services sector;
2. never sentenced for committing criminal offenses in the field of financial services business and/or economy based on a court decision that has had permanent legal force;
3. never sentenced for committing criminal offenses based on a court decision that has had permanent legal force in the last 5 (five) years;
4. never declared bankrupt or caused a business entity to be declared bankrupt based on a court decision that has had permanent legal force in the last 5 (five) years;
5. does not hold concurrent positions as Directors in other MFIs for Directors;
6. does not hold concurrent positions as Commissioners in more than 2 (two) other MFIs for Directors; and
7. does not hold concurrent positions as Commissioners in more than 3 (three) other MFIs for Commissioners;
   e. certificate or written proof of having operational experience in the field of microfinance institutions or other financial service institutions for at least 1 (one) year for one of the Directors; f. certificate or written proof of having operational experience in the field of microfinance institutions conducting business activities based on Sharia Principles or other Sharia financial service institutions for at least 1 (one) year for one of the Directors, for MFIs conducting business activities based on Sharia Principles;

3. Recommendation letter for the appointment of DPS from the National Sharia Board of the Indonesian Ulema Council (DSN MUI) for MFIs conducting business activities based on Sharia Principles;
4. Organizational structure and management, work systems and procedures of the MFI.
5. Projection of financial position reports and financial performance reports for 4 (four) months starting from when the MFI begins operational activities for the first 2 (two) years
6. Annual financial reports consisting of at least financial position reports and financial performance reports for the last 2 (two) years;
7. Closing financial position reports and opening financial position reports from the MFI to be confirmed;
8. MFI financing performance for the last 2 (two) years;
9. Data on shareholders or members.
10. List of borrowing customers outside the business area coverage (if any), as follows:
    No. Name of Borrowing Customer
    /Financing Recipient
    Loan/Financing Amount
    Due Date
11. ... ... ...
12. ... ... ...
13. ... ... ...
    No. Name of Depositor Customer Deposit Amount
14. ... ...
15. ... ...
16. ... ...

Thus our application is submitted, and for your attention, Sir/Madam*), we express our gratitude.
........, date, month, year
Board of Directors
PT/Cooperative*) MFI/MFIS*) .....
......................................
*) delete what is not needed
Established in Jakarta on October 31, 2014
CHAIRMAN OF THE COMMISSIONERS BOARD
FINANCIAL SERVICES AUTHORITY,
Signed,
Copy matches the original MULIAMAN D. HADAD
Legal Director 1
Legal Department,
Signed,
Tini Kustini