Form and Structure of Periodic Reports for Pension Funds Administering Sharia-Compliant Pension Programs

To:

Management of Sharia-Compliant Employer Pension Funds;
Acting Management of Sharia-Compliant Financial Institution Pension Funds;
Management of Employer Pension Funds that have Sharia Units; and
Acting Management of Financial Institution Pension Funds that sell Sharia investment packages,

At your respective locations.

COPY
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY REPUBLIC OF INDONESIA NUMBER 5 /SEOJK.05/2021 CONCERNING THE FORM AND STRUCTURE OF PERIODIC REPORTS FOR PENSION FUNDS ADMINISTERING PENSION PROGRAMS BASED ON SHARIA PRINCIPLES

In accordance with the mandate of Article 13 and Article 14 paragraph (3) of the Financial Services Authority Regulation Number 5/POJK.05/2018 concerning Periodic Reports of Pension Funds (State Gazette of the Republic of Indonesia Year 2018 Number 45, Supplement to the State Gazette of the Republic of Indonesia Number 6195), it is necessary to regulate the form, structure, and procedures for submitting periodic reports of pension funds that administer pension programs based on Sharia principles in this Financial Services Authority Circular Letter as follows:

I. GENERAL PROVISIONS

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

Pension Fund is a legal entity that manages and implements programs promising pension benefits, including Pension Funds that conduct all or part of their business based on Sharia principles.
Sharia Principles are Islamic legal provisions based on fatwas and/or Sharia compliance statements from the National Sharia Board of the Indonesian Ulema Council.
Sharia-Compliant Pension Program is a Pension Program administered based on Sharia Principles.
Sharia-Compliant Employer Pension Fund, hereinafter referred to as Sharia Pension Fund, is a Pension Fund whose entire activities are administered based on Sharia Principles.
Employer Pension Fund, hereinafter abbreviated as DPPK, is a Pension Fund established by a person or entity employing employees, as the founder, to administer defined benefit pension programs or defined contribution pension programs, for the benefit of some or all of its employees as participants, and which creates obligations for the employer.
Financial Institution Pension Fund, hereinafter abbreviated as DPLK, is a Pension Fund established by a bank or life insurance company to administer defined contribution pension programs for individuals, whether employees or self-employed workers, which are separate from DPPK for employees of the respective bank or life insurance company.
Sharia Unit is a unit established by a DPPK to administer Sharia-Compliant Pension Programs.
Sharia Supervisory Board, hereinafter abbreviated as DPS, is a board responsible for providing advice and suggestions and supervising the fulfillment of Sharia Principles in the administration of Sharia-Compliant Pension Programs.
Sharia Investment Package is a collection of Sharia-Compliant investment types offered by a DPLK.
Periodic Report is a report prepared by a Pension Fund for the benefit of the Financial Services Authority for a specific period.
Monthly Report is a report prepared by a Pension Fund for the benefit of the Financial Services Authority, covering the period from January 1 to the end of the respective month.
Annual Report is a report prepared by a Pension Fund for the benefit of the Financial Services Authority, covering the period from January 1 to the end of the respective year.
Other Reports are reports prepared by a Pension Fund for the benefit of the Financial Services Authority other than Monthly Reports and Annual Reports, submitted during a specific period.
Electronic Data is financial data referring to financial statements audited by public accountants and can be used for electronic data processing using a specific format.

II. FORM AND STRUCTURE OF PERIODIC REPORTS FOR PENSION FUNDS ADMINISTERING SHARIA-COMPLIANT PENSION PROGRAMS

Periodic Reports of Pension Funds are divided into the following types of reports:
a. Monthly Reports; b. Annual Reports; and
c. Other Reports.
Annual Reports as referred to in point 1 letter b for Pension Funds consist of:
a. annual financial reports; and b. technical reports.
Annual financial reports as referred to in point 2 letter a consist of:
a. annual financial reports audited by public accountants; and b. Electronic Data.
Periodic Reports for Sharia Pension Funds consist of Periodic Reports as referred to in point 1.
Periodic Reports for Sharia Units consist of Monthly Reports as referred to in point 1 letter a and Annual Reports in the form of annual financial reports as referred to in point 2 letter a.
Annual financial reports audited by public accountants as referred to in point 3 letter a follow the applicable financial accounting standards in Indonesia.
For Sharia-Compliant DPPK including Sharia Units, the form and structure of Periodic Reports as referred to in point 1 are as contained in Appendix I which is an integral part of this Financial Services Authority Circular Letter, with the following provisions:
a. the form and structure of Monthly Reports as referred to in point 1 letter a and Electronic Data as referred to in point 3 letter b, for Sharia-Compliant DPPK including Sharia Units, administering defined benefit pension programs, are as contained in Format IA; b. the form and structure of Monthly Reports as referred to in point 1 letter a and Electronic Data as referred to in point 3 letter b, for Sharia-Compliant DPPK including Sharia Units, administering defined contribution pension programs, are as contained in Format IB;
c. the form and structure of technical reports as referred to in point 2 letter b are as contained in Format IC; and
d. the form and structure of Other Reports as referred to in point 1 letter c are as contained in Format ID.
For Sharia-Compliant DPLK, the form and structure of Periodic Reports as referred to in point 1 are as contained in Appendix II which is an integral part of this Financial Services Authority Circular Letter, with the following provisions:
a. the form and structure of Monthly Reports as referred to in point 1 letter a and Electronic Data as referred to in point 3 letter b are as contained in Format IIA; b. the form and structure of technical reports as referred to in point 2 letter b are as contained in Format IIB; and
c. the form and structure of Other Reports as referred to in point 1 letter c are as contained in Format IIC.
For DPLK selling Sharia Investment Packages, the form and structure of Periodic Reports as referred to in point 1 follow the provisions in the OJK Circular Letter regarding the form and structure of Periodic Reports of Pension Funds, with the addition of information regarding Sharia Investment Packages in the Monthly Reports and Annual Reports submitted, as contained in Appendix III which is an integral part of this Financial Services Authority Circular Letter.

III. PROCEDURES FOR SUBMITTING PERIODIC REPORTS

Submission of Periodic Reports is conducted online (daring) through the Financial Services Authority's data communication network system.
In the event that the Financial Services Authority's data communication network system as referred to in point 1 is not yet available, or experiences technical disturbances, Sharia Pension Funds and Sharia Units must submit Periodic Reports online (daring) via email to the Financial Services Authority.
In the event that Sharia Pension Funds must submit Periodic Reports online (daring) via email to the Financial Services Authority as referred to in point 2, the Financial Services Authority provides the Sharia Pension Fund with the email address used for the submission of Periodic Reports.
In order to submit online (daring) via email as referred to in point 2, Sharia Pension Funds and Sharia Units must submit in writing to the Financial Services Authority the email address of the Sharia Pension Fund and Sharia Unit used for the submission of Periodic Reports to the Financial Services Authority.
In the event that the Financial Services Authority's data communication network system and email system as referred to in point 1 and point 2 experience technical disturbances, or Sharia Pension Funds and Sharia Units experience disturbances such that they cannot submit Periodic Reports online (daring), Periodic Reports are submitted offline (luring) accompanied by written notification and supporting documents in the form of Periodic Reports, either using media such as compact disk (CD) or other electronic data storage media, and sent to the Financial Services Authority via a letter signed by the management/acting management and addressed to:
Financial Services Authority u.p. Director of Sharia Financial Institutions and Business Entities Supervision Wisma Mulia 2 Building, 15th Floor Jalan Jenderal Gatot Subroto Kav. 40 Jakarta 12710.
Submission of Periodic Reports offline (luring) as referred to in point 5 is conducted by one of the following methods:
a. handed directly to the Financial Services Authority office; or b. sent via a courier service company.
Sharia Pension Funds and Sharia Units are deemed to have submitted Periodic Reports with the following provisions:
a. for online (daring) submission via:

the Financial Services Authority's data communication network system, evidenced by a receipt from the Financial Services Authority's data communication network system; or
email to the Financial Services Authority, evidenced by proof of email transmission in the event that transmission via the data communication network cannot be performed; or
b. for offline (luring) submission, evidenced by a receipt from the Financial Services Authority.

The Financial Services Authority may request original printed documents of Periodic Reports submitted by Sharia Pension Funds and Sharia Units through the Financial Services Authority's data communication network system.

IV. CLOSING PROVISIONS

Upon the effective date of this Financial Services Authority Circular Letter, Financial Services Authority Circular Letter Number 4/SEOJK.05/2019 concerning the Form and Structure of Periodic Reports for Pension Funds Administering Sharia-Compliant Pension Programs is revoked and declared invalid.

This copy is consistent with the original.
Director of Legal Affairs I
Legal Department signed
Mufli Asmawidjaja

The provisions in this Financial Services Authority Circular Letter take effect on April 30, 2021.

Established in Jakarta on January 21, 2021 EXECUTIVE HEAD OF INSURANCE, PENSION FUNDS, FINANCING INSTITUTIONS, AND OTHER FINANCIAL SERVICES INSTITUTIONS SUPERVISOR FINANCIAL SERVICES AUTHORITY REPUBLIC OF INDONESIA, signed RISWINANDI

APPENDIX I
FINANCIAL SERVICES AUTHORITY CIRCULAR LETTER REPUBLIC OF INDONESIA NUMBER 5 /SEOJK.05/2021 CONCERNING THE FORM AND STRUCTURE OF PERIODIC REPORTS FOR PENSION FUNDS ADMINISTERING PENSION PROGRAMS BASED ON SHARIA PRINCIPLES

FORMAT IA
To:
Director of Sharia Financial Institutions and Business Entities Supervision Financial Services Authority MONTHLY REPORT / ELECTRONIC DATA DEFINED BENEFIT PENSION PROGRAM Per DD-MM-YYYY SHARIA-COMPLIANT EMPLOYER PENSION FUND / SHARIA UNIT

General Data
Reporting Date
Pension Fund Code
Pension Fund Name
Reporting Period
Reporting Month
Fiscal Year
Type of Reporting Period: Annual Report/Monthly Report Management Name Management Position SID Number Audit Data Auditor License Number Type of Audit Auditor Code Auditor Name Opinion Audit Executor Audit Date Report Preparer Officer Name Division Telephone Fax E-mail Management Responsible Person Responsible Person Name Position Telephone Fax E-mail Pension Fund Address

Description Code Percentage
Investment Program Pension Program Other Combined Benefits ASSETS SHARIA INVESTMENT Bank Savings 1101 On-call Deposits at Banks 1102 Time Deposits at Banks 1103 Bank Deposit Certificates 1104 Sharia-Compliant Securities issued by Bank Indonesia 1105 Sharia-Compliant Government Securities 1106 Sharia-Compliant Stocks listed on the Indonesia Stock Exchange 1107 Corporate Sukuk listed on the Indonesia Stock Exchange 1109 Regional Sukuk 1110 Sharia-Compliant Mutual Funds 1111 Sharia-Compliant MTN 1112 Sharia-Compliant Asset-Backed Securities 1113 Sharia-Compliant Real Estate Investment Funds in the form of collective investment contracts 1114 Sharia-Compliant Infrastructure Investment Funds in the form of collective investment contracts 1115 Options contracts and forward contracts for Sharia-Compliant Securities listed on the Indonesia Stock Exchange 1116 REPO 1117 Direct Investment 1118 Land in Indonesia Buildings in Indonesia Land and Buildings in Indonesia TOTAL INVESTMENT CURRENT ASSETS OUTSIDE INVESTMENT Cash and Banks 1201 Contribution Receivables 1202

Normal Contributions from Employers
Normal Contributions from Participants
Voluntary Contributions from Participants
Additional Contributions
Prepaid Expenses 1204
Investment Receivables 1205
Investment Income Receivables 1206
Other Receivables 1207
TOTAL CURRENT ASSETS OUTSIDE INVESTMENT
OPERATIONAL ASSETS
Land and Buildings 1301
Vehicles 1302
Computer Equipment 1303
Office Equipment 1304
Other Operational Assets 1305
TOTAL OPERATIONAL ASSETS
OTHER ASSETS 1401
AVAILABLE ASSETS
LIABILITIES
Liabilities Outside Actuarial Present Value Due Pension Benefits and Other Benefits 1501 Voluntary Benefits Payable 1502 Tazir Fund Payable 1507 Investment Payable 1503 Unearned Revenue 1504 Accrued Expenses 1505 Other Payables 1506 Total Liabilities Outside Actuarial Present Value TOTAL LIABILITIES NET ASSETS DEFINED BENEFIT PENSION PROGRAM NET ASSETS REPORT Per DD-MM-YYYY

Program Pension Program Other Combined Benefits ADDITIONS Investment Income Profit Sharing Dividends Rent Profit (Loss) on Investment Disposal Other Investment Income Total Investment Income Increase (Decrease) in Investment Value 401 Due Contributions: 402

Normal Contributions from Employers
Normal Contributions from Participants
Voluntary Contributions from Participants
Additional Contributions
Non-Investment Income 403
Transfer of Funds from Other Pension Funds 404 Total Additions REDUCTIONS Investment Expenses 405 Operational Expenses 406 Non-Investment and Operational Expenses 407 Pension Benefits and Other Benefits Income Tax 408 Transfer of Funds to Other Pension Funds 409 Total Reductions INCREASE (DECREASE) IN NET ASSETS NET ASSETS AT BEGINNING OF PERIOD NET ASSETS AT END OF PERIOD Details Code DEFINED BENEFIT PENSION PROGRAM NET ASSETS CHANGE REPORT Accumulated as of DD-MM-YYYY

Description Accumulated as of DD-MM-YYYY

ASSETS
INVESTMENT (Historical Value)
Bank Savings
On-call Deposits at Banks
Time Deposits at Banks
Bank Deposit Certificates
Sharia-Compliant Securities issued by Bank Indonesia Sharia-Compliant Government Securities Sharia-Compliant Stocks listed on the Indonesia Stock Exchange Corporate Sukuk listed on the Indonesia Stock Exchange Regional Sukuk Sharia-Compliant Mutual Funds Sharia-Compliant MTN Sharia-Compliant Asset-Backed Securities Sharia-Compliant Real Estate Investment Funds in the form of collective investment contracts Sharia-Compliant Infrastructure Investment Funds in the form of collective investment contracts Options contracts and forward contracts for Sharia-Compliant Securities listed on the Indonesia Stock Exchange REPO Direct Investment Land in Indonesia Buildings in Indonesia Land and Buildings in Indonesia Accumulated Depreciation of Buildings TOTAL INVESTMENT INVESTMENT VALUATION DIFFERENCES CURRENT ASSETS OUTSIDE INVESTMENT Cash and Banks Contribution Receivables

Normal Contributions from Employers
Normal Contributions from Participants
Voluntary Contributions from Participants
Additional Contributions
Prepaid Expenses
Investment Receivables
Investment Income Receivables
Other Receivables
TOTAL CURRENT ASSETS OUTSIDE INVESTMENT
OPERATIONAL ASSETS
Land and Buildings
Vehicles
Computer Equipment
Office Equipment
Other Operational Assets
Accumulated Depreciation
TOTAL OPERATIONAL ASSETS
OTHER ASSETS
TOTAL ASSETS
LIABILITIES
ACTUARIAL PRESENT VALUE
ACTUARIAL PRESENT VALUE DIFFERENCES
LIABILITIES OUTSIDE ACTUARIAL PRESENT VALUE Due Pension Benefits and Other Benefits Voluntary Benefits Payable Tazir Fund Payable Investment Payable Unearned Revenue Accrued Expenses Other Payables TOTAL LIABILITIES OUTSIDE ACTUARIAL PRESENT VALUE TOTAL LIABILITIES

Description
DEFINED BENEFIT PENSION PROGRAM
BALANCE SHEET
Per DD-MM-YYYY
Program Pension Program Other Combined Benefits

PPMP_LPHU
Program Pension Program Other Combined Benefits INVESTMENT INCOME Profit Sharing Dividends Rent Profit (Loss) on Investment Disposal Other Investment Income Total Investment Income INVESTMENT EXPENSES Transaction Expenses Land and Building Maintenance Expenses Building Depreciation Expenses Investment Manager Expenses Custodian Expenses Other Investment Expenses Total Investment Expenses INVESTMENT OPERATING RESULTS OPERATIONAL EXPENSES Salaries/Honorariums for Employees, Management, Supervisory Board, and DPS Office Expenses Maintenance Expenses Depreciation Expenses Third-Party Service Expenses Other Operational Expenses Total Operational Expenses OTHER INCOME AND EXPENSES Profit (Loss) on Sale of Operational Assets Profit (Loss) on Sale of Other Assets Other Non-Investment Income Non-Investment and Operational Expenses Total Other Income and Expenses INCOME BEFORE TAX INCOME TAX INCOME AFTER TAX

Description
DEFINED BENEFIT PENSION PROGRAM
INCOME STATEMENT REPORT
Accumulated as of DD-MM-YYYY
Accumulated as of DD-MM-YYYY

Program Pension Program Other Combined Benefits CASH FLOWS FROM INVESTMENT ACTIVITIES Profit Sharing Receipts Dividend Receipts Rent Receipts Other Investment Income Investment Disposal Investment Investment Investment Expense Payments Net Cash Flows from Investment Activities CASH FLOWS FROM OPERATIONAL ACTIVITIES Operational Expense Payments Sale of Operational Assets Purchase of Operational Assets Sale of Other Assets Purchase of Other Assets Ta'zir Fund Receipts Ta'zir Fund Expenditures Other Non-Investment Income Non-Investment and Operational Expenses Income Tax Net Cash Flows from Operational Activities CASH FLOWS FROM FINANCING ACTIVITIES Normal Contributions from Employers Receipts Normal Contributions from Participants Receipts Voluntary Contributions from Participants Receipts Additional Contributions Receipts Transfer of Funds from Other Pension Funds Receipts Transfer of Funds to Other Pension Funds Payments Pension Benefits and Other Benefits Payments Net Cash Flows from Financing Activities INCREASE (DECREASE) IN NET CASH CASH AT BEGINNING OF PERIOD CASH AT END OF PERIOD

Description
DEFINED BENEFIT PENSION PROGRAM
CASH FLOW STATEMENT
Accumulated as of DD-MM-YYYY
Accumulated as of DD-MM-YYYY

Pensioners
PENSION FUND PARTICIPATION
Per DD-MM-YYYY
Description Program Pension Program Other Total (1) Active Participants a. Founder b. Partner Founder (2) Inactive Participants a. Founder
Children
Deferred Retirement
(4) Number of Partner Companies of the Pension Fund Founder
Widows/Widowers
Children
Deferred Retirement
b. Partner Founder
Pensioners
Widows/Widowers
(3) Total DPPK Participants (1) + (2)

Value
Net Asset Value based on audited financial statements* a. b.
c. etc.
a. Participant Contributions b. Employer Contributions
c. Additional Contributions
3 Other Receivables a. b.
c. etc.
4 Other Assets a. b.
c. etc.
*: audited financial statements only for annual reports Total Funding Wealth Per DD-MM-YYYY Description Deductions Wealth in court disputes, or controlled or seized by competent authorities Actuarial interest rate .....% Total Deductions Funding Wealth Value Contributions, which on the actuarial valuation date have not been paid for more than 3 (three) months since the due date Total Actuarial interest rate Total

Bank Savings
On-call Deposits at Banks
Time Deposits at Banks
Bank Deposit Certificates
Sharia-Compliant Securities issued by Bank Indonesia Sharia-Compliant Government Securities Sharia-Compliant Stocks listed on the Indonesia Stock Exchange Corporate Sukuk listed on the Indonesia Stock Exchange Regional Sukuk Sharia-Compliant Mutual Funds Sharia-Compliant MTN Sharia-Compliant Asset-Backed Securities Sharia-Compliant Real Estate Investment Funds in the form of collective investment contracts Sharia-Compliant Infrastructure Investment Funds in the form of collective investment contracts Options contracts and forward contracts for Sharia-Compliant Securities listed on the Indonesia Stock Exchange REPO Direct Investment Land in Indonesia Buildings in Indonesia Land and Buildings in Indonesia TOTAL INVESTMENT DEFINED BENEFIT PENSION PROGRAM Nov Dec Sep Oct INVESTMENT RECAPITULATION Per DD-MM-YYYY May Jun Jul Aug Description Jan Feb Mar Apr

Profit Sharing Dividends Rent Profit/Loss Disposal Others Bank Savings On-call Deposits at Banks Time Deposits at Banks Bank Deposit Certificates Sharia-Compliant Securities issued by Bank Indonesia Sharia-Compliant Government Securities Sharia-Compliant Stocks listed on the Indonesia Stock Exchange Corporate Sukuk listed on the Indonesia Stock Exchange Regional Sukuk Sharia-Compliant Mutual Funds Sharia-Compliant MTN Sharia-Compliant Asset-Backed Securities Sharia-Compliant Real Estate Investment Funds in the form of collective investment contracts Sharia-Compliant Infrastructure Investment Funds in the form of collective investment contracts Options contracts and forward contracts for Sharia-Compliant Securities listed on the Indonesia Stock Exchange REPO Direct Investment Land in Indonesia Buildings in Indonesia Land and Buildings in Indonesia Total Note:
the Realized Investment Income column uses data according to the Increase/Decrease in Investment Value account on the LPAN sheet DEFINED BENEFIT PENSION PROGRAM INVESTMENT INCOME REPORT Per DD-MM-YYYY Type of Investment Realized Investment Income ROI Average Investment Net Investment Income Investment Expenses Unrecognized Investment Income

Profit Sharing Dividends Rent Profit/Loss Disposal Others Bank Savings On-call Deposits at Banks Time Deposits at Banks Bank Deposit Certificates Sharia-Compliant Securities issued by Bank Indonesia Sharia-Compliant Government Securities Sharia-Compliant Stocks listed on the Indonesia Stock Exchange Corporate Sukuk listed on the Indonesia Stock Exchange Regional Sukuk Sharia-Compliant Mutual Funds Sharia-Compliant MTN Sharia-Compliant Asset-Backed Securities Sharia-Compliant Real Estate Investment Funds in the form of collective investment contracts Sharia-Compliant Infrastructure Investment Funds in the form of collective investment contracts Options contracts and forward contracts for Sharia-Compliant Securities listed on the Indonesia Stock Exchange REPO Direct Investment Land in Indonesia Buildings in Indonesia Land and Buildings in Indonesia Total Note:
the Unrecognized Investment Income column uses data according to the Increase/Decrease in Investment Value account on the LPAN sheet DEFINED BENEFIT PENSION PROGRAM OTHER BENEFITS INVESTMENT INCOME REPORT Per DD-MM-YYYY Type of Investment Realized Investment Income Unrecognized Investment Income Investment Expenses Net Investment Income Average Investment ROI

Rupiah Non Rupiah Total Rupiah Non Rupiah Total Rupiah Non Rupiah Total Rupiah Non Rupiah Total Rupiah Non Rupiah Total A. Investment Assets Bank Savings Bank On-Call Deposits Bank Time Deposits Bank Certificates of Deposit Sharia Securities Issued by Bank Indonesia Sharia Government Securities Sharia Stocks Listed on the Indonesian Stock Exchange Corporate Sukuk Listed on the Indonesian Stock Exchange Regional Sukuk Sharia Mutual Funds Sharia MTN Sharia Asset-Backed Securities Sharia Real Estate Investment Fund in the form of Collective Investment Contracts Sharia Infrastructure Investment Fund in the form of Collective Investment Contracts Sharia Effect Options and Forward Contracts Listed on the Indonesian Stock Exchange REPO Direct Participation Land in Indonesia Buildings in Indonesia Land and Buildings in Indonesia Total Investments B. Current Assets Excluding Investments Cash and Bank Contribution Receivables Normal Contributions from Employers Normal Contributions from Participants Voluntary Participant Contributions Additional Contributions Prepaid Expenses Investment Receivables Investment Income Receivables Other Receivables Total Current Assets Excluding Investments
C. Operational Assets
Land and Buildings
Vehicles
Computer Equipment
Office Equipment
Other Operational Assets
Total Operational Assets
D. Other Assets
E. Total Assets (A+B+C+D)
F. Actuarial Present Value
G. Liabilities Excluding Actuarial Present Value Due Pension Benefits and Other Benefits Due Voluntary Benefit Liabilities Tazir Fund Liabilities Investment Liabilities Unearned Income Expenses Payable Other Liabilities Total Liabilities Excluding Actuarial Present Value H. Total Liabilities (F+G)
I. Difference Between Total Assets and Total Liabilities (E-H)
J. Percentage (%) Fund Sufficiency Ratio Total DEFINED BENEFIT PENSION PROGRAM ASSET AND LIABILITY RECAPITULATION As of DD-MM-YYYY (in Rupiah) Due >= 10 Years Due < 1 Year 1 Year <= Due < 5 Years 5 Year <= Due < 10 Years

Type Amount Percentage of Total Investment a b c d e f g ... Details of Investments with a Single Counterparty As of DD-MM-YYYY No Counterparty Name Investment Limit in Instructions Investment Limit According to Regulations

Type Amount Percentage of Total Investment a b c d e f g ... Details of Investments with Affiliated Parties As of DD-MM-YYYY No Counterparty Name Investment Affiliation Relationship Description

Type Amount Percentage of Total Investment a b c d e f g ... Notes:
a. Sharia Stocks with issuers indicated to be bankrupt b. Sharia Mutual Funds indicated to be traded abnormally
c. Bond issuers or deposit-issuing banks recording losses.
d. There is a downgrade of bond instrument ratings below investment grade. e. There is a delay in coupon payments for Corporate Sukuk or profit-sharing for Deposits. Problematic investments can be obtained from the investment balance with identified problematic parties from the Sharia Pension Fund/Sharia Unit Financial Statements. Information on investees experiencing problems (default risk) can be obtained, among others, from investee financial statements, media disclosures, and/or from f. Bond issuers or deposit issuers involved in legal cases or indicated fraud. g. Restructured bonds h. Land and/or Building ownership not yet in the name of the Pension Fund Details of Identified Problematic Investments As of DD-MM-YYYY No Counterparty Name Investment Problematic Category Description

Name Type
Investment
Balance
Name Type
Investment
Bond Series
Type
Ownership
Rating Balance
Name Type
Investment
Investment Manager
Fair Value % SBSN in Mutual Funds Balance Name Type Investment Investment Manager Recipient Fund/Project Balance Name Type Investment Bond Series Type Ownership Rating Balance Name Type Investment Balance
.....
Total
DETAILS OF COMPLIANCE WITH REGULATIONS REGARDING SBSN AND INFRASTRUCTURE INVESTMENTS No SBSN SUKUK INFRASTRUCTURE MUTUAL FUNDS UNDERLYING SBSN MUTUAL FUNDS LIMITED PARTICIPATION EFFECTS ASSET-BACKED OTHER INVESTMENTS FOR PROJECT FINANCING INFRASTRUCTURE GOVERNMENT

Investment Income Ratio (ROI)
A. Total Investment Income – Investment Expenses B. Average Investments
C. Ratio (A:B)
Investment Income Ratio against Assets (ROA) A. (Total Investment Income + Non-Investment Income) - (Investment Expenses + Operating Expenses + Non-Investment and Operating Expenses) B. Average available assets
C. Ratio (A:B)
Operating Expense Ratio (BOPO)
A. Operating Expenses
B. Investment Income + Non-Investment Income
C. Ratio (A:B)
Fund Sufficiency Ratio (RKD)
A. Funding Wealth (KUP) x 100%
B. Actuarial Present Value (NKA)
C. Ratio (A:B)
Contribution Receivable Age Ratio (RUPI) A. Contribution Receivables (LAN) x Number of Months Elapsed B. Due Contributions (LPAN)
C. Ratio (A:B)
Investment to Net Assets Ratio (RITA)
A. Total Investments x 100%
B. Total Net Assets
C. Ratio (A:B)
Investment Receivables and Investment Income Receivables against Total Investments A. Investment Receivables + Investment Income Receivables B. Total Investments
C. Ratio (A:B)
Investment Growth Ratio
A. (Total Investments t1 - Total Investments t0) x 100% B. Total Investments t0
C. Ratio (A:B)
Market price changes in Pension Fund assets A. (SPIn-SPIn-1) x 100% B. SPIn-1
C. Ratio (A:B)
SPI compared to total income
A. SPI
B. Total Income
C. Ratio (A:B)
SPI compared to net assets
A. SPI
B. Net Assets
C. Ratio (A:B)
Minimum Liquidity Ratio / Cash Ratio
A. Current assets or investments for minimum liquidity fulfillment B. Operating Costs + Investment Costs + Pension Benefits and Other Benefits Due within one year
C. Ratio (A:B)
Cash Inflows compared to Cash Outflows
A. Cash Inflows from Investment, Operating, and Financing Activities B. Cash Outflows from Investment, Operating, and Financing Activities
C. Ratio (A:B)
Contribution Receivable Ratio against Net Assets A. Contribution Receivables B. Net Assets
C. Ratio (A:B)
Growth Ratio of Founder's Contribution Receivables (Employer Contributions + Additional Contributions) A. (Total Founder's Contribution Receivables t1 - Total Founder's Contribution Receivables t0) X 100% B. Total Founder's Contribution Receivables t0
C. Ratio (A:B)
Ratio of Total Long-Term Assets to Total Long-Term Liabilities A. Total Long-Term Assets x 100% B. Total Long-Term Liabilities
C. Ratio (A:B)
Income to Expenditure Ratio
A. Operating Expenses + Investment Expenses + Pension Benefit Payments B. Total Income
C. Ratio (A:B)
Interest rate spread
A. Investment Income Ratio (ROI)
B. Actuarial Interest Rate
C. Ratio (A-B)
Current Assets to Total Assets Ratio
A. Current Assets
B. Total Assets
C. Ratio (A:B)
Current Liabilities to Total Liabilities Ratio A. Current Liabilities B. Total Liabilities
C. Ratio (A:B)
Operating Expense Ratio
A. Operating Expenses + Investment Expenses B. Investment Income
C. Ratio (A:B)

Comparison between long-term assets and long-term liabilities is obtained from the Pension Fund Financial Statements
Assets with a life > 1 year according to information as stated in the Pension Fund Financial Statements
Liabilities with a life > 1 year according to information as stated in the Pension Fund Financial Statements
Current assets are assets with a maturity of less than 1 year (excluding operational assets and other assets)
as presented in the Pension Fund Financial Statements.
Total assets are available assets as presented in the Pension Fund Financial Statements
Current liabilities are liabilities with a maturity of less than 1 year as presented in the Pension Fund
Financial Statements.
Total Liabilities are Actuarial Present Value for DBPP and
Pension Benefit Liabilities for DCPP.
Operating expenses are as presented in the Statement of Changes in Net Assets
Investment expenses are as presented in the Statement of Changes in Net Assets
Investment income includes realized and unrealized investment income as presented in the Statement of Changes in Net Assets.
Total Investment Income is as presented in the Statement of Changes in Net Assets.
Investment Expenses are as presented in the Statement of Changes in Net Assets.
For the calculation of average investments, use the average investment assets throughout the year.
Total Investment Income is income that is already
realized and unrealized. Total Investment Income is as presented in the Statement of Changes in Net Assets.
Non-Investment Income is as presented in the
Statement of Changes in Net Assets.
Investments are as presented in the Net Assets Statement.
For the calculation of Operating Expenses, it is as presented
in the Statement of Changes in Net Assets.
For the calculation of total available assets, use the average assets
throughout the year. Total Available Assets are as presented in the Net Assets Statement.
Operating expenses as stated in the statement of changes in net assets
Investment Income is realized income
as stated in the statement of changes in net assets
Non-Investment Income as stated in the
statement of changes in net assets
SPI is the Investment Valuation Difference for instruments
exposed to market risk traded actively. Examples:
investments in the capital market and deposits denominated in foreign currency
Total Income is total realized and
unrealized income on the statement of changes in net assets
SPI is the Investment Valuation Difference for instruments exposed
to market risk traded actively.
Example: investments in the capital market and deposits denominated in foreign currency
Cash Flows from investment activities are all investment activities
except placement and release of investments as presented in financial statements.
Cash Flows from operating activities are all operating
activities except placement and release of operational assets and other assets as presented in financial statements.
Cash Flows from financing activities are as presented
in financial statements.
FINANCIAL RATIOS
As of DD-MM-YYYY
Description Other Pension Programs Total Notes

No. Investment Manager Name Contract Number Contract Date Agreement Period Investment Type Amount Fair Value Funds Managed (Rp) Acquisition Value (Managed by Investment Manager) n Investment Valuation Difference Return (%) Net Investment Yield (Rp) Total Management Fees Charged (Rp) Affiliated with Pension Fund (Yes/No) 1. 2.
3. etc
1.
2.
3. etc
1.
2.
3. etc
: if using Investment Manager services
Investment Fund Management Contract (KPD) Format by Investment Manager Pension Fund ….. Use of Investment Manager As of DD-MM-YYYY Total etc.

Self-Managed/ KPD
Investment Manager Name a b c d e f g h i j k … Total Program Type 1 Pension Program 2 Other Benefits Notes DETAILS OF SAVINGS No Bank Name Branch Bank Code Acquisition Date Nominal Value Interest Rate/Profit Sharing Rate Pension Program/ Other Benefits Management

Self-Managed/ KPD
Investment Manager Name a b c d e f g h i j k l … Total Notes DETAILS OF ON-CALL DEPOSITS No Bank Name Branch Bank Code Acquisition Date Nominal Value Tenor Interest Rate/Profit Sharing Rate Pension Program/ Other Benefits Management

Self-Managed/ KPD
Investment Manager Name a b c d e f g h i j k l … Total Notes DETAILS OF TIME DEPOSITS No Bank Name Branch Bank Code Acquisition Date Nominal Value Tenor Interest Rate/Profit Sharing Rate Pension Program/ Other Benefits Management

a b c d e f g h i j k l m n o p
…
Total
% Self-Managed/ KPD
Investment Manager Name
DETAILS OF FOREIGN CURRENCY TIME DEPOSITS No Bank Name Branch Bank Code Acquisition Date Nominal Value Fair Value Investment Valuation Difference Tenor Interest Rate/Profit Sharing Rate Pension Program/ Other Benefits Management Notes Currency Type Value

Self-Managed/ KPD
Investment Manager Name a b c d e f g h i j k l … Total Notes DETAILS OF CERTIFICATES OF DEPOSIT No Bank Name Branch Bank Code Acquisition Date Nominal Value Tenor Interest Rate/Profit Sharing Rate Pension Program/ Other Benefits Management

Value %
Self-Managed/ KPD
Investment Manager Name a b c d e f g h i j k l m n … Total Pension Program/ Other Benefits Notes Management DETAILS OF SHARIA CERTIFICATES OF BANK INDONESIA No Bond Code Acquisition Date Nominal Value Coupon (%) Maturity Date Acquisition Value Fair Value Investment Valuation Difference

Value %
Self-Managed/ KPD
Investment Manager Name a b c d e f g h i j k l m n o … Total Pension Program/ Other Benefits Recording Method Notes Management DETAILS OF SHARIA GOVERNMENT SECURITIES No Bond Code Acquisition Date Nominal Value Coupon (%) Maturity Date Acquisition Value Fair Value Investment Valuation Difference

Value %
Self-Managed/ KPD
Investment Manager Name a b c d e f g h i j k l m n … Total Pension Program/ Other Benefits Notes Management DETAILS OF SHARIA STOCKS No Stock Code Issuer Name /Issuer Acquisition Date Number of Shares Acquisition Value Market Value Investment Valuation Difference Economic Sector

Start End Value % Self-Managed/ KPD
Investment Manager Name a b c d e f g h i j k l m n o p q r s t … Total Investment Valuation Difference Pension Program/ Other Benefits Economic Sector Recording Method Notes Management DETAILS OF CORPORATE SUKUK No Issuer Name Sukuk Code Sukuk Name Acquisition Date Nominal Value Coupon (%) Maturity Rating Acquisition Value Fair Value

Start End Value % Self-Managed/ KPD
Investment Manager Name a b c d e f g h i j k l m n o p q r s t … Total Notes DETAILS OF REGIONAL SUKUK No Issuer Name Regional Sukuk Code Regional Sukuk Name Acquisition Date Nominal Value Maturity Rating Coupon (%) Recording Method Pension Program/ Other Benefits Management Acquisition Value Fair Value Investment Valuation Difference Economic Sector

Value % Self-Managed/ KPD
Investment Manager Name a b c d e f g h i j k l m n o … Total *) letter d:
Filled with Type of Sharia Mutual Fund is Money Market Mutual Fund/Fixed Income Mutual Fund/Mixed Mutual Fund/Equity Mutual Fund/Protected Mutual Fund/Guaranteed Mutual Fund/Index Mutual Fund/Collective Investment Contract Limited Participation Mutual Fund/Mutual Funds whose Shares/Participation Units are Traded on the Stock Exchange Management DETAILS OF SHARIA MUTUAL FUNDS No Code Product Name Type of Sharia Mutual Fund *) Investment Manager Acquisition Date Number of Units Acquisition Value Fair Value Investment Valuation Difference Pension Program/ Other Benefits Notes

Start End Value % Self-Managed/ KPD
Investment Manager Name a b c d e f g h i j k l m n o p q r s … Total Notes Management Economic Sector DETAILS OF SHARIA MTN No Code Product Name Issuer Name Acquisition Date Nominal Value Coupon (%) Maturity Date Rating Acquisition Value Fair Value Investment Valuation Difference Pension Program/ Other Benefits

Start End Value % Self-Managed/ KPD
Investment Manager Name a b c d e f g h i j k l m n o p q r s … Total Notes Management Economic Sector DETAILS OF SHARIA ASSET-BACKED SECURITIES No Code Product Name Issuer Name Acquisition Date Nominal Value Coupon (%) Maturity Date Rating Acquisition Value Fair Value Investment Valuation Difference Pension Program/ Other Benefits

Value % Self-Managed/ KPD
Investment Manager Name a b c d e f g h i j k l m n … Total Pension Program/ Other Benefits Notes Management DETAILS OF SHARIA REAL ESTATE INVESTMENT FUNDS IN THE FORM OF COLLECTIVE INVESTMENT CONTRACTS No Code Product Name Investment Manager Acquisition Date Number of Units Acquisition Value Fair Value Investment Valuation Difference

Value % Self-Managed/ KPD
Investment Manager Name a b c d e f g h i j k l m n … Total Pension Program/ Other Benefits Notes Management DETAILS OF SHARIA INFRASTRUCTURE INVESTMENT FUNDS IN THE FORM OF COLLECTIVE INVESTMENT CONTRACTS No Code Product Name Investment Manager Acquisition Date Number of Units Acquisition Value Net Asset Value Investment Valuation Difference

Value % Self-Managed/ KPD Investment Manager Name a b c d e f g h i j k l m … Total Notes Management DETAILS OF SHARIA EFFECT OPTIONS AND FORWARD CONTRACTS LISTED ON THE INDONESIAN STOCK EXCHANGE No Issuer Name Buyer Name Acquisition Date Tenor Acquisition Value Fair Value Investment Valuation Difference Pension Program/ Other Benefits

Start End Nominal % Value % Self-Managed/ KPD Investment Manager Name a b c d e f g h i j k l m n o p q r s t … Total DETAILS OF REPO No Counterparty Type of Collateral (SBSN/SBIS) Acquisition Date Collateral Value Rating Tenor Category (KSEI/BIS4) Acquisition Value Notes Management Margin Amortized Cost Sale Value Investment Valuation Difference Pension Program/ Other Benefits

Name Position Date % Ownership Total % Ownership Total Date % Ownership Total Value % a b c d e f g h i j k l m n o p q r … Total Self-Managed/ KPD Investment Manager Name Pension Fund Founder Founder Partner Board of Directors Custody Recipients Labor Unions whose Members are DP Participants Others Founder Partner Board of Directors Custody Recipients Labor Unions whose Members are DP Participants Others s t u v w x y z a1 b1 c1 d1 e1 f1 g1 h1 i1 j1 k1 … Total ) letter e :
Filled with Domestic LJK/Non-Domestic LJK/Foreign LJK/Non-Foreign LJK DETAILS OF DIRECT PARTICIPATION Management Notes Total Capital Paid Acquisition Value As of Report Date Appraisal/Fair Value Investment Valuation Difference No Economic Sector No Company Name (1) Pension Fund Representative Participation Category) Acquisition Date Pension Program/ Other Benefits Initial Placement Ownership Percentage (v) Subsidiaries of Direct Participation (2) Total Capital Paid Subsidiaries of Direct Participation Ownership Percentage (e1)

Object Type
(Land/Building/Land&Building) Value % Self-Managed/ KPD Investment Manager Name a b c d e f g h i j k l m n o p q r s t u … Total Investment Valuation Difference DETAILS OF LAND, BUILDINGS, OR LAND AND BUILDINGS IN INDONESIA No Address Location (City,Province) Area Type of Proof Ownership Ownership Document Number Acquisition Date Acquisition Value Accumulated Depreciation Book Value Acquisition Value on report date Notes Management Appraisal Value/ Fair Value Appraisal Year Appraiser Name Public/Independent KJPP Name

No Cash/Bank Name Branch Bank Code Account Number Nominal Pension Program/ Other Benefits Notes (Purpose of use) a b c d e f g h … Total DETAILS OF CASH AND BANK

Age of Receivables <=3
Months
Age of Receivables >3
Months
Total
Age of Receivables <=3
Months
Age of Receivables >3
Months
Total
Age of Receivables <=3
Months
Age of Receivables >3
Months
Total a b c d e f g h i j k l m n
…
Total
DETAILS OF CONTRIBUTION RECEIVABLES
Notes
No
Participant Voluntary
Contribution Receivables
Employer Name
(Founder/Founder Partner)
Employer Contribution Receivables Participant Contribution Receivables Additional Contribution Receivables Pension Program/ Other Benefits

No Type of Expense Amount Pension Program/ Other Benefits Notes a b c d e … Total DETAILS OF PREPAID EXPENSES

No Type of Investment Receivable Counterparty Nominal Pension Program/ Other Benefits Notes a b c d e f … Total DETAILS OF INVESTMENT RECEIVABLES

No Type of Investment Income Receivable Counterparty Nominal Pension Program/ Other Benefits Notes a b c d e f … Total DETAILS OF INVESTMENT INCOME RECEIVABLES

No Type of Other Receivable Counterparty Nominal Pension Program/ Other Benefits Notes a b c d e f … Total DETAILS OF OTHER RECEIVABLES

No
Type of Object
(Land/Building/Land&
Building)
Certificate Number Address Location Acquisition Date Acquisition Value Accumulated Depreciation Book Value Acquisition Value on report date Notes a b c d e f g h i j … Total DETAILS OF LAND AND BUILDINGS

No Vehicle Plate Number Type of Vehicle Acquisition Date Acquisition Value Accumulated Depreciation Book Value Notes a b c d e f g h … Total DETAILS OF VEHICLES

No
Type of Computer
Equipment
Acquisition Date Acquisition Value Accumulated Depreciation Book Value Notes a b c d e f g … Total DETAILS OF COMPUTER EQUIPMENT

No Type of Office
Equipment
Acquisition
Date
Acquisition Value Accumulated
Depreciation
Book Value Notes a b c d e f g
…
Total
DETAILS OF OFFICE EQUIPMENT

No
Type of Other Operational
Assets
Acquisition Date Acquisition Value
Accumulated
Depreciation
Book Value Notes a b c d e f g
…
Total
DETAILS OF OTHER OPERATIONAL ASSETS

No Type of Other Assets Acquisition Date Asset Value Notes a b c d e … Total Details of Other Assets

<= 1 year >1 year Total a b c d e f
…
Total
DETAILS OF DUE PENSION BENEFITS LIABILITIES No Amount Pension Program/ Other Benefits Notes

<= 1 year >1 year Total a b c d e
…
Total
No
Amount
DETAILS OF DUE VOLUNTARY PENSION BENEFITS LIABILITIES Notes

Amount Notes
1 Recipient Name 1
2 Recipient Name 2
3 … etc.
D. Ending Balance (A+B-C)
DETAILS OF TAZIR FUND LIABILITIES
Details
A. Beginning Balance
B. Additions in Current Year
C. Usage in Current Year

No Type of Investment Counterparty Value Pension Program/ Other Benefits Notes a b c d e f … Total DETAILS OF INVESTMENT LIABILITIES

No
Details of Unearned
Income
Counterparty Value
Pension Program/
Other Benefits
Notes a b c d e f
…
Total
DETAILS OF UNEARNED INCOME

No
Details of Expenses Payable
Counterparty Value
Pension Program/
Other Benefits
Notes a b c d e f
…
Total
DETAILS OF EXPENSES PAYABLE

No Type of Other Liabilities Counterparty Value Pension Program/ Other Benefits Notes a b c d e f … Total DETAILS OF OTHER LIABILITIES

No. Type of Investment
Investment Valuation Difference
Increase/
Decrease
Pension Program/
Other Benefits
Notes a b c d e f
...
Total
Details of Investment Increase/Decrease

% Amount % Amount a b c d e f g h i j k l m n o p r s ...
Total
Details of Due Contributions
No.
Founder Name/
Founder Partner
PhDP
Due Contributions Contribution Receipts Under/Over Payment Pension Program/ Other Benefits Notes Normal Participant Contributions Additional Contributions Normal Participant Contributions Normal Participant Contributions Normal Employer Contributions Additional Contributions Normal Employer Contributions Voluntary Participant Contributions

No.
Type of Non-Investment
Income
Amount
Pension Program/
Other Benefits
Notes a b c d e
...
Total
Details of Non-Investment Income

No.
Pension Fund Name that transferred
Amount
Pension Program/
Other Benefits
Details of Other Benefits *)
Notes a b c d e f
...
Total
*) letter e:
Details of Transfers from Other Pension Funds Filled with Education Fund/Housing Fund/Religious Worship Fund/Disability Benefit/Death Benefit/Health Benefit/Severance Fund/Additional Benefit Fund

No. Type of Expense Amount
Pension Program/
Other Benefits
Notes a b c d e
...
Total
Details of Investment Expenses

No. Type of Expense Amount
Pension Program/
Other Benefits
Notes a b c d e
...
Total
Details of Operating Expenses

No. Type of Expense Amount
Pension Program/
Other Benefits
Notes a b c d e
...
Total
Details of Non-Investment and Operating Expenses

No.
Type of Income Tax
Amount
Pension Program/
Other Benefits
Notes a b c d e
…
Total
Details of Income Tax

No.
Pension Fund that receives Transfer
Amount
Pension Program/
Other Benefits
Details of Other Benefits *) Notes a b c d e f ...
Total
*) letter e:
Details of Transfers to Other Pension Funds Filled with Education Fund/Housing Fund/Religious Worship Fund/Disability Benefit/Death Benefit/Health Benefit/Severance Fund/Additional Benefit Fund

FORMAT I B
To
Honorable Director of Sharia IKNB
Financial Services Authority
MONTHLY REPORT / ELECTRONIC DATA
EMPLOYER PENSION FUNDS BASED ON SHARIA PRINCIPLES / SHARIA UNITS DEFINED CONTRIBUTION PENSION PROGRAM As of DD-MM-YYYY

General Data
Reporting Date
Pension Fund Code
Pension Fund Name
Reporting Period
Reporting Month
Fiscal Year
Type of Reporting Period Annual Report/Monthly Report Manager Name Manager Position SID Number Audit Data Auditor License Number Audit Type Auditor Code Auditor Name Opinion Audit Executor Audit Date Report Preparer Officer Name Division Phone Fax E-mail Manager Responsible Person Responsible Person Name Position Phone Fax E-mail Pension Fund Address

Description Detail Code Percentage
Investment
Other Benefit Pension Program Combined
ASSETS
SHARIA INVESTMENTS
Bank Savings 1101
On-call Deposits at Banks 1102
Time Deposits at Banks 1103
Bank Certificates of Deposit 1104
Sharia-based Securities issued by Bank Indonesia 1105 Sharia Government Securities (SBSN) 1106 Sharia Stocks listed on the Indonesia Stock Exchange 1107 Corporate Sukuk listed on the Indonesia Stock Exchange 1109 Regional Sukuk 1110 Sharia Mutual Funds 1111 Sharia MTN 1112 Sharia Asset-Backed Securities 1113 Sharia real estate investment funds in the form of collective investment contracts 1114 Infrastructure investment funds in the form of collective investment contracts 1115 Sharia equity option and forward contracts listed on the Indonesia Stock Exchange 1116 REPO 1117 Direct participation 1118 Land in Indonesia Buildings in Indonesia Land and Buildings in Indonesia TOTAL INVESTMENTS CURRENT ASSETS EXCLUDING INVESTMENTS Cash and Bank 1201 Contribution Receivables 1202

Normal Contributions from Employers
Normal Contributions from Participants
Voluntary Contributions from Participants
Prepaid Expenses 1204
Investment Receivables 1205
Investment Income Receivables 1206
Other Receivables 1207
TOTAL CURRENT ASSETS EXCLUDING INVESTMENTS OPERATIONAL ASSETS Land and Buildings 1301 Vehicles 1302 Computer Equipment 1303 Office Equipment 1304 Other Operational Assets 1305 TOTAL OPERATIONAL ASSETS OTHER ASSETS 1401 AVAILABLE ASSETS LIABILITIES Liabilities other than Pension Benefit Liabilities Due Pension Benefit and Other Benefits 1501 Voluntary Benefit Payables 1502 Ta'zir Fund Payables 1507 Investment Payables 1503 Unearned Revenue 1504 Accrued Expenses 1505 Other Payables 1506 Total Liabilities other than Pension Benefit Liabilities TOTAL LIABILITIES NET ASSETS DEFINED CONTRIBUTION PENSION PROGRAM NET ASSET REPORT As of DD-MM-YYYY

Other Benefit Pension Program Combined
INCREASES
Investment Income
Profit Sharing
Dividends
Rent
Gain (Loss) on Investment Disposal
Other Investment Income
Total Investment Income
Increase (Decrease) in Investment Value 401 Due Contributions: 402

Normal Contributions from Employers
Normal Contributions from Participants
Voluntary Contributions from Participants
Non-Investment Income 403
Fund Transfers from Other Pension Funds 404 Total Increases DECREASES Investment Expenses 405 Operational Expenses 406 Non-Investment and Non-Operational Expenses 407 Pension Benefits and Other Benefits Income Tax 408 Fund Transfers to Other Pension Funds 409 Total Decreases INCREASE (DECREASE) IN NET ASSETS NET ASSETS AT BEGINNING OF PERIOD NET ASSETS AT END OF PERIOD Detail Code STATEMENT OF CHANGES IN NET ASSETS Accumulation as of DD-MM-YYYY DEFINED CONTRIBUTION PENSION PROGRAM Accumulation as of DD-MM-YYYY

ASSETS
INVESTMENTS (Historical Value)
Bank Savings
On-call Deposits at Banks
Time Deposits at Banks
Bank Certificates of Deposit
Sharia-based Securities issued by Bank Indonesia Sharia Government Securities (SBSN) Sharia Stocks listed on the Indonesia Stock Exchange Corporate Sukuk listed on the Indonesia Stock Exchange Regional Sukuk Sharia Mutual Funds Sharia MTN Sharia Asset-Backed Securities Sharia real estate investment funds in the form of collective investment contracts Infrastructure investment funds in the form of collective investment contracts Sharia equity option and forward contracts listed on the Indonesia Stock Exchange REPO Direct participation Land in Indonesia Buildings in Indonesia Land and Buildings in Indonesia Accumulated Depreciation of Buildings TOTAL INVESTMENTS INVESTMENT VALUATION DIFFERENCES CURRENT ASSETS EXCLUDING INVESTMENTS Cash and Bank Contribution Receivables

Normal Contributions from Employers
Normal Contributions from Participants
Voluntary Contributions from Participants
Prepaid Expenses
Investment Receivables
Investment Income Receivables
Other Receivables
TOTAL CURRENT ASSETS EXCLUDING INVESTMENTS OPERATIONAL ASSETS Land and Buildings Vehicles Computer Equipment Office Equipment Other Operational Assets Accumulated Depreciation TOTAL OPERATIONAL ASSETS OTHER ASSETS TOTAL ASSETS LIABILITIES PENSION BENEFIT LIABILITIES LIABILITIES OTHER THAN PENSION BENEFIT LIABILITIES Due Pension Benefit and Other Benefits Voluntary Benefit Payables Ta'zir Fund Payables Investment Payables Unearned Revenue Accrued Expenses Other Payables TOTAL LIABILITIES OTHER THAN PENSION BENEFIT LIABILITIES TOTAL LIABILITIES Description DEFINED CONTRIBUTION PENSION PROGRAM As of DD-MM-YYYY BALANCE SHEET Other Benefit Pension Program Combined

PPMP_LPHU
Other Benefit Pension Program Combined
INVESTMENT INCOME
Profit Sharing
Dividends
Rent
Gain (Loss) on Investment Disposal
Other Investment Income
Total Investment Income
INVESTMENT EXPENSES
Transaction Expenses
Land and Building Maintenance Expenses
Building Depreciation Expenses
Investment Manager Expenses
Custodian Expenses
Other Investment Expenses
Total Investment Expenses
INVESTMENT BUSINESS RESULTS
OPERATIONAL EXPENSES
Employee, Manager, Supervisory Board, and DPS Salaries/Honoraria Office Expenses Maintenance Expenses Depreciation Expenses Third-Party Service Expenses Other Operational Expenses Total Operational Expenses OTHER INCOME AND EXPENSES Gain (Loss) on Sale of Operational Assets Gain (Loss) on Sale of Other Assets Other Non-Investment Income Other Non-Investment and Non-Operational Expenses Total Other Income and Expenses PRE-TAX BUSINESS RESULTS INCOME TAX POST-TAX BUSINESS RESULTS Description DEFINED CONTRIBUTION PENSION PROGRAM Accumulation as of DD-MM-YYYY Accumulation as of DD-MM-YYYY STATEMENT OF COMPREHENSIVE INCOME

Other Benefit Pension Program Combined
CASH FLOWS FROM INVESTMENT ACTIVITIES
Receipts from Profit Sharing
Dividend Receipts
Rent Receipts
Other Investment Income
Investment Disposal
Investment Placement
Payment of Investment Expenses
Net Cash from Investment Activities
CASH FLOWS FROM OPERATIONAL ACTIVITIES
Payment of Operational Expenses
Sale of Operational Assets
Purchase of Operational Assets
Sale of Other Assets
Purchase of Other Assets
Receipts of Ta'zir Funds
Expenditure of Ta'zir Funds
Other Non-Investment Income
Other Non-Investment and Non-Operational Expenses Income Tax Net Cash from Operational Activities CASH FLOWS FROM FINANCING ACTIVITIES Receipts of Normal Contributions from Employers Receipts of Normal Contributions from Participants Receipts of Fund Transfers from Other Pension Funds Payment of Fund Transfers to Other Pension Funds Payment of Pension Benefits & Other Benefits Net Cash from Financing Activities INCREASE (DECREASE) IN NET CASH CASH AT BEGINNING OF PERIOD CASH AT END OF PERIOD Description DEFINED CONTRIBUTION PENSION PROGRAM CASH FLOW STATEMENT Accumulation as of DD-MM-YYYY Accumulation as of DD-MM-YYYY

Pensioners
PENSION FUND PARTICIPATION
Description Pension Program Quantity
As of DD-MM-YYYY
(4) Total Partner Companies Founding the Pension Fund
Children
Deferred Retirement
(3) Total DPPK Participants (1) + (2)
Other benefits
Widows/Widowers
Children
Deferred Retirement
b. Partner Companies
Pensioners
Widows/Widowers
(1) Active Participants a. Founders b. Partner Companies (2) Inactive Participants a. Founders

Bank Savings
On-call Deposits at Banks
Time Deposits at Banks
Bank Certificates of Deposit
Sharia-based Securities issued by Bank Indonesia Sharia Government Securities (SBSN) Sharia Stocks listed on the Indonesia Stock Exchange Corporate Sukuk listed on the Indonesia Stock Exchange Regional Sukuk Sharia Mutual Funds Sharia MTN Sharia Asset-Backed Securities Sharia real estate investment funds in the form of collective investment contracts Infrastructure investment funds in the form of collective investment contracts Sharia equity option and forward contracts listed on the Indonesia Stock Exchange REPO Direct participation Land in Indonesia Buildings in Indonesia Land and Buildings in Indonesia TOTAL INVESTMENTS Sep Oct DEFINED CONTRIBUTION PENSION PROGRAM As of DD-MM-YYYY May Jun Jul Aug Description Jan Feb Mar Apr Nov Dec INVESTMENT RECAP

Bank Savings Time Deposits Certificates of Deposit Sharia SBI SBSN a b c d e f g Investment Assets Total Participants Life Cycle Fund Assets Total Funds As of DD-MM-YYYY

Profit Sharing Dividends Rent Gain/Loss
Disposal
Others
Bank Savings
On-call Deposits at Banks
Time Deposits at Banks
Bank Certificates of Deposit
Sharia-based Securities issued by Bank Indonesia Sharia Government Securities (SBSN) Sharia Stocks listed on the Indonesia Stock Exchange Corporate Sukuk listed on the Indonesia Stock Exchange Regional Sukuk Sharia Mutual Funds Sharia MTN Sharia Asset-Backed Securities Sharia real estate investment funds in the form of collective investment contracts Infrastructure investment funds in the form of collective investment contracts Sharia equity option and forward contracts listed on the Indonesia Stock Exchange REPO Direct participation Land in Indonesia Buildings in Indonesia Land and Buildings in Indonesia Total Note:
the Unrealized Investment Income column uses data according to the Increase/Decrease Investment Value accounts on the LPAN sheet DEFINED CONTRIBUTION PENSION PROGRAM INVESTMENT INCOME REPORT Type of Investment Realized Investment Income As of DD-MM-YYYY Average ROI Investment Net Investment Income Investment Expenses Unrealized Investment Income

Profit Sharing Dividends Rent Gain/Loss
Disposal
Others
Bank Savings
On-call Deposits at Banks
Time Deposits at Banks
Bank Certificates of Deposit
Sharia-based Securities issued by Bank Indonesia Sharia Government Securities (SBSN) Sharia Stocks listed on the Indonesia Stock Exchange Corporate Sukuk listed on the Indonesia Stock Exchange Regional Sukuk Sharia Mutual Funds Sharia MTN Sharia Asset-Backed Securities Sharia real estate investment funds in the form of collective investment contracts Infrastructure investment funds in the form of collective investment contracts Sharia equity option and forward contracts listed on the Indonesia Stock Exchange REPO Direct participation Land in Indonesia Buildings in Indonesia Land and Buildings in Indonesia Total Note:
the Unrealized Investment Income column uses data according to the Increase/Decrease Investment Value accounts on the LPAN sheet DEFINED CONTRIBUTION PENSION PROGRAM OTHER BENEFIT INVESTMENT INCOME REPORT As of DD-MM-YYYY Type of Investment Realized Investment Income Unrealized Investment Income Investment Expenses Net Investment Income Average Investment ROI

Rupiah Non-Rupiah Total Rupiah Non-Rupiah Total Rupiah Non-Rupiah Total Rupiah Non-Rupiah Total Rupiah Non-Rupiah Total A. Investment Assets Bank Savings On-call Deposits at Banks Time Deposits at Banks Bank Certificates of Deposit Sharia-based Securities issued by Bank Indonesia Sharia Government Securities (SBSN) Sharia Stocks listed on the Indonesia Stock Exchange Corporate Sukuk listed on the Indonesia Stock Exchange Regional Sukuk Sharia Mutual Funds Sharia MTN Sharia Asset-Backed Securities Sharia real estate investment funds in the form of collective investment contracts Infrastructure investment funds in the form of collective investment contracts Sharia equity option and forward contracts listed on the Indonesia Stock Exchange REPO Direct participation Land in Indonesia Buildings in Indonesia Land and Buildings in Indonesia Total Investments B. Current Assets Excluding Investments Cash & Bank Contribution Receivables Normal Contributions from Employers Normal Contributions from Participants Voluntary Contributions from Participants Prepaid Expenses Investment Receivables Investment Income Receivables Other Receivables Total Current Assets Excluding Investments
C. Operational Assets
Land and Buildings
Vehicles
Computer Equipment
Office Equipment
Other Operational Assets
Total Operational Assets
D. Other Assets
E. Total Assets (A+B+C+D)
F. Pension Benefit Liabilities
G. Liabilities Other Than Pension Benefit Liabilities Due Pension Benefit and Other Benefits Voluntary Benefit Payables Ta'zir Fund Payables Investment Payables Unearned Revenue Accrued Expenses Other Payables Total Liabilities Other Than Pension Benefit Liabilities H. Total Liabilities (F+G)
I. Difference Between Total Assets and Total Liabilities (E-H)
J. Percentage (%) Fund Sufficiency Ratio DEFINED CONTRIBUTION PENSION PROGRAM Total ASSET AND LIABILITY RECAPITULATION (in Rupiah) Due >= 10 Years Description of Due < 1 year 1 year <= Due < 5 years 5 years <= Due < 10 years As of DD-MM-YYYY

Type Quantity Percentage of Total Investment a b c d e f g … Detail of Investments with a Single Counterparty No. Counterparty Name Investment Limit in Instructions Investment Investment Limit According to Regulations As of DD-MM-YYYY

Type Quantity Percentage of Total Investment a b c d e f g … Detail of Investments with Affiliated Parties As of DD-MM-YYYY No. Counterparty Name Investment Affiliation Relationship Description

Type Quantity Percentage of Total Investment a b c d e f g … Note:
a. Sharia Stocks with issuers indicated to be bankrupt b. Sharia Mutual Funds indicated to be traded abnormally
c. Debt security issuers or deposit-issuing banks recording losses.
d. There is a downgrade of debt instrument ratings below investment grade. e. There is a delay in Sukuk coupon payments or Deposit profit sharing. Identified problematic investments can be obtained from the investment balance with identified problematic parties from the Sharia Pension Fund Financial Statements/Sharia unit. Information on investees experiencing problems (default risk) can be obtained, among others, from investee financial statements, media disclosures, and/or from f. Debt security or deposit issuers involved in legal cases or indicated fraud. g. Restructured debt securities h. Ownership of Land and/or Buildings not yet in the name of the Pension Fund Detail of Identified Problematic Investments As of DD-MM-YYYY No. Counterparty Name Investment Problematic Category Description

Name Type
Investment
Balance
Name Type
Investment
Security Series
Type
Ownership
Rating Balance
Name Type
Investment
Investment Manager
Fair Value
% SBSN in
Mutual Funds
Balance
Name Type
Investment
Investment Manager
Recipient Fund/Project
Balance
Name Type
Investment
Security Series
Type
Ownership
Rating Balance Name Type of Investment Balance …..
Total
MUTUAL FUNDS LIMITED PARTICIPATION ASSET-BACKED SECURITIES OTHER INVESTMENTS FOR PROJECT FINANCING GOVERNMENT INFRASTRUCTURE MUTUAL FUNDS UNDERLYING SBSN DETAIL OF COMPLIANCE WITH REGULATIONS REGARDING SBN INVESTMENTS No SBN SUKUK INFRASTRUCTURE

Investment Income Ratio (ROI)
A. Total Investment Income – Investment Expenses B. Average Investment
C. Ratio (A:B)
Investment Income Ratio to Assets (ROA)
A. (Total Investment Income+Non-Investment Income)-(Investment Expenses+Operational Expenses+Non-Investment and Non-Operational Expenses) B. Average Available Assets
C. Ratio (A:B)
Operational Expense Ratio (BOPO)
A. Operational Expenses
B. Investment Income + Non-Investment Income
C. Ratio (A:B)
Contribution Receivable Age Ratio (RUPI) A. Contribution Receivables (LAN) x Number of Months Elapsed B. Due Contributions (LPAN)
C. Ratio (A:B)
Investment to Net Asset Ratio (RITA)
A. Total Investments x 100%
B. Total Net Assets
C. Ratio (A:B)
Investment Receivables and Investment Income Receivables to Total Investments A. Investment Receivables + Investment Income Receivables B. Total Investments
C. Ratio (A:B)
Investment Growth Ratio
A. (Total Investments t1 - Total Investments t0) x 100% B. Total Investments t0
C. Ratio (A:B)
Market price changes over Pension Fund assets A. (SPIn-SPIn-1) x 100% B. SPIn-1
C. Ratio (A:B)
SPI compared to total income
A. SPI
B. Total Income
C. Ratio (A:B)
SPI compared to net assets
A. SPI
B. Net Assets
C. Ratio (A:B)
Minimum Liquidity Ratio/Cash Ratio
A. Current assets or investments for minimum liquidity fulfillment B. Operational Costs + Investment Costs + Pension Benefits and Other Benefits Due for one year
C. Ratio (A:B)
Cash Inflows compared to Cash Outflows
A. Cash Inflows from Investment, Operational, and Financing Activities B. Cash Outflows from Investment, Operational, and Financing Activities
C. Ratio (A:B)
Contribution Receivable Ratio to Net Assets A. Contribution Receivables B. Net Assets
C. Ratio (A:B)
Growth Ratio of Founder Contribution Receivables (Employer Contribution Receivables + Additional Contributions) A. (Total Founder Contribution Receivables t1 - Total Founder Contribution Receivables t0) X 100% B. Total Founder Contribution Receivables t0
C. Ratio (a:b)
Ratio of Total Long-Term Assets to Total Long-Term Liabilities A. Total Long-Term Assets x 100% B. Total Long-Term Liabilities
C. Ratio (A:B)
Income to Expenditure Ratio
A. Operational Expenses + Investment Expenses + Pension Benefit Payments B. Total Income
C. Ratio (A:B)
Interest rate spread
A. Investment Income Ratio (ROI)
B. Actuarial Interest Rate
C. Ratio (A-B)
Current Assets to Total Assets Ratio
A. Current Assets
B. Total Assets
C. Ratio (A:B)
Current Liabilities to Total Liabilities Ratio A. Current Liabilities B. Total Liabilities
C. Ratio (A:B)
Business Expense Ratio
A. Operational Expenses + Investment Expenses B. Investment Income
C. Ratio (A:B)
FINANCIAL RATIOS
As of DD-MM-YYYY
Description Pension Program Other Benefits Total Description

Comparison between long-term assets and long-term liabilities is obtained from the Pension Fund Financial Statements
Assets with a life > 1 year according to information as stated in the Pension Fund Financial Statements
Liabilities with a life > 1 year according to information as stated in the Pension Fund Financial Statements
Current assets are assets with a maturity of less than 1 year (excluding operational assets and other assets)
as presented in the Pension Fund Financial Statements.
Total assets are available assets as presented in the Pension Fund Financial Statements
Current liabilities are liabilities with a maturity of less than 1 year as presented in the Pension Fund Financial Statements.
Total Liabilities is the Actuarial Present Value for PPMP and
Benefit Obligations for PPIP.
Operational expenses are as presented in the Statement of Changes in Net Assets
Investment expenses are as presented in the Statement of Changes in Net Assets
Investment income includes realized and unrealized investment income as presented in the Statement of Changes in Net Assets.
Total Investment Income is as presented in the Statement of Changes in Net Assets.
Investment Expenses are as presented in the Statement of Changes in Net Assets.
For the calculation of average investment, the average investment assets throughout the year are used.
Total Investment Income is income that is already realized and unrealized. Total Investment Income is
as presented in the Statement of Changes in Net Assets.
Non-Investment Income is as presented in the Statement of Changes in Net Assets.
Investments are as presented in the Net Asset Report.
For the calculation of Operational Expenses, it is as presented in the Statement of Changes in Net Assets.
For the calculation of total available assets, the average assets throughout the year are used. Total Available Assets are as presented in the Net Asset Report.
Operational expenses as stated in the statement of changes in net assets
Investment Income is realized income as stated in the statement of changes in net assets
Non-Investment Income as stated in the statement of changes in net assets
SPI is Investment Valuation Differences for instruments exposed to market risk that are actively traded.
Example: investments in the capital market and deposits denominated in foreign currencies
Total Income is total realized and unrealized income on the statement of changes in net assets
SPI is Investment Valuation Differences for instruments exposed to market risk that are actively traded.
Example: investments in the capital market and deposits denominated in foreign currencies
Cash Flows from investment activities are all investment activities except for placement and disposal of investments as presented in the financial statements.
Cash Flows from operational activities are all operational activities except for placement and disposal of operational assets and other assets as presented in the financial statements.
Cash Flows from financing activities are as presented in the financial statements.

(in millions of Rupiah)
Receipt Number Nominal Date Due Acquisition Value Fair Value Date Due Total PENSION FUNDS PERIODIC PENSION BENEFIT INVESTMENT REPORT Bank Name/Serial Number SBN Deposits SBN Total Total MP Participants Periodic Lump Sum MP Initial Reserve (20%) Description

No. Investment Manager Name Contract Number Contract Date Contract Period Type of Investment Total Fair Value of Funds Managed (Rp) Acquisition Value (managed by Investment Manager) n Investment Valuation Differences Return (%) Net Investment Return Rate (Rp) Total Management Fees Charged (Rp) Affiliated with Pension Fund (Yes/No) 1. 2.
3. etc
1.
2.
3. etc
1.
2.
3. etc
: if using Investment Manager services
Investment Fund Management Contract (KPD) Format by Investment Manager Pension Fund ….. Use of Investment Manager As of DD-MM-YYYY Total etc.

Self-Management/ KPD
Investment Manager Name a b c d e f g h i j k … Total Description SAVINGS DETAIL No. Bank Name Branch Bank Code Acquisition Date Nominal Value Interest Rate/Nisbah Pension Program/ Other Benefits Management

Self-Management/ KPD
Investment Manager Name a b c d e f g h i j k l … Total Description ON-CALL DEPOSIT DETAIL No. Bank Name Branch Bank Code Acquisition Date Nominal Value Term Interest Rate/Nisbah Pension Program/ Other Benefits Management

Self-Management/ KPD
Investment Manager Name a b c d e f g h i j k l … Total Description TIME DEPOSIT DETAIL No. Bank Name Branch Bank Code Acquisition Date Nominal Value Term Interest Rate/Nisbah Pension Program/ Other Benefits Management

a b c d e f g h i j k l m n o p
…
Total
FOREIGN CURRENCY TIME DEPOSIT DETAIL
No. Bank Name Branch Bank Code Acquisition Date Nominal Value Fair Value Investment Valuation Differences Term Interest Rate/Nisbah Pension Program/ Other Benefits Management Description Value % Self-Management/ KPD Investment Manager Name Type of Currency

Self-Management/ KPD
Investment Manager Name a b c d e f g h i j k l … Total Description CERTIFICATE OF DEPOSIT DETAIL No. Bank Name Branch Bank Code Acquisition Date Nominal Value Term Interest Rate/Nisbah Pension Program/ Other Benefits Management

Value % Self-Management/ KPD Investment Manager Name a b c d e f g h i j k l m n … Total Pension Program/ Other Benefits Description Management DETAIL OF SHARIA BANK CERTIFICATES OF DEPOSIT No. Security Code Date Acquisition Nominal Value Coupon % Date Due Acquisition Value Fair Value Investment Valuation Differences

Value % Self-Management/ KPD
Investment Manager Name a b c d e f g h i j k l m n o … Total Pension Program/ Other Benefits Method Recording Description Management DETAIL OF SHARIA GOVERNMENT SECURITIES No. Security Code Date Acquisition Nominal Value Coupon (%) Date Due Acquisition Value Fair Value Investment Valuation Differences

Percentage Value Self-Management/ KPD Investment Manager Name a b c d e f g h i j k l m n … Total Pension Program/ Other Benefits Management Notes DETAILS OF SHARIAH SHARES No. Share Code Issuer Name Date of Acquisition Number of Shares Acquisition Value Market Value Investment Valuation Difference Economic Sector Economic Sector Beginning End Value % Self-Management/ KPD Investment Manager Name a b c d e f g h i j k l m n o p q r s t … Total Pension Program/ Other Benefits Recording Method Management Notes DETAILS OF CORPORATE SUKUK No. Issuer Name/ Issuer Sukuk Code Sukuk Name Date of Acquisition Nominal Value Coupon (%) Maturity Date Rating Acquisition Value Fair Value Investment Valuation Difference

Economic Sector
Beginning End Value % Self-Management/ KPD Investment Manager Name a b c d e f g h i j k l m n o … Total *) letter d:
Filled with Mutual Fund Type is Money Market Mutual Fund/Fixed Income Mutual Fund/Mixed Mutual Fund/Equity Mutual Fund/Protected Mutual Fund/Guaranteed Mutual Fund/Index Mutual Fund/Contractual Collective Investment Participation Limited Mutual Fund/ and Mutual Fund whose Shares/Participation Units are Traded on the Stock Exchange Management Notes DETAILS OF SHARIAH MUTUAL FUNDS No. Code Product Name Mutual Fund Type Shariah *) Investment Manager Date of Acquisition Number of Units Acquisition Value Fair Value Investment Valuation Difference Pension Program/ Other Benefits Management Notes

Beginning End Value % Self-Management/ KPD Investment Manager Name a b c d e f g h i j k l m n o p q r s … Total Economic Sector DETAILS OF SHARIAH MTN No. Code Product Name Issuer Name Date of Acquisition Nominal Value Coupon (%) Maturity Date Rating Acquisition Value Fair Value Investment Valuation Difference Pension Program/ Other Benefits Management Notes

Beginning End Value % Self-Management/ KPD Investment Manager Name a b c d e f g h i j k l m n o p q r s … Total Economic Sector DETAILS OF SHARIAH ASSET-BACKED SECURITIES No. Code Product Name Issuer Name Date of Acquisition Nominal Value Coupon (%) Maturity Date Rating Acquisition Value Fair Value Investment Valuation Difference Pension Program/ Other Benefits Management Notes

Percentage Value Self-Management/ KPD Investment Manager Name a b c d e f g h i j k l m n … Total Pension Program/ Other Benefits Management Notes DETAILS OF SHARIAH COLLECTIVE INVESTMENT CONTRACT REAL ESTATE INVESTMENT FUNDS No. Code Product Name Investment Manager Date of Acquisition Number of Units Acquisition Value Fair Value Investment Valuation Difference

Percentage Value Self-Management/ KPD Investment Manager Name a b c d e f g h i j k l m n … Total Pension Program/ Other Benefits Management Notes DETAILS OF COLLECTIVE INVESTMENT CONTRACT INFRASTRUCTURE INVESTMENT FUNDS No. Code Product Name Investment Manager Date of Acquisition Number of Units Acquisition Value Fair Value Net Asset Value Investment Valuation Difference

Percentage Value Self-Management/ KPD Investment Manager Name a b c d e f g h i j k l m … Total Management Notes DETAILS OF SHARIAH OPTIONS CONTRACTS AND EFFECTS FORWARD CONTRACTS REGISTERED ON THE INDONESIA STOCK EXCHANGE No. Issuer Name Buyer Name Date of Acquisition Duration Acquisition Value Fair Value Investment Valuation Difference Pension Program/ Other Benefits

Beginning End Nominal % Value % Self-Management/ KPD Investment Manager Name a b c d e f g h i j k l m n o p q r s t … Total Investment Valuation Difference Pension Program/ Other Benefits Management Notes DETAILS OF REPO No. Counterparty Collateral Type (SBSN/SBIS) Date of Acquisition Collateral Value Rating Duration Category (KSEI/BIS4) Acquisition Value Margin Amortized Cost Selling Price

Name Position Date % Ownership Total % Ownership Total Date % Ownership Total Value % a b c d e f g h i j k l m n o p q r … Total Self-Management/ KPD Investment Manager Name Pension Fund Founder Founding Partner Board of Trustees Beneficiary of Entrustment Labor Union whose Members are DP Participants Others Founder Founding Partner Board of Trustees Beneficiary of Entrustment Labor Union whose Members are DP Participants Others s t u v w x y z a1 b1 c1 d1 e1 f1 g1 h1 i1 j1 k1 … Total ) letter e :
Filled with Domestic CPA/Non-Domestic CPA/Foreign CPA/Non-Foreign CPA Appraisal Value/Fair Value Investment Valuation Difference Economic Sector Pension Program/ Other Benefits DETAILS OF DIRECT PARTICIPATION Total Paid-Up Capital Ownership Percentage (v) Subsidiaries of Direct Participation (2) Total Paid-Up Capital Subsidiaries of Direct Participation Ownership Percentage (e1) No. Management Notes No. Company Name (1) Pension Fund Representative Participation Category) Date of Acquisition Initial Placement Acquisition Value As of report date

Object Type
(Land/Building/Land & Building) Value % Self-Management/ KPD Investment Manager Name a b c d e f g h i j k l m n o p q r s t u … Total Book Value Appraisal Value/ Fair Value Appraisal Year Public/Independent Appraiser Name KJPP Name Investment Valuation Difference DETAILS OF LAND, BUILDINGS, OR LAND AND BUILDINGS IN INDONESIA No. Address Location (City, Province) Area Type of Proof of Ownership Ownership Document Number Date of Acquisition Acquisition Value Accumulated Depreciation Pension Program/ Other Benefits Management Notes

No. Cash/Bank Name Branch Bank Code Account Number Nominal Pension Program/ Other Benefits Management Notes (Purpose of use) a b c d e f g h … Total DETAILS OF CASH AND BANK

Receivable Age <=3
Months
Receivable Age >3
Months
Total
Receivable Age <=3
Months
Receivable Age >3
Months
Total a b c d e f g h i j k
…
Total
DETAILS OF CONTRIBUTION RECEIVABLES
No.
Employer Name
(Founder/Founding Partner)
Employer Contribution Receivable Participant Contribution Receivable Participant Voluntary Contribution Receivable Pension Program/ Other Benefits Management Notes

No. Expense Type Amount
Pension Program/
Other Benefits
Management Notes a b c d e
…
Total
DETAILS OF PREPAID EXPENSES

No. Investment Receivable Type Counterparty Nominal Pension Program/ Other Benefits Management Notes a b c d e f … Total DETAILS OF INVESTMENT RECEIVABLES

No. Investment Return Receivable Type Counterparty Nominal Pension Program/ Other Benefits Management Notes a b c d e f … Total DETAILS OF INVESTMENT RETURN RECEIVABLES

No. Other Receivable Type Counterparty Nominal Pension Program/ Other Benefits Management Notes a b c d e f … Total DETAILS OF OTHER RECEIVABLES

No. Object Type
(Land/Building/Land
& Building)
Certificate Number
Location Address Date of Acquisition Acquisition Value Accumulated Depreciation Book Value Acquisition Value on report date Management Notes a b c d e f g h i j … Total DETAILS OF LAND AND BUILDINGS

No. Vehicle Plate Number Vehicle Type Date of Acquisition Acquisition Value Accumulated Depreciation Book Value Management Notes a b c d e f g h … Total DETAILS OF VEHICLES

No. Computer Equipment Type
Date of Acquisition Acquisition Value Accumulated Depreciation Book Value Management Notes a b c d e f g … Total DETAILS OF COMPUTER EQUIPMENT

No. Office Equipment Type
Date of Acquisition Acquisition Value Accumulated Depreciation Book Value Management Notes a b c d e f g … Total DETAILS OF OFFICE EQUIPMENT

No. Other Operational Asset Type
Date of Acquisition Acquisition Value Accumulated Depreciation Book Value Management Notes a b c d e f g … Total DETAILS OF OTHER OPERATIONAL ASSETS

No. Other Asset Type Date of Acquisition Asset Value Management Notes a b c d e … Total Other Asset Details

<= 1 year >1 year Total a b c d e f
…
Total
DETAILS OF DUE PENSION BENEFIT LIABILITIES No.
Amount Pension Program/
Other Benefits
Management Notes

<= 1 year >1 year Total a b c d e
…
Total
DETAILS OF DUE VOLUNTARY PENSION BENEFIT LIABILITIES No.
Amount Management Notes

Amount Management Notes
1 Beneficiary Name 1
2 Beneficiary Name 2
3 … etc.
D. Ending Balance (A+B-C)
DETAILS OF TA'ZIR FUND LIABILITIES
Details
A. Beginning Balance
B. Additions in Current Year
C. Usage in Current Year

No. Investment Type Counterparty Value
Pension Program/
Other Benefits
Management Notes a b c d e f
…
Total
DETAILS OF INVESTMENT LIABILITIES

No.
Details of
Unearned Revenue
Counterparty Value
Pension Program/
Other Benefits
Management Notes a b c d e f
…
Total
DETAILS OF UNEARNED REVENUE

No.
Details of
Expenses Still Payable
Counterparty Value
Pension Program/
Other Benefits
Management Notes a b c d e f
…
Total
DETAILS OF EXPENSES STILL PAYABLE

No. Other Liability Type Counterparty Value Pension Program/ Other Benefits Management Notes a b c d e f … Total DETAILS OF OTHER LIABILITIES

No. Investment Type Investment Valuation Difference Increase/ Decrease Pension Program/ Other Benefits Management Notes a b c d e f ... Total Details of Investment Increase/Decrease

% Amount % Amount a b c d e f g h i j k l m n o ...
Total
Details of Due Contributions
No.
Founder Name/
Founding Partner
PhDP
Due Contribution Contribution Received Over/Under Payment Pension Program/ Other Benefits Management Notes Normal Participant Contribution Normal Employer Contribution Voluntary Participant Contribution Normal Participant Contribution Normal Employer Contribution Voluntary Participant Contribution Normal Participant Contribution Normal Employer Contribution

No.
Other Investment
Income Type
Amount
Pension Program/
Other Benefits
Management Notes a b c d e
...
Total
Details of Income Other Than Investment

No.
Pension Fund Name that transfers
Amount
Pension Program/
Other Benefits
Details of Other Benefits *) Management Notes a b c d e f ... Total *) letter e:
Details of Transfer from Other Pension Funds Filled with Education Fund/Housing Fund/Religious Worship Fund/Disability Benefit/Death Benefit/Health Benefit/Severance Fund/Additional Benefit Fund

No. Expense Type Amount
Pension Program/
Other Benefits
Management Notes a b c d e
...
Total
Details of Investment Expenses

No. Expense Type Amount
Pension Program/
Other Benefits
Management Notes a b c d e
...
Total
Details of Operational Expenses

No. Expense Type Amount
Pension Program/
Other Benefits
Management Notes a b c d e
...
Total
Details of Expenses Other Than Investment and Operational

No.
Income Tax Type
Amount
Pension Program/
Other Benefits
Management Notes a b c d e
Total
Details of Income Tax

No.
Pension Fund that receives Transfer
Amount
Pension Program/
Other Benefits
Details of Other Benefits *)
Management Notes a b c d e f
...
Total
*) letter e:
Details of Transfer to Other Pension Funds Filled with Education Fund/Housing Fund/Religious Worship Fund/Disability Benefit/Death Benefit/Health Benefit/Severance Fund/Additional Benefit Fund

FORMAT I C
FORMAT AND STRUCTURE OF ANNUAL REPORTS FOR TECHNICAL REPORTS OF EMPLOYER PENSION FUNDS THAT ADMINISTER PENSION PROGRAMS BASED ON SHARIA PRINCIPLES
I. Pension Fund Profile
A. General Profile
Pension Fund Name :
General Register Book Number
(NBDU)
:
SID Number :
Taxpayer Identification Number
(Tax ID/NPWP)
:
Address :
a. Building/Floor/Room/Street :
b. City
Postal Code :
c. Province :
d. Telephone 1 (area code-telephone) :
e. Telephone 2 (area code-telephone) :
f. Telephone 3 (area code-telephone) :
g. Facsimile (area code - facsimile)
:
h. Email :
i. Website :
B. Founder
Founder Name :
Address :
a. Building/Floor/Room/Street :
b. City :
Postal Code :
c. Province :
d. Telephone 1 (area code-telephone) :
e. Telephone 2 (area code-telephone) :
f. Telephone 3 (area code-telephone) :
g. Facsimile (area code - facsimile)
:
h. Email :
i. Website :
j. Founder Business Field :
k. Founder Ownership Status
(State-Owned Enterprise/Non-State-Owned Enterprise) :
l. Founding Partner (Yes/No) :
C. Administration

Board of Trustees
a. Is there any change in the Board of Trustees or extension of the term of office of the Board of Trustees during the activity period?

If Yes, has this matter been reported to the OJK? b. Does the Board of Trustees have a basic knowledge certificate in the field of Pension Funds?
c. Do the Board of Trustees members who have a basic knowledge certificate in the field of Pension Funds meet the minimum continuing education points?
d. Does the Board of Trustees have proof of expertise in the field of Shariah finance? e. Is there any change in the Board of Supervisors or extension of the term of office of the Board of Supervisors during the activity period? If Yes, has this matter been reported to the OJK? f. Is there any change in the Shariah Supervisory Board or extension of the term of office of the Shariah Supervisory Board during the activity period? If Yes, has this matter been reported to the OJK? g. Does the Shariah Supervisory Board have a recommendation letter from DSNMUI? h. Does the Shariah Supervisory Board have a Founder's Decision letter regarding appointment?
i. Do the number and composition of the Board of Trustees, Board of Supervisors, and Shariah Supervisory Board comply with PDP and applicable laws and regulations regarding Pension Funds?
j. Does the Board of Trustees have an Investment Field and/or Risk Management certificate?

Number of Pension Fund Employees Based on Education Level
SD :
SMP :
SMA :
Diploma :
S1 :
S2 :
S3 :
Total :
List of Names and Positions of Pension Fund Employees Under the Board of Trustees Organizational Structure
Third-Party Service Users:
No. Name Position a. Does the Pension Fund use third-party services to manage participant administration? If Yes, fill in the name of the Participant Administration Manager:
5 etc. b. Does the Pension Fund use third-party services to entrust ownership documents of assets? If Yes, fill in the name of the custodian used:
5 etc.
c. Does the Pension Fund use Investment Manager services?
If Yes, fill in the list of Investment Manager names used (sorted by asset management proportion):
5 etc.

d. Does the Pension Fund use Appraiser services?
If Yes, fill in the list of Appraisers used:
5 etc.
5. Contributions
a. Does the Employer pay contributions in the correct amount? b. Does the Employer pay contributions on time?
c. Are there voluntary contributions from Participants?
6. Other Benefits
Does the Pension Fund administer Other Benefit programs for Participants?
7. Investment
a. Are investment activities during the reporting period in accordance with applicable laws and regulations? b. Has information regarding investments been submitted to participants?
c. Information on the Number and Date/Month/Year of the Last Investment Directive Determination
8. Governance
a. Does the Pension Fund have a Pension Fund Governance Guideline? b. Has the Pension Fund implemented Pension Fund Governance?
c. Information on the Number and Date/Month/Year of the Governance Guideline Determination
D. Pension Fund Participation

Number of Active Pension Fund Participant Employees at the end of the activity period::
Founder (persons) :
a. Pension Program :
b. Other Benefits :

Founding Partner (persons) :
a. Pension Program :
b. Other Benefits :
Total (persons) :
a. Pension Program :
b. Other Benefits :
2. Total number of participants entitled to deferred pension under the pension program at the end of the activity period
:
3. Active Participant Age Structure for the pension program
a. Number of Active Participants up to 20 :
20 to 30 :
30 to 40 :
40 to 50 :
above 50 :
b. Number of Participants entitled to deferred pension under the pension program up to 20 :
20 to 30 :
30 to 40 :
40 to 50 :
above 50 :
Estimated number of pension program participants entering normal retirement age in the next activity period :
4. Number of Founding Partners
E. Pensioners and Parties Entitled to Pension Program Description Amount ≤ Rp 1,600,000,

Rp
1,600,000,
≤ Rp
500,000,000,
Rp
500,000,000,

Number of Benefit Recipients -
a. Number of
Benefit Recipients
Pension benefits paid monthly at the end of the activity period (including those choosing maximum first payment 20%)
i. Pensioners
ii. Widows/Widowers
iii. Children
iv. Parties designated
by Participants or pensioners if
Participants or pensioners are not married and do not have children b. Number of Benefit Recipients Pension benefits paid as a lump sum during the activity period due to:
i. Monthly pension benefits
below the ministerial regulation threshold
ii. Reasons other than item b (i)
c. Number of
Benefit Recipients
Purchasing annuities during the period
Distribution of the number of
pension benefit recipients based on the category of pension benefit amounts received monthly at the end of the activity period
i. Pensioners
(persons)
ii. Widows/Widowers
iii. Children

iv. Parties designated by
Participants or pensioners if Participants or pensioners are not married and do not have children Board of Trustees Statement We, the Board of Trustees of the Pension Fund, declare that all data and information provided in this technical report are true and accurate and correspond to the actual conditions of the Pension Fund. If it is later discovered that there is data/information that does not correspond to the actual conditions, we are willing to be held accountable in accordance with applicable laws and regulations. Place, Date (date/month/year) (signature) Full Name Position

II. Report on Pension Fund Investment Performance Evaluation by the Board of Supervisors
Acknowledged,
(Signature)
(Name)
(Board of Supervisors Position)
(substance of the report is filled in and signed by the Board of Supervisors considering the Reasonableness of the Board of Trustees' explanation of the discrepancy between Pension Fund Investment Performance and Investment Directives and Annual Investment Plan)

III. Report on Good Corporate Governance Implementation for Pension Funds Administering All or Part of Their Business Based on Shariah Principles

Transparency of Good Governance Implementation for Pension Funds Administering All or Part of Their Business Based on Shariah Principles
a. DPPK Board of Trustees

Number, name, position, criteria, appointment date, term of office, nationality, and domicile of DPPK Board of Trustees members
No. Name Position
Criteria
Appointment
Date
Term of
Office
Nationality
Domicile
Last Formal
Education
And
Professional Degree
Competency
And
Fit and Proper Test

Etc
.
2) Concurrent positions of DPPK Board of Trustees members
No. Name
Position in
Pension Fund
Position in Other
Pension Fund
Position in
Company and/or other institutions
1.
1.
2.
Etc.
2.
1.
2.
Etc.
Etc
3) Frequency of DPPK Board of Trustees meetings held in 1 (one) month.
No. Name Position
Number of Board Meetings (... meetings)
% Attendance
Physical Attendance
Teleconference/Video
Conference/Other Electronic Media
1.
2.
Etc

Family relationships between DPPK Board of Trustees members with other Board of Trustees and/or DPPK Board of Supervisors members at the Pension Fund where the DPPK Board of Trustees member serves.
No. Name
Family Relationship With
Other Board of Trustees Members Board of Supervisors Yes No Note* Yes No Note* 1. 2. Etc Note:
*) Form of family relationship: husband/wife/child/parent/sibling/in-law, etc. b. Board of Supervisors
Number, name, position, criteria, appointment date, term of office, nationality, and domicile of Board of Supervisors members
No. Name Position
Criteria
Appointment
Date
Term of
Office
Nationality
Domicile
Last Formal Education and
Professional Degree
Competency
And
Fit and Proper Test

Etc.
2) Concurrent positions of Board of Supervisors members
No. Name
Position in
Pension Fund
Position in Other
Pension Fund
Position in
Company and/or other institutions
1.
1.
2.
Etc.
2.
1.
2.
Etc.
Etc.
3) Frequency of Board of Supervisors meetings held in 1 (one) month.
No. Name Position
Number of Board of Supervisors Meetings
(... meetings) % Attendance
Physical Attendance
Teleconference/Video/Conference/Other Electronic Media 1.
2.
Etc
4) Family relationships between Board of Supervisors members with other Board of Supervisors members and/or DPPK Board of Trustees members at the Pension Fund where the Board of Supervisors member serves.
No. Name
Family Relationship With
Other Board of Supervisors Members
DPPK Board of Trustees Members
Yes No Note* Yes No Note*
1.
2.
Etc
Note:
 Form of family relationship: husband/wife/child/parent/sibling/in-law, etc.
c. Shariah Supervisory Board

Number, name, position, criteria, appointment date, term of office, nationality, and domicile of Shariah Supervisory Board members
No. Name Position
Criteria
Appointment
Date
Term of
Office
Nationality
Domicile
Last Formal Education and
Professional Degree
Competency
And
Fit and Proper Test

Etc.
2) Concurrent positions of Shariah Supervisory Board members
No. Name
Position in
Pension Fund
Position in Other
Pension Fund
Position in Company and/or other institutions 1.
1.
2.
Etc.
2.
1.
2.
Etc.
Etc.
3) Frequency of Shariah Supervisory Board meetings held in
3 (three) months.

No. Name Position
Number of Shariah Supervisory Board Meetings (... meetings) % Attendance Physical Attendance Teleconference/ Video Conference /Other Electronic Media 1. 2. Etc
4) Family relationships between Shariah Supervisory Board members with other Shariah Supervisory Board members, DPPK Board of Trustees members,
and/or Board of Supervisors members at the Pension Fund where the Shariah Supervisory Board member serves. No. Name Family Relationship With Other Shariah Supervisory Board Members DPPK Board of Trustees Members Board of Supervisors Members Yes No Note* Yes No Note* Yes No Note* 1. 2. Etc Note:
 Form of family relationship: husband/wife/child/parent/sibling/in-law, etc. d. Board of Supervisors Supervision Results Report Board of Supervisors activity report on the implementation of Good Corporate Governance for Pension Funds Supervision Results Recommendations  Filled with details of the Board of Supervisors' assessment regarding the implementation of Good Corporate Governance for Pension Funds, including quantitative and qualitative assessments of Good Corporate Governance for Pension Funds and factors affecting performance, as well as efforts to improve Pension Fund performance, if according to their assessment there is a decline in Pension Fund performance e. Committees

Functions under the DPPK Board of Trustees

No.
Name
Function
Name
Member
Position*
Work
Tenure
Appointment
Letter
Number of
Meetings in One Year
1.
Internal
Audit
Function
1.
2.
Etc
2.
Risk
Management
Function
1.
2.
Etc
3. Compliance
Function
1.
2.
Etc
Etc
2) Committees under the Board of Supervisors
No.
Name
Committee
Name
Member
Position*
Work
Tenure
Appointment
Letter
Number of
Meetings in One Year
1.
Audit
Committee
1.
2.
Etc
2.
Risk
Monitoring
Committee
1.
2.
Etc
3. Nomination and
Remuneration
Committee
1.
2.
Etc
Etc f. Implementation of external audit functions.
No. Description Year n-2 Year n-1 Year n 1.
Public Accounting Firm Name
2. Public Accountant Name
3. Audit Period
4.
Board of Supervisors Appointment *)
Note:
 Date of Appointment by the Board of Supervisors

g. Implementation of Remuneration policies and other facilities for DPPK Board of Trustees members, Board of Supervisors members, Shariah Supervisory Board members, and Employees. Number of DPPK Board of Trustees, Board of Supervisors, Shariah Supervisory Board, and Employee members receiving Remuneration packages in 1 (one) year, grouped by income level as follows:
Number
Remuneration per person in 1 year *)
Number of
DPPK Board of
Trustees
Number of
Board of
Supervisors
Number of Shariah
Supervisory Board
Employees
Above Rp2 billion
Above Rp1 billion to Rp2 billion
Above Rp500 million to Rp1 billion
Rp500 million and below
Note:
 received in cash h. Outsourcing of Investment Management *) No. Type of Investment Outsourcing Company Name Investment Value No. Agreement % of total Investment Portfolio 1. 2. Etc Note:
 Pension Funds only outsource Investment Management in the form of KPD
i. Disclosure of other material matters
No. Description
Checklist *) If Yes,
Yes No Explain
1.
Resignation or dismissal of external audit
2. Material transactions with related parties )
3.
Ongoing Conflicts of Interest.
4.
Other material information regarding the Pension Fund
5. Pension Fund has a compliance function

No. Description Checkbox *) If Yes, Yes No Explain
6. The Pension Fund has an internal audit
7.
The Pension Fund has a risk management function 8.
The Pension Fund has an investment management function/unit 9. The Pension Fund has a special work unit and/or appoints a Capital Market Institution official responsible for the application of AML and CFT programs

select one answer by placing a mark “√”
Related Parties are individuals or companies/entities that have a controlling relationship with the Pension Fund, directly or indirectly, through ownership, management, and/or financial relationships

Self-Assessment on the Implementation of Good Corporate Governance for Pension Funds
The completion of the questionnaire on the Implementation of Good Corporate Governance for Pension Funds is carried out by the respective Pension Fund. The completion of this questionnaire is done by providing answers to the questions/statements in the aforementioned questionnaire.

Filling Method:
Generally, answers to the Questions/Statements consist of 5 criteria as follows (except for answers requiring different criteria):
A= The respective Pension Fund DOES NOT HAVE a written policy regarding the Question/Statement in question. B= The respective Pension Fund HAS a written policy regarding the Question/Statement in question, but the policy has NOT been implemented. C= The respective Pension Fund HAS a written policy regarding the Question/Statement in question, but the policy has NOT been implemented CONSISTENTLY. D= The respective Pension Fund HAS a written policy regarding the Question/Statement in question, the policy is IMPLEMENTED CONSISTENTLY but has NOT BEEN UPDATED periodically. E= The respective Pension Fund HAS a written policy regarding the Question/Statement in question and the policy is IMPLEMENTED CONSISTENTLY and UPDATED periodically.

Interpretation of Results
An assessment is required to interpret the score obtained in answering the questions in this Questionnaire, the majority of whose answers consist of 5 (five) scales from the lowest assessment (A/No) to the highest assessment (E/Yes). Specifically for the answer "A/No" on assessment criteria required by statutory regulations (mandatory), a negative score is given. For groups of Questions/Statements skipped due to "None" and which are not "not applicable", the interpretation of results must still be considered by giving the same score as the answer "A/No".

A. BUSINESS ETHICS AND CODE OF CONDUCT

The Pension Fund has Vision, Mission, and Values
A B C D E
The Pension Fund has a Business Ethics Policy which includes:
2.1. General policies directing towards applicable statutory regulations and applicable codes of ethics.
A B C D E
2.2. Policies for Pension Fund organs.
A B C D E
2.3. Policies for employees.
A B C D E
2.4. Policies for Participants and/or parties entitled to pension benefits.
A B C D E
2.5. Policies for business partners.
A B C D E
2.6. Policies for other pension funds.
A B C D E
The Pension Fund has a Code of Conduct which is an elaboration of Values and Business Ethics.
A B C D E
The Code of Conduct includes guidelines on:
4.1. Conflicts of interest.
A B C D E
4.2. Gifts and donations.
A B C D E
4.3. Compliance with regulations.
A B C D E
4.4. Information confidentiality.
A B C D E
4.5. Reporting of violations and protection for whistleblowers.
A B C D E
In carrying out their duties, the Board of Trustees, Supervisory Board, and pension fund employees:
5.1. Make a statement of "no conflict of interest" regarding every decision made by the authorized party.
Yes No
5.2. Make an annual statement regarding the implementation of the Code of Conduct established by the Pension Fund.
Yes No
5.3. Make an annual statement not to receive and/or give anything that can influence decision-making.
Yes No
The Pension Fund records its assets, liabilities, and own equity correctly using generally accepted accounting principles or special accounting principles applicable to pension funds.
Yes No
Has a complaint system regarding violations of the Code of Conduct, Pension Fund regulations, and statutory regulations, as well as matters related to Participants, which ensures protection for Whistleblowers.
A B C D E

B. PENSION FUND ORGANS a. Founders and Co-Founders Founders and Co-Founders according to their respective functions have carried out the following:
1.1. Internal control.
A B C D E
1.2. Risk management.
A B C D E
1.3. Implementation of GCG.
A B C D E
1.4. Following up on findings and recommendations from work units performing the Pension Fund's internal audit function, external audit of the Pension Fund, and/or results of supervision by the Financial Services Authority.
A B C D E

b. Board of Trustees (BoT)

Composition, Appointment, and Dismissal of Board of Trustees
1.1. The number of Board of Trustees members has been adjusted to the complexity of the Pension Fund while still considering the effectiveness of decision-making.
Yes No
1.2. The Board of Trustees consists of members who collectively have competencies such as:
1.2.a. Investment field.
Yes No
1.2.b. Risk Management field.
Yes No
Requirements for Board of Trustees
2.1. Board of Trustees members meet the articles of association requirements.
Yes No
2.2. Board of Trustees members meet the capability and propriety requirements according to the regulations of the supervisory and regulatory authority.
Yes No
2.3. Board of Trustees members must understand and implement good corporate governance for Pension Funds.
A B C D E
2.4. Board of Trustees members are prohibited from utilizing the Pension Fund for the interests of themselves, family, business groups, and/or other parties that harm the interests of the Pension Fund.
Yes No
2.5. Do not hold concurrent positions as members of the Supervisory Board or DPS on the same Pension Fund.
Yes No
2.6. Do not hold concurrent positions as directors or board of commissioners or equivalent in other companies and/or institutions, except in subsidiary companies where the pension fund is invested, directly or indirectly.
Yes No
2.7. Board of Trustees members do not hold concurrent positions as Board of Trustees members, Executive Board of Trustees, Supervisory Board, or DPS on other Pension Funds.
Yes No
Functions of Board of Trustees
3.1. Management
3.1.1. The Board of Trustees is fully responsible for the management of the Pension Fund.
A B C D E
3.1.2. The Board of Trustees manages the resources owned, effectively and efficiently, including ensuring the availability of human resources meeting certain qualifications to perform their functions.
A B C D E
3.1.3. The Board of Trustees considers the legitimate interests of stakeholders.
A B C D E
3.1.4. The Board of Trustees has and complies with rules of procedure and work guidelines (charters) regulated in the PDP and statutory regulations in the field of Pension Funds.
A B C D E
3.1.5. Board of Trustees members who oversee the compliance function cannot be concurrently held by Board of Trustees members who oversee the funding, financial, or investment functions, except if the number of Board of Trustees members is 2 (two), the compliance function can be concurrently held by the Board of Trustees member overseeing the financial function.
Yes No
3.2. Risk Management
3.2.1. The Board of Trustees formulates and implements a Risk Management System covering all aspects of the Pension Fund's activities.
A B C D E
3.2.2. The Pension Fund has a Risk Monitoring Committee and a Risk Management Work Unit.
Yes No
3.3. Internal Control
3.3.1. The Pension Fund has an internal supervision function.
Yes No
3.3.2. Responsible for the execution of their duties to the Founders and Co-Founders.
Yes No
3.4. Information Technology
3.4.1. The Pension Fund has an integrated computerized administration system.
3.4.2. The Pension Fund has Standard Operating Procedures for the Information Technology division.
Accountability of Board of Trustees
4.1. The Board of Trustees prepares a report on the management of the Pension Fund in the form of an Annual Report.
Yes No
4.2. Criteria for the Annual Report include:
4.2.1. Containing at least:
a. Financial statements.
Yes No b. Pension Fund activity report.
Yes No
c. Report on the implementation of good corporate governance for Pension Funds.
Yes No
4.2.2. Obtains approval from Founders and Co-Founders.
Yes No
4.2.3. Specifically, financial statements must obtain confirmation from Founders and Co-Founders.
Yes No
4.3. Board of Trustees Meetings
4.3.1. Every strategic policy and decision must be decided through a Board of Trustees DPPK meeting, considering supervision according to the duties and responsibilities of the Supervisory Board.
Yes No
4.3.2. The Board of Trustees holds meetings periodically at least 1 (one) time in 1 (one) month.
Yes No
4.3.3. The Board of Trustees establishes meeting rules of procedure.
Yes No
4.3.4. Minutes of every Board of Trustees meeting are made.
Yes No
4.3.5. Meeting minutes include differing opinions (dissenting opinion) with the decisions taken in the meeting (if any).
A B C D E
4.3.6. Every Board of Trustees member, whether attending or not attending the meeting, has the right to receive a copy of the Board of Trustees Meeting Minutes.
Yes No

c. Supervisory Board

Composition, Appointment, and Dismissal of Supervisory Board
1.1. The number of Supervisory Board members has been adjusted to the complexity of the Pension Fund while still considering the effectiveness of decision-making.
Yes No
1.2. The entire Supervisory Board consists of members who collectively have competencies relevant to their positions.
Yes No
1.3. Do not hold concurrent positions as Board of Trustees or DPS on the same Pension Fund, or Supervisory Board, Board of Trustees, or DPS on other Pension Funds.
Yes No
Competence and Integrity of Supervisory Board
2.1. Meet the Fit and Proper Test requirements.
Yes No
2.2. Monitor the effectiveness of the implementation of good corporate governance for Pension Funds.
A B C D E
2.3. Do not utilize the Pension Fund for the interests of themselves, family, their business groups, or other parties that can harm the Pension Fund.
Yes No
Supervisory Functions of the Supervisory Board
3.1. Fully responsible for the supervision of the Pension Fund.
A B C D E
3.2. Execute the duties and responsibilities of the Supervisory Board as regulated in the PDP and statutory regulations in the field of Pension Funds independently.
Yes No
3.3. The Supervisory Board holds meetings periodically at least 1 (one) time in 3 (three) months.
Yes No
3.4. Minutes of every Supervisory Board meeting are made.
Yes No
3.5. Meeting minutes include differing opinions (dissenting opinion) with the decisions taken in the meeting.
A B C D E
3.6. Every Supervisory Board member, whether attending or not attending the meeting, has the right to receive a copy of the Supervisory Board Meeting Minutes.
Yes No

d. Sharia Supervisory Board (SSB)

Composition, Appointment, and Dismissal of Sharia Supervisory Board
1.1. The number of Sharia Supervisory Board members has been adjusted to the complexity of the Pension Fund while still considering the effectiveness of decision-making.
Yes No
1.2. Are Sharia experts appointed by the Founder based on recommendations from the National Sharia Council of the Indonesian Ulema Council, and their appointment must be clearly stated in the Founder's decision letter.
Yes No
1.3. The entire Sharia Supervisory Board consists of members who collectively have competencies relevant to their positions.
Yes No
1.4. Do not hold concurrent positions as Board of Trustees DPPK or Supervisory Board on the same Pension Fund.
Yes No
1.5. SSB members are prohibited from holding concurrent positions as SSB members in more than 4 (four) other Sharia financial service institutions.
Yes No
Competence and Integrity of Sharia Supervisory Board
2.1. Meet the Fit and Proper Test requirements.
Yes No
2.2. Monitor the effectiveness of the implementation of good corporate governance for Pension Funds.
A B C D E
2.3. Do not utilize the Pension Fund for the interests of themselves, family, their business groups, or other parties that can harm the Pension Fund.
Yes No
Supervisory Functions of the Sharia Supervisory Board
3.1. Fully responsible for the supervision of DPPK.
A B C D E
3.2. Execute the duties and responsibilities of the Sharia Supervisory Board as regulated in the PDP and statutory regulations in the field of Pension Funds independently.
A B C D E
3.3. The Sharia Supervisory Board holds meetings periodically at least 1 (one) time in 3 (three) months.
Yes No
3.4. Minutes of every Sharia Supervisory Board meeting are made.
Yes No
3.5. Meeting minutes include differing opinions (dissenting opinion) with the decisions taken in the meeting.
A B C D E
3.6. Every Sharia Supervisory Board member, whether attending or not attending the meeting, has the right to receive a copy of the Sharia Supervisory Board Meeting Minutes.
Yes No
3.7. The number of SSB meetings held and the attendance of each SSB member must be included in the report on the implementation of Good Corporate Governance for Pension Funds.
Yes No
3.8. In the event that the number of SSB members is 1 (one), the SSB meeting is held together with the Pension Fund Supervisory Board meeting.
Yes No
Supervisory Board Committees (answered if applicable)
4.1. Audit Committee
Yes No continue to 4.1.7.
The Audit Committee acts as a facilitator for the Supervisory Board to ensure the following:
4.1.1. The Pension Fund's internal control structure is implemented well.
A B C D E
4.1.2. Internal audit is carried out according to applicable audit standards.
A B C D E
4.1.3. Follow-up on internal audit findings is implemented by management.
A B C D E
4.1.4. External audit has been carried out according to applicable audit standards.
Yes No
4.1.5. Follow-up on external audit findings is implemented by management.
A B C D E
4.1.6. Members of the Audit Committee consist of:
a. Supervisory Board members
Yes No b. Parties outside the Pension Fund who do not have financial, management, and/or family relationships with the Supervisory Board, Board of Trustees of the Pension Fund, and/or Founder, or other relationships that can influence their ability to act independently. Yes No
4.1.7. For Pension Funds that do not have an Audit Committee, there is a Supervisory Board member who specifically serves to ensure the following:
a. The Pension Fund's internal control structure has been implemented well. A B C D E b. Internal audit is carried out according to applicable audit standards. A B C D E
c. Follow-up on internal audit findings is implemented by management.
A B C D E d. External audit has been carried out according to applicable audit standards. Yes No e. Follow-up on external audit findings is implemented by management. A B C D E
4.2. Risk Monitoring Committee
Yes No continue to 4.2.4.
The Risk Monitoring Committee acts as a facilitator for the Supervisory Board for the following:
4.2.1. Assess the quality of risk management policies.
A B C D E
4.2.2. Assess the effectiveness of risk management applied by the Pension Fund, including assessing the risk tolerance taken by the Board of Trustees.
A B C D E
4.2.3. Members of the Risk Monitoring Committee consist of:
a. Supervisory Board members representing Participants.
Yes No b. Other parties.
Yes No
4.2.4. For Pension Funds that do not have a Risk Monitoring Committee, there is a Supervisory Board member who specifically serves for the following:
a. Assess the quality of risk management policies.
A B C D E b. Assess the effectiveness of risk management applied by the Pension Fund, including assessing the risk tolerance taken by the Board of Trustees. A B C D E

4.3. Nomination and Remuneration Committee
Yes No continue to 4.3.4.
The Nomination and Remuneration Committee acts as a facilitator for the Supervisory Board for the following:
4.3.1. Facilitator for the Supervisory Board in helping the Founder establish criteria and select candidates for the Supervisory Board and Board of Trustees of the Pension Fund.
A B C D E
4.3.2. Facilitator for the Supervisory Board in helping the Founder establish the Remuneration system.
A B C D E
4.3.3. Members of the Nomination and Remuneration Committee consist of:
a. Supervisory Board members.
Yes No b. Other parties.
Yes No
4.3.4. For Pension Funds that do not have a Nomination and Remuneration Committee, there is a Supervisory Board member who specifically serves as follows:
a. Help the Founder establish criteria and select candidates for the Supervisory Board and Board of Trustees of the Pension Fund. A B C D E b. Help the Founder establish the Remuneration system. A B C D E

C. HEALTHY BUSINESS PRACTICES
External Auditor

External Auditor (public accounting firm) conducts independent examinations of the truthfulness of the Pension Fund's financial statements.
Yes No
The appointed public accounting firm (KAP) is registered with the Financial Services Authority.
Yes No
Action Plan
No. Corrective Action Completion Target Completion Obstacles Notes 1. ...
Implementation of Anti-Fraud Strategy
(Pension Fund Name)..............................
FRAUD CONTROL REPORT AND ANTI-FRAUD STRATEGY IMPLEMENTATION YEAR …… a. Inventory of Fraud Incidents and Follow-up Type of Fraud a) Date of Fraud Occurrence Division/Unit of Fraud Occurrence Parties Involved b) Position Loss in Rupiah c) Pension Fund's Action d) Weaknesses/Causes of Fraud e) Follow-up/Improvement f) Chronology of Fraud Incident g) b. Progress of Anti-Fraud Strategy Implementation

Prevention:
……………………………………………………………………………………………
……………………………………………………………………………………………
……………………………………………………………………………………………
Detection:
……………………………………………………………………………………………
……………………………………………………………………………………………
……………………………………………………………………………………………
Investigation, Reporting, and Sanctions:
……………………………………………………………………………………………
……………………………………………………………………………………………
……………………………………………………………………………………………
Monitoring, Evaluation, and Follow-up:
……………………………………………………………………………………………
……………………………………………………………………………………………
……………………………………………………………………………………………
EXPLANATION FOR FILLING THE REPORT:
a) Types of Fraud include, fraud, deception, asset embezzlement, information leakage, criminal acts of the Pension Fund, or others. b) Parties involved include all parties indicated to be involved/participate in Fraud. If more than 1 (one) party is involved, the role of each party is explained. c) Losses are filled with actual losses or estimated losses. d) Pension Fund's action is the Pension Fund's response to the Fraud incident, either actions against the perpetrator, the injured party, or other actions. Actions against the Fraud perpetrator include administrative sanctions and/or compensation obligations. Actions against the injured party include compensation and/or reputation restoration efforts. Other actions include reports to authorities and/or legal efforts. e) Weaknesses/causes of Fraud are identifications of weaknesses in the Pension Fund that cause Fraud, which can be policy, system, and procedure weaknesses, or human resource weaknesses, or other causes not originating from the Pension Fund. f) Follow-up/improvement are efforts that have been or will be carried out by the Pension Fund regarding weaknesses causing Fraud. g) Briefly explain the process of prevention, detection, investigation, reporting, sanctions, and monitoring, evaluation, and follow-up steps for the implementation of the anti-Fraud strategy in the reporting period.

IV. Sharia Supervisory Board Supervision Results Report
SHARIA SUPERVISORY BOARD SUPERVISION RESULTS REPORT Pension Fund Name :
PPBS Implementation Scheme
: [1] Full Fledged Sharia
[2] Sharia Unit of DPPK
[3] Sharia Investment Package of DPLK
Report Period : s.d.
Report Date :

GENERAL INFORMATION

Pension Fund Name :
Type of Pension Fund : (1) DPPK PPMP
(2) DPPK PPIP
(3) DPLK
PPBS Implementation Scheme
: (1) Full Fledged Sharia
(2) Sharia Unit of DPPK
(3) Sharia Investment Package of DPLK
Pension Fund Address :
SSB Composition :
No. Full Name Position SSB Appointment Decision Letter Number Date 1. 2. ...
Summary of correspondence and/or meeting minutes related to SSB supervision results
No. Correspondence and/or Meeting Minutes Summary of Substance Number Date Matter 1. 2. ...
Information regarding the report preparer (contact person):
a. Name :
b. Position :
c. Telephone Number :
d. E-mail Address :

SSB STATEMENT a. IF NO PRACTICES VIOLATING THE SHARIA SUPERVISORY BOARD STATEMENT WERE FOUND Bismillahirrahmanirrahim We have supervised the implementation of the basic principles of PPBS implementation carried out by the Sharia Pension Fund..../DPPK Sharia Unit......... during the period from date .......... to date .........................., as mandated in Article 22 of OJK Regulation Number 33/POJK.05/2016 concerning the Implementation of Pension Programs Based on Sharia Principles. In order to carry out such supervision, we carry out assessments on the implementation of the aforementioned Sharia-based Pension Program, which include aspects of the Contracts used, contribution management aspects, investment placement aspects, Pension Benefit aspects, Other Benefits aspects, and other activities. From the supervision results, no management practices violating Sharia Principles were found. Thus, based on the assessment results of the aspects in paragraph 1 above, in our opinion, the implementation of such matters by the Sharia Pension Fund..../DPPK Sharia Unit....... has been in accordance with Sharia Principles. ....................(City Name),...........................(date-month-year) Sharia Supervisory Board No. Name Signature

b. IF PRACTICES NOT YET IN ACCORDANCE WITH SHARIA PRINCIPLES WERE FOUND SHARIA SUPERVISORY BOARD STATEMENT Bismillahirrahmanirrahim We have supervised the implementation of the basic principles of PPBS implementation carried out by the Sharia Pension Fund..../DPPK Sharia Unit …..... during the period from date .......... to date ....................., as mandated in Article 22 of OJK Regulation Number 33/POJK.05/2016 concerning the Implementation of Pension Programs Based on Sharia Principles. In order to carry out such supervision, we carry out assessments on the implementation of the aforementioned Sharia-based Pension Program, which include aspects of the Contracts used, contribution management aspects, investment placement aspects, Pension Benefit aspects, Other Benefits aspects, and other activities. From the supervision results, it is known that the Sharia Pension Fund..../DPPK Sharia Unit....... has carried out management practices not yet in accordance with Sharia Principles. Thus, based on the assessment results of the aspects in paragraph 1 above, in our opinion, the implementation of such matters by the Sharia Pension Fund..../DPPK Sharia Unit...... has not been in accordance with Sharia Principles. Summary of Practices Not Yet in Accordance with Sharia Principles No. Practice Period of Occurrence Cause Factor Notes ....................(City Name),...........................(date-month-year) Sharia Supervisory Board No. Name Position Signature

SUPERVISION RESULTS SUMMARY AND RECOMMENDATIONS Supervision Results Summary and Recommendations Based on the results of supervision and assessment of the implementation of Sharia Principles in the operational management of Sharia Pension Programs (PPBS) at Sharia Pension Fund....../Sharia Unit of DPPK....... during the period from date...................to..............., the following summary of supervision results and recommendations can be conveyed:

A. Contracts Used
Main Material 1:
Suitability of contracts used with PPBS activities Suitability Status:
Status Description:
Recommendation:
Main Material 2:
Implementation of systems and procedures for contract usage in PPBS activities Suitability Status:
Status Description:
Recommendation:
Main Material 3:
Determination of fair and transparent ujrah/nisbah in PPBS activities Suitability Status:
Status Description:
Recommendation:

B. Contribution Management
Main Material 1:
Implementation of membership systems and procedures in PPBS Suitability Status:
Status Description:
Recommendation:
Main Material 2:
Implementation of systems and procedures for receipt and management of PPBS contributions Suitability Status:
Status Description:
Recommendation:
Main Material 3:
Implementation of systems and procedures for imposing sanctions (ta’zir) and use of Ta’zir Funds. Suitability Status:
Status Description:
Recommendation:

C. Investment Placement
Main Material 1:
Implementation of systems and procedures for PPBS investment placement Suitability Status:
Status Description:
Recommendation:
Main Material 2:
Administration of proof of ownership of PPBS investment assets Suitability Status:
Status Description:
Recommendation:
Main Material 3:
Management of PPBS investments in the event of PPBS investments that are not in accordance with Sharia Principles Description:
Recommendation:
Main Material 4:
Recording of PPBS investments
Description:
Recommendation:

D. Pension Benefit Payments
Main Material 1:
Implementation of systems and procedures for Pension Benefit payments Suitability Status:
Status Description:
Recommendation
Main Material 2:
Pension Benefit calculation and payment have been carried out in accordance with the employer's promise, or in accordance with Participant ownership rights, and do not contradict Sharia Principles. Suitability Status:
Status Description:
Recommendation

E. Other Benefits (if any)
Main Material 1:
Implementation of systems and procedures for managing contribution funds for Other Benefits Suitability Status:
Status Description:
Recommendation:
Main Material 2:
Implementation of systems and procedures for investment placement for Other Benefits Suitability Status:
Status Description:
Recommendation:
Main Material 3:
Implementation of systems and procedures for Other Benefit payments Suitability Status:
Status Description:
Recommendation:
Main Material 4:
Other Benefit calculation and payment have been carried out in accordance with the employer's promise, or in accordance with Participant ownership rights, and do not contradict Sharia Principles and regulations in the field of Pension Funds. Suitability Status:
Status Description:
Recommendation

F. Other Activities
Main Material 1:
Implementation of systems and procedures for placing PPBS assets other than investments Suitability Status:
Status Description:
Recommendation:
Main Material 2:
Administration of proof of ownership of other assets Suitability Status:
Status Description:
Recommendation:
Main Material 3:
Recording and administration of PPBS Participant accounts Suitability Status:
Status Description:
Recommendation:

Main Material 4:
implementation of other activities not yet regulated in regulations in the field of Pension Funds, including fatwas from DSN MUI Suitability Status:
Status Description:
Recommendation:

V. Proof of Fulfillment of Continuity Requirements for Managers and Employees Handling Investments
FORM:
SELF ASSESSMENT FORM
CONTINUITY REQUIREMENTS FULFILLMENT REPORT FOR MANAGERS AND EMPLOYEES HANDLING INVESTMENTS Pension Fund Name :
Report Letter Number :
Report Letter Date :
Contact Person (Name,
Phone/email)
:
NO DESCRIPTION LEGAL BASIS YES NO DESCRIPTION 1.
Continuity requirement fulfillment report is submitted by the Pension Fund Manager to the OJK no later than April 30 of the following year. o POJK 3/POJK.05/2015 o POJK 5/POJK.05/2018 o POJK 29/POJK.05/2018
2. Proof of continuity requirement fulfillment
Additional description (if necessary):
No Name
Type
Principal Party *) *)
No. and date
SK
(FPT)
Type
Fulfiller *)
Title
Activity
Organizer
Activity
Date
Fulfillment
Year
Proof of fulfillment *)
..... o Manager o Employee
..... o attend seminar, workshop, or other similar activities o attend course, training, or educational program similar o write papers, articles, or other written works published o become speaker in seminar, workshop, or other similar activities, become teacher or instructor in activities ..... o financial services supervisory agency in and outside the country o financial services institution association in and outside the country o higher education institutions in and outside the country o training institutions that have obtained permission from the competent authority ..... ..... ..... o certificate (number and date) o attendance proof o others, namely
.....

course, training, or educational program similar Description:

Filling method: click twice on the box, then select "Checked"
*) Choose one
) Specifically for managers
*) for all employees handling investments
This Self Assessment Form is prepared based on OJK Regulation No. 3/POJK.05/2015 concerning Pension Fund Investments; OJK Regulation No.5/POJK.05/2018 concerning Pension Fund Periodic Reports, and OJK Regulation No.29/POJK.05/2018 concerning Amendments to Financial Services Authority Regulation Number 3/POJK.05/2015 concerning Pension Fund Investments
Types of fulfillment of continuity requirements related to knowledge in the field of investments and/or risk management as regulated in OJK Regulation No. 3/POJK.05/2015 Concerning Pension Fund Investments.

FORMAT I D
FORM AND STRUCTURE OF OTHER REPORTS FOR EMPLOYER PENSION FUNDS ADMINISTERING PENSION PROGRAMS BASED ON SHARIA PRINCIPLES A. Consumer Complaint Service and Resolution Report for Financial Services Business Actors The form and structure of consumer complaint reports and follow-up on service and resolution of consumers as referred to in the Financial Services Authority Regulations regarding Consumer Complaint Services in the Financial Services Sector refer to the form and structure as contained in the Appendix of the Financial Services Authority Circular Letter regarding Guidelines for Implementation of Consumer Complaint Services in the Financial Services Sector. B. Report on Appointment of Public Accountants and/or Public Accounting Firms In the Context of Audit on Annual Historical Financial Information The form and structure of the report on the appointment of public accountants and/or public accounting firms in the context of audit on annual historical financial information as referred to in the Financial Services Authority Regulations regarding the Use of Public Accountants and Public Accounting Firms in Financial Services Activities refer to the form and structure as contained in the Appendix of the Financial Services Authority Circular Letter regarding Procedures for the Use of Public Accountants and Public Accounting Firms in Financial Services Activities.
C. Audit Committee Evaluation Report on the Implementation of Audit Services
On Annual Historical Financial Information by Public Accountants and/or Public Accounting Firms The form and structure of the audit committee's evaluation report on the implementation of audit services on annual historical financial information by public accountants and/or public accounting firms as referred to in the Financial Services Authority Regulations regarding the Use of Public Accountants and Public Accounting Firms in Financial Services Activities refer to the form and structure as contained in the Appendix of the Financial Services Authority Circular Letter regarding Procedures for the Use of Public Accountants and Public Accounting Firms in Financial Services Activities.

D. Periodic Actuarial Reports a. Actuarial Report for Employer Pension Funds Administering Defined Benefit Pension Programs General Data Report Number Report Date NBDU Pension Fund Name Pension Fund Address Reporting Period Reporting Month Fiscal Year Type of Reporting Period Annual Report Manager Name Manager Position

Actuarial Statement
1.1 Pension Fund Actuarial Information:

Actuarial Name;
Actuarial Firm Name;
Office Address and Telephone Number;
STTD No. Actuarial Consultant (with valid license at IKNB);
1.2 Statement regarding Actuarial Present Value, Solvency Liability,
Funding Assets, Surplus or Deficit, Solvency Ratio, Funding Ratio, and funding quality.
1.3 Statement regarding:

the amount of Normal Contributions to be paid until the end of the first fiscal year after the actuarial valuation date, detailed for the portion to be paid by Participants and Employers;
the percentage of Normal Contributions against basic pension income for years after the fiscal year referred to in item 1, up to the submission of the next Periodic Actuarial Report;
the portion of Normal Contributions whose fulfillment becomes the responsibility of the Employer that can be paid from Surplus for Periodic Actuarial Reports as referred to in the Financial Services Authority Regulations concerning Pension Fund Funding
that occurred along with the period of its use; and
1.4 Statement regarding the amount of Additional Monthly Contributions along with the payment period.
1.5 Pension Cost Sharing/non cost sharing (Choose one)
I, the undersigned, declare that:
All data received is complete, and can be accounted for for the purpose of preparing the Actuarial Report to the extent of the actuary's knowledge, and for that purpose, testing has been conducted to assess its reliability.
The Report complies with regulations in the field of Pension Funds.
The Report complies with Employer regulations.
The Report is prepared based on PDP; and
The Report is prepared based on actuarial practice standards for Pension Funds applicable in Indonesia;
Place, date of preparation
Signature.
Name
No. Indonesia Actuarial Association (PAI) Register Public Actuarial License No.:
Founder and Co-Founder Statement
We, the undersigned, declare that:
the data and PDP submitted are complete and correct;
we are able to pay contributions in accordance with the minimum funding stated in the Actuarial Statement; and
in the event of a surplus, it is used to reduce Employer Normal Contributions, including those representing the statement of all employers in the case of sharing/non-sharing pension cost
Place, date of preparation Position*)
Signature.
Name
Actuarial Valuation Date
Actuarial valuation date reported
Actuarial valuation date of the previous period
Purpose of Preparation
Summary of PDP and Changes occurring in PDP since the previous actuarial valuation date
Summary of the number of Participants and entitled parties along with changes occurring since the previous actuarial valuation date
Description DD-MM-YYYY
(reporting period)
DD-MM-YYYY
(previous period)
Active Participants
Passive Participants

Pensioners
Deferred Pensioners
Widows/Widowers
Children
Designated Parties

Actuarial Valuation Method and Actuarial Assumptions Used
Description DD-MM-YYY
(reporting period)
DD-MM-YYY
(previous period)
Actuarial Calculation Method
Actuarial Present Value Calculation Method Solvency Liability Calculation Method Economic Assumptions Inflation Rate Interest Rate Rate of increase in basic pension income Rate of increase in pension benefits Demographic Assumptions Mortality rate during active period Mortality rate during pension period Disability rate Withdrawal rate Other Assumptions Tax (in the event that tax on pension benefits is borne by the Pension Fund) Age difference between husband and wife Pension program management costs Reasons for selecting actuarial valuation method and actuarial assumptions Reasons if there are changes from those used in the previous actuarial valuation
Overall Actuarial Valuation Results
Actuarial Calculation Results
Description
DD-MM-YYYY
(reporting period)
DD-MMYYYY
(previous period) a. Funding Asset Value Assets Funding assets Liabilities Solvency Liability Actuarial Present Value b. Analysis of Surplus or Deficit Changes Funding Position Surplus Surplus excess Period of surplus use Total Deficit Pre-legislative Deficit Deficit categorized as solvency deficiency External Deficit categorized as solvency deficiency Analysis:
Funding Quality Level
Funding Ratio
Solvency Ratio
Contributions
Normal Contributions
First Year (Rp)
Subsequent Years

Participant Normal Contribution (%)
Employer Normal Contribution
(%)
Total
Additional Contributions
Monthly Contribution
Installment period (months)
c. Overall Actuarial Valuation Results
9. Monthly Actuarial Present Value Projection for at least the first 3 (three) years
10. Name and address of the Actuary and explanation of whether the Actuary also signed the Actuarial Statement in the previous Actuarial Report
b. Actuarial Report for Employer Pension Funds Administering Defined Contribution Programs and Making Periodic Pension Benefit Payments General Data Report Number Report Date NBDU Pension Fund Name Pension Fund Address Reporting Period Reporting Month Fiscal Year Type of Reporting Period Annual Report Manager Name Manager Position

Actuarial Statement
1.1 Pension Fund Actuarial Information:

Actuarial Name;
Actuarial Firm Name;
Office Address and Telephone Number;
STTD No. Actuarial Consultant (with valid license at
IKNB);
I, the undersigned, declare that:

All data received is complete, and can be accounted for for the purpose of preparing the Actuarial Report to the extent of the actuary's knowledge, and for that purpose, testing has been conducted to assess its reliability.
The Report complies with regulations in the field of Pension Funds.
The Report complies with Employer regulations.
The Report is prepared based on PDP; and
The Report is prepared based on actuarial practice standards for Pension Funds applicable in Indonesia;
Place, date of preparation
Signature.
Name
No. Indonesia Actuarial Association (PAI) Register Public Actuarial License No.:
Actuarial Valuation Date
Actuarial valuation date reported
Actuarial valuation date of the previous period
Purpose of Preparation
Summary of PDP including payment pattern and normal retirement age
Summary of the number of Participants, widows/widowers, and children choosing periodic Pension Benefit payments
Description DD-MM-YYY
(reporting period)
DD-MM-YYYY
(previous period)
Active Participants
Passive Participants

Pensioners
Deferred Pensioners
Widows/Widowers
Children
Designated Parties

Interest rate used
Cash Flow Projection
Actuarial Gain or Loss Analysis
Investment Results and Cost Analysis
Conversion Table
Conclusions and Recommendations
c. Actuarial Report for Employer Pension Funds Administering
Defined Benefit Other Benefit Programs
General Data
Report Number
Report Date
NBDU
Pension Fund Name
Pension Fund Address
Reporting Period
Reporting Month
Fiscal Year
Type of Reporting Period Annual Report
Manager Name
Manager Position
Actuarial Statement
1.1 Pension Fund Actuarial Information:

Actuarial Name;
Actuarial Firm Name;
Office Address and Telephone Number;
STTD No. Actuarial Consultant (with valid license at
IKNB);
1.2 statement regarding the program asset value of PMLMP, the present value of potential Other Benefit payments, and the adequacy of PMLMP funds.
1.3 statement regarding the amount of funding required in the management of PMLMP
1.4 Pension Cost Sharing/ non cost sharing (Choose one)
I, the undersigned, declare that:

All data received is complete, and can be accounted for for the purpose of preparing the Actuarial Report to the extent of the actuary's knowledge, and for that purpose, testing has been conducted to assess its reliability.
The Report complies with regulations in the field of Pension Funds.
The Report complies with Employer regulations.
The Report is prepared based on PDP;
The Report is prepared based on actuarial practice standards for Pension Funds applicable in Indonesia;
Program asset value of PMLMP, present value of potential Other Benefit payments, and adequacy of PMLMP funds; and
The amount of funding required in the management of PMLMP for each employer.
Place, date of preparation
Signature.
Name
No. Indonesia Actuarial Association (PAI) Register Public Actuarial License No.:
Founder/Co-Founder Statement
We, the undersigned, declare that:
The data and PDP submitted are complete and correct;
We are able to pay contributions in accordance with the minimum funding stated in the Actuarial Statement; and
In the event of PMLMP funding excess, it is used to reduce PMLMP contributions, including those representing the statement of all employers in the case of sharing/non-sharing pension cost.
Place, date of preparation Position*)
Signature.

Name
3. Actuarial Valuation Date
Actuarial valuation date reported
Actuarial valuation date of the previous period
4. Purpose of Preparation
5. Summary of PDP and Changes occurring in PDP since the previous actuarial valuation date
6. Summary of the number of Participants and entitled parties for Other Benefits along with changes occurring since the previous actuarial valuation date
Description DD-MM-YYY
(reporting period)
DD-MM-YYYY
(previous period)
Active Participants
Passive Participants

Pensioners
Deferred Pensioners
Widows/Widowers
Children
Designated Parties

Actuarial Valuation Method and Actuarial Assumptions Used
Description
DD-MM-YYY
(reporting period)
DD-MM-YYY
(previous period)
Actuarial Calculation Method
Actuarial Present Value Calculation Method Solvency Liability Calculation Method Economic Assumptions Inflation Rate Interest Rate Rate of increase in basic pension income Rate of increase in pension benefits Demographic Assumptions Mortality rate during active period

Mortality rate during pension period
Disability rate
Withdrawal rate
Other Assumptions
Tax (in the event that tax on pension benefits is borne by the Pension Fund) Age difference between husband and wife Pension program management costs Reasons for selecting actuarial valuation method and actuarial assumptions Reasons if there are changes from those used in the previous actuarial valuation
8. Overall Actuarial Valuation Results
Actuarial Calculation Results
Description
DD-MM-YYYY
(reporting period)
DD-MM-YYYY
(previous period) a. Funding Asset Value Assets Funding assets Liabilities Solvency Liability Actuarial Present Value b. Analysis of Surplus or Deficit Changes Funding Position Surplus Surplus excess Period of surplus use Total Deficit Pre-legislative Deficit Deficit categorized as solvency deficiency External Deficit categorized as solvency deficiency Analysis:
Funding Quality Level
Funding Ratio
Solvency Ratio
Contributions
Normal Contributions

First Year (Rp)
Subsequent Years
Participant Normal Contribution (%)
Employer Normal Contribution
(%)
Total
Additional Contributions
Monthly Contribution
Installment period (months)
c. Overall Actuarial Valuation Results
9. Program asset value of PMLMP
10. Description of PMLMP program asset value determination
11. Analysis of PMLMP fund adequacy changes
12. Present value projection of potential Other Benefit payments semi-annually for at least the first 3 (three) years
13. Amount of funding required in the management of PMLMP

E. Pension Fund Business Plan
BUSINESS PLAN REPORT
Year ...............................
(fill in name and address of Pension Fund) Approved, Supervisory Board (Pension Fund Stamp) N a m e C l e a r Position 20xx Management, (Pension Fund Stamp) N a m e C l e a r Position Business Plan Report in accordance with Article 3 paragraph (1) of POJK Number 24/POJK.05/2019 concerning Business Plans of Non-Bank Financial Service Institutions with a submission deadline no later than November 30 before the year the Business Plan begins. .

TABLE OF CONTENTS
FORMAT FOR EMPLOYER PENSION FUND BUSINESS PLAN Format 1 : Sharia Pension Fund Profile/Sharia Unit Format 2 : Executive Summary Format 3 : Evaluation of Previous Business Plan Period Implementation Format 4 : Vision, Mission, and Business Strategy Format 5 : Business Activity Plan Format 6 : Business Activity Development or Expansion Plan Format 7 : Investment Plan Format 8 : Funding Plan Format 9 : Office Network or Distribution Channel Development and/or Change Plan Format 10 : Organization, Human Resources, and/or Information Technology Development Plan Format 11 : Financial Statement Projections, Format 12 : Projection of Ratios and Certain Other Items, and Assumptions Used Format 13 : Other Information

Format 1 : Pension Fund Profile

General Pension Fund Information

Pension Fund Name
Pension Fund Code
Approval Decree
Program
Management
Supervisory Board
Office Address
Report Date
Business Plan Year

Pension Fund Organizational Structure
(Filled with the Pension Fund organizational structure chart)
General Founder Information

Founder Name
Address
Board of Directors
Board of Commissioners
Business Sector

pension fund investments, decrease in pension fund receivables, increase in pension benefits or other benefits, and increase in pension fund efficiency

Financial Indicators
(in full rupiah units)
No. Performance Description
Sept X-1
Projection
Dec X-1 Jun X Dec X
Net Assets
Investments
Investment Income
Investment Expenses
Operating Expenses
Note:
X-1: year of report preparation.
X: year of business plan position.
Description of Pension Fund Financial Conditions
...............................................................................................................................
...............................................................................................................................
...........................................

Description of the pension fund's financial conditions as reflected by financial indicators and ratios, including reasons for increases/decreases.

Financial Ratios
No. Description
Performance Sept
X-1
(%)
Projection (%)
Dec X-1 Jun X Dec X
Investment Income Ratio (ROI)

Investment Income to Asset Ratio (ROA)
3. Operating Expense Ratio (BOPO)
4.
Receivables Age Ratio (RUPI)
5. Funding Ratio (Specific to PPMP)
6. Solvency Ratio (Specific to PPMP)
Note:
X-1: year of report preparation.
X: year of business plan position.

Format 3: Evaluation of Previous Business Plan Implementation Period

Comparison Between Business Plan and Business Plan Realization Every Year (Ignore if the Pension Fund is a new Pension Fund and/or submitting the business plan report for the first time).
(Detail the current business plan and its realization with the business plan every year. In this section, the Pension Fund can view the Pension Fund's performance during that period by comparing the business plan with the business plan realization. The table example below can be modified in more detail according to the Pension Fund's needs.) Indicator 20XX-1 Business Plan Realization % Achievement (1) (2) (2/1) Net Assets Investments Contributions:
a. Normal Participant Contributions b. Voluntary Participant Contributions
c. Normal Employer Contributions
d. Additional Contributions
Pension Benefit Payments
Investment Income
Investment Expenses
Operating Expenses
Investment Income Ratio (ROI)
Investment Income to Asset Ratio (ROA)
Operating Expense Ratio (BOPO)
Receivables Age Ratio (RUPI)
Funding Ratio (specific to PPMP)
Solvency Ratio (specific to PPMP)
Challenges Faced and Problem-Solving Efforts*
...............................................................................................................................
.......................

Clearly state the challenges faced in implementing the established plans and the solutions to those problems.

Problem-Solving Efforts*
...............................................................................................................................
...............................................................................................................................
................................

Clearly state the solutions to the problems.

Format 4: Vision, Mission, and Business Strategy

Pension Fund Vision *
...............................................................................................................................
...............................................................................................................................
..........................................

Vision is the description of the Pension Fund's condition in the future and is the Pension Fund's ideal. Vision is a statement answering the question of the Pension Fund's direction forward.

Pension Fund Mission *
...............................................................................................................................
...............................................................................................................................
..........................................

Mission is the elaboration of the vision, where the mission elaborates a careful analysis of the desired benefits for Participants. The mission also elaborates the existing environmental and market conditions and the Pension Fund's anticipation for the future.

Pension Fund Business Strategy
No. Target Policy Strategy
a.

Etc. b.
1)
2)
Etc.
Etc.
2. a.
1)
2)
Etc. b.
1)
2)
Etc.

Format 5: Business Activity Plan
....................................................................................................................
....................................................................................................................
....................................................................................................................
....................................................................................................................
.................................................
(Plan regarding the implementation of business activities previously carried out by the Pension Fund, referring to regulations concerning the implementation of Pension Funds. Can be supplemented with reasons and considerations in preparing the plan and strategies to realize the plan.)

Format 6: Business Development or Expansion Plan (Additional Benefits Other Than Pension Benefits) No. Type Other Benefits General Description Other Benefits Time Implementation Other Benefits Purpose Other Benefits Risks upon Implementation Other Benefits Risk Mitigation upon Implementation Other Benefits Reasons and Considerations Strategy Note:
a. Additional Benefits Plan includes the implementation plan for Other Benefits based on the approval of the Financial Services Authority (OJK). b. In accordance with the POJK regarding Contributions, Pension Benefits, and Other Benefits implemented by Pension Funds, it can be filled regarding other benefits. Pension fund business activities categorized as a form of business development or expansion are business activities that:
a. have never been previously carried out by the Pension Fund, such as the implementation of other benefit programs for Pension Funds that have not yet implemented other benefit programs or periodic pension benefit payments by Pension Funds implementing defined contribution programs; or

b. have been previously carried out by the Pension Fund, but involve development that changes or increases certain Risk exposures on the Pension Fund, such as changes to pension programs for Defined Contribution Pension Funds (DPPK).

Format 7: Investment Plan

Investment Composition

Based on Acquisition Value
No. Investment Type Actual
As of 30 Sept
20XX-1
Projection
As of 31 Dec
20XX-1
As of 30 Jun
20XX
As of 31 Dec
20XX
Nominal % Nominal % Nominal % Nominal %

Savings
at Banks
On-call Deposits
at Banks
Time Deposits
at Banks
Certificate of
Deposits at
Banks
Securities
Based on
Sharia Principles issued by
Bank Indonesia
Securities
Sharia
State
Sharia Stocks
listed on the Indonesia Stock Exchange
Corporate Sukuk
Listed on the Indonesia Stock Exchange
Regional Sukuk
Sharia Mutual Funds

Based on Fair Value

Sharia MTN
Sharia Asset-Backed Securities
Sharia Real Estate Investment Funds
structured as collective investment contracts
Sharia Infrastructure Investment Funds
structured as collective investment contracts
Options Contracts and Sharia
Forward Contracts for Securities listed on the Indonesia Stock Exchange
REPO
Direct Participation
Land in
Indonesia
Buildings in
Indonesia
Land and
Buildings in
Indonesia
No. Investment Type
Actual
As of 30 Sept
20XX-1
Projection
As of 31 Dec
20XX-1
As of 30 Jun
20XX
As of 31 Dec
20XX
Nominal % Nominal % Nominal % Nominal %
Savings
at Banks
On-call Deposits
at Banks
Time Deposits
at Banks
Certificate of
Deposits at
Banks
Securities
Based on
Sharia Principles issued by
Bank Indonesia
Securities
Sharia
State
Sharia Stocks
listed on the Indonesia Stock Exchange
Corporate Sukuk
Listed on the Indonesia Stock Exchange
Regional Sukuk
Sharia Mutual Funds
Sharia MTN
Sharia Asset-Backed Securities
Sharia Real Estate Investment Funds
structured as collective investment contracts
Sharia Infrastructure Investment Funds
structured as collective investment contracts
Options Contracts and Sharia
Forward Contracts for Securities
Investment Result Plan
No.
Type
Invest
Actual
Projection
As of 30 Sept 20XX-1 As of 31 Dec 20XX-1 As of 30 Jun 20XX As of 31 Dec 20XX Result Inve st Real Result Inve st Unr al Exp Inve st Result Inve st Net Result Inve st Real Result Inve st Unr al Exp Inve st Result Inve st Net Result Inve st Real Result Inve st Unr al Exp Inve st Result Inve st Net Result Inve st Real Result Inve st Unr al Exp Inve st Result Inve st Net a b c d=(a +b)- c a b c d=(a +b)- c a b c d=(a +b)- c a b c d=( a+b )-c
Sav
ings at
Banks
Dep
osits on call at
Banks
Dep
osits
Time at
Banks
Cert
ificates
Depo sites at
Banks
Sec
urities
Based on
Princ iples
Shari ah issued by
Bank
Indo nesia
Sec
urities
Shari ah
State
Sha
res
Shari ah listed on
Burs a
Efek
Indo nesia
Suku
k
Corp orate
Listed on
Burs a
Efek
Indo nesia
Suku
k
Regi onal
. Mutual
Funds
Shari ah
. MTN
Shari ah
. Sec urities
Asset
Backed
Shari ah
. Funds invest ment real estat
Shari ah struc tured as contra ct invest ment colle ctive . Funds invest ment infra struc ture struc tured as contra ct invest ment colle ctive . Contra ct options and contra ct forward Securities Shari ah listed on Burs a Efek Indo nesia . REP O . Part icipa tion direct . Land in Indo nesia . Build ings in Indo nesia . Land and Build ings in Indo nesia
Considerations Underlying the Investment Plan
........................................................................................................................................
........................................................................................................................................
........................................
(Filled with considerations or assumptions used by the Board of Trustees as the basis for determining the investment plan in accordance with the POJK regarding Pension Fund Investments.)

Format 8: Funding Plan
Funding plans for Partner Pension Funds need to be detailed for each partner. (Funding plans generally originating from contributions or their development. Contributions can be made by the employer alone or jointly between the employer and employees (participants)).

Plan to Fulfill Funding Ratio

Table of Plan to Fulfill Funding Ratio (Specific to PPMP)
Description
Actual
As of 30 Sept
20XX-1
Projection
As of 31 Dec
20XX-1
As of 30 Jun
20XX
As of 31 Dec
20XX
Wealth for
Funding
Actuarial Present Value
Solvency Liabilities
Surplus / Deficit
Funding Ratio (%)
Solvency Ratio (%)
Funding Quality*
Note:

X-1: year of report preparation.
X: year of business plan position.

The term Funding Quality refers to the Funding Quality as per POJK 8/POJK.05/2018 article 2 paragraph (1) including the following conditions:
(a). first level, namely if the Defined Contribution Pension Fund (DPPK) implementing the Defined Benefit Program (PPMP) is in a Fully Funded state; (b). second level, namely if Wealth for Funding is less than Actuarial Present Value and not less than Solvency Liabilities; and (c). third level, namely if Wealth for Funding is less than Solvency Liabilities.

Reasons and Considerations *
.........................................................................................................................
.........................................................................................................................
...................

Filled with reasons/considerations in preparing the plan to fulfill the Funding Ratio.

Strategy *
.........................................................................................................................
.........................................................................................................................
...................

Filled with strategies to realize the plan to fulfill the Funding Ratio.

Funding Projection
Description
Actual
As of 30 Sept
20XX-1
Projection
As of 31 Dec
20XX-1
As of 30 Jun
20XX
As of 31 Dec
20XX
Normal Participant Contributions
Voluntary Participant Contributions
Normal Employer
Contributions
Additional Contributions
Employer
Total Fund Contributions
Note:
X-1 year of report preparation.
X year of business plan position.

Format 9: Plan for Office Network and/or Distribution Channel Development and/or Changes (Plans for office network and/or distribution channel development and/or changes at minimum include plans for opening and merging offices outside the head office.) Note:
¹ Filled with the month of the planned implementation time. ² For locations in the DKI Jakarta region, at minimum state the name of the DKI Jakarta province. For locations outside the DKI Jakarta region, at minimum state the name of the Regency/City. ³ Detailed notes can be attached in a separate sheet.

Format 10: Organizational, Human Resources, and/or Information Technology Development Plan

Organizational Development Plan

Description of Organizational Development Plan*
.........................................................................................................................
.........................................................................................................................
...................
No. Office Network Changes
Time implementation 1
Location 2 Note 3
A. Opening

B. Merging
1.
2.
C. Address Change
1.
2.
Etc.
D. Office Closure
1.
2.
Etc.

Filled with explanations regarding organizational development plans,
including plans for the formation of work units/divisions, plans for changes to work units/divisions, and plans for the formation of committees, adjusted to the size and complexity of the Pension Fund's business.

Reasons and Considerations*
.........................................................................................................................
.........................................................................................................................
...................

Filled with reasons/considerations in preparing the organizational development plan.

Strategy
.........................................................................................................................
.........................................................................................................................
...................

Filled with strategies to realize the organizational development plan.

Plan to Fulfill Human Resources

Description of Plan to Fulfill Human Resources
No.
Level
Position
Number
HR as of 30 Sept
20XX-1
Semester II
20XX-1
Semester I
20XX
Semester II
20XX
(+)* (-)* (+) (-) (+) (-)

Etc.
Total

Filled with additions and reductions in the number of employees.

Reasons and Considerations
.........................................................................................................................
.........................................................................................................................
...................

Filled with reasons/considerations in preparing the plan to fulfill human resources.

Strategy*
.........................................................................................................................
.........................................................................................................................
...................

Filled with strategies to realize the plan to fulfill human resources.

Plan for Human Resource Education and Training for Trustees, Supervisory Board, and Employees

Table of Human Resource Development Plan
No. Material/Topic
Name
Participant
Position
Certification already owned
Time
Training

Etc.

Reasons and Considerations*
.........................................................................................................................
.........................................................................................................................
...................

Filled with reasons/considerations in preparing the human resource development plan.

Strategy
.........................................................................................................................
.........................................................................................................................
...................

Filled with strategies to realize the human resource development plan.

Plan for Utilization of Outsourced Labor

Table of Plan for Utilization of Outsourced Labor
No.
Field
Task
Reason
Utilization
Outsourced
Labor
Number
Outsourced
Labor
Name
Company
Provider
Outsourced
Labor
(if any)
Contract Period with
Outsourced
Labor Company

...

Reasons and Considerations*

Filled with reasons/considerations in preparing the plan for utilizing outsourced labor.

Strategy*
.........................................................................................................................
.........................................................................................................................
...................

Filled with strategies to realize the plan for utilizing outsourced labor.

Plan for Information Technology System Development

Table of Plan for Utilization of Information Technology Systems
No.
Type/Name
Application
Ownership
(In-house/vendor)
Vendor Name
Function
Application

Filled with plans for the development and procurement of fundamental information technology, including: significant changes to information technology configuration or core applications, procurement of new core applications, cooperation with information technology service providers, and/or other fundamental information technology development and procurement that can add and/or increase the Pension Fund's risk. Additionally, information regarding the costs of information technology development and maintenance must be filled in.

Reasons and Considerations
.........................................................................................................................
.........................................................................................................................
...................

Filled with reasons/considerations in preparing the plan for fundamental information technology development and procurement.

Strategy

Filled with strategies to realize the plan for fundamental information technology development and procurement.

Format 11: Financial Report Projection

Net Asset Projection for Pension Funds
(in full rupiah units)
DESCRIPTION Actual As of 30
Sep 20XX-1
Projection
As of 31
December
20XX-1
As of 30 Jun
20XX
As of 31 Dec
20XX
ASSETS
INVESTMENTS
Savings at
Banks
On-call Deposits at Banks
Time Deposits at Banks
Certificate of Deposits at Banks
Securities
Based on
Sharia Principles issued by
Bank Indonesia
Securities
Sharia
State
Sharia Stocks listed on the Indonesia Stock Exchange Corporate Sukuk Listed on the Indonesia Stock Exchange Regional Sukuk Sharia Mutual Funds Sharia MTN Sharia Asset-Backed Securities

DESCRIPTION Actual As of 30
Sep 20XX-1
Projection
As of 31
December
20XX-1
As of 30 Jun
20XX
As of 31 Dec
20XX
Sharia Real Estate Investment Funds structured as collective investment contracts Sharia Infrastructure Investment Funds structured as collective investment contracts Options Contracts and Forward Contracts for Sharia Securities listed on the Indonesia Stock Exchange REPO Direct Participation Land in Indonesia Buildings in Indonesia Land and Buildings in Indonesia TOTAL INVESTMENTS CURRENT ASSETS OUTSIDE INVESTMENTS Cash and Banks Receivables from Contributions

Normal Employer
Contributions
Normal Participant
Contributions
Voluntary Participant
Contributions
Additional Contributions
Prepaid Expenses
Investment Receivables
Investment Income
Receivables
Other Receivables
TOTAL CURRENT ASSETS
OUTSIDE INVESTMENTS
OPERATIONAL ASSETS
Land and
Buildings
Vehicles

DESCRIPTION Actual As of 30
Sep 20XX-1
Projection
As of 31
December
20XX-1
As of 30 Jun
20XX
As of 31 Dec
20XX
Computer Equipment
Office Equipment
Operational Assets
Other
TOTAL OPERATIONAL ASSETS
OTHER ASSETS
ASSETS AVAILABLE
LIABILITIES
Liabilities Outside Actuarial
Present Value (PPMP)
Liabilities Outside
Pension Benefit Liabilities (PPIP)
Pension Benefit and
Other Benefits Payable
Voluntary Benefit Payables
Dana Tazir Payables
Investment Payables
Income
Received in Advance
Expenses Still
To Be Paid
Other Liabilities
Total Liabilities Outside
Actuarial Present Value/Pension
Benefit Liabilities
TOTAL LIABILITIES
NET ASSETS
Note:

If the business plan submission is for the year 2020, then 20XX-1
is the year 2019 (current year), 20XX is the year 2020, etc.
Net Asset Nominal is equal to the Net Asset Nominal at the End of the Period in the Net Asset Change Projection.

Net Asset Change Projection
(in full rupiah units)

Description Actual as of 30
Sept 20XX-1
Projection as of 31 Dec
20XX-1 as of 30 Jun
20XX as of 31 Dec
20XX
INCREASES
Investment Income
Interest/Profit Sharing
Dividends
Rent
Profit (Loss)
Investment Disposal
Other Investment
Income
Total Investment Income
Increase (Decrease) in
Investment Value
Contributions Due:

Normal Employer
Contributions
Normal Participant
Contributions
Voluntary Participant
Contributions
Additional Contributions
Income Outside
Investment
Transfer of Funds From
Other Pension Funds
Total Increases
DECREASES
Investment Expenses
Operating Expenses
Expenses Outside
Investment and
Operations
Pension Benefits and
Other Benefits
Income Tax
Transfer of Funds to
Other Pension Funds
Total Decreases
INCREASE (DECREASE) IN NET
ASSETS
BEGINNING NET ASSETS
OF THE PERIOD
ENDING NET ASSETS
OF THE PERIOD
Note:

If the business plan submission is for the year 2020, then 20XX-1 is the year 2019 (current year), 20XX is the year 2020, etc.
The Net Asset Value at the End of the Period is equal to the Net Assets in the Net Asset Projection Report

Format 12: Projection of Ratios and Other Specific Items, and Assumptions Used

Ratios and Other Specific Items
(ratios in percentage)

DESCRIPTION
Actual as of 30 Sept 20XX-1
Projection as of 31 Dec 20XX-1
Projection as of 30 Jun 20XX
Projection as of 31 Dec 20XX

Investment Income Ratio (ROI)
Investment Income Ratio against Assets (ROA)
Operating Expense Ratio (BOPO)
Contribution Receivable Age Ratio (RUPI)
Funding Ratio (RKD) specifically for PPMP
Solvency Ratio specifically for PPMP

Note:

If the business plan submission is for the year 2020, then 20XX-1 is the year 2019 (current year), 20XX is the year 2020, etc.

Assumptions Used

No.
DESCRIPTION
Actual as of 30 Sept 20XX
Projection as of 31 Dec 20XX
Projection as of 30 Jun 20XX+1
Projection as of 31 Dec 20XX+1

Actuarial Interest Rate Assumption (specific for PPMP) (%)

Note:

If the business plan submission is for the year 2020, then 20XX-1 is the year 2019 (current year), 20XX is the year 2020, etc.

Format 13: Other Information

Other information must at least include information that needs to be submitted because it affects the business activities of the Pension Fund, which is not mentioned in the scope of the Business Plan.

Examples:
a. plan for dissolution; b. plan for dissolution of founding partners;
c. plan for transfer of membership;
d. plan for change of business activities not based on Sharia principles to based on Sharia principles; and e. Sustainable Finance Action Plan based on POJK regarding the Implementation of Sustainable Finance for Financial Service Institutions, Issuers, and Public Companies.

Actuarial Calculation Method Assumptions
Mortality Rate Assumptions
Target Investment Return Rate in Investment Directives (%)
etc. (other relevant assumptions)

F. Pension Fund Business Plan Realization Report

The Business Plan Realization Report is in accordance with the provisions of Article 14 paragraph (5) of POJK Number 24/POJK.05/2019 concerning Business Plans for Non-Bank Financial Service Institutions, with a submission deadline of at most 1 (one) month after the relevant semester ends.

BUSINESS PLAN REALIZATION REPORT
Year ...............................
(fill in the name and address of the Pension Fund)

Approved,
Supervisory Board
(Pension Fund Stamp)

Full Name
Position
, 20xx

Management,
(Pension Fund Stamp)

Full Name
Position

Explanation Regarding Business Plan Achievement
Filled with an explanation regarding the achievement of the Business Plan, including the achievement of the Business Plan and the comparison of the plan and its realization, which must at least include:
realization of business activities plans as referred to in Format 5 in the pension fund business plan;
realization of business development or expansion plans as referred to in Format 6 in the pension fund business plan;
realization of investment plans as referred to in Format 7 in the pension fund business plan;
realization of funding plans as referred to in Format 8 in the pension fund business plan;
realization of office network and/or distribution channel development and/or changes plans as referred to in Format 9 in the pension fund business plan;
realization of organization, human resources, and/or information technology development plans as referred to in Format 10 in the pension fund business plan;
realization of financial statement projections, as referred to in Format 11 in the pension fund business plan;
realization of projections of ratios and other specific items, and assumptions used, as referred to in Format 12 in the pension fund business plan; and
filling of the business plan based on the business plan report submitted to the OJK most recently.
Explanation Regarding Deviations from Business Plan Realization

Net Asset Report Realization for Pension Funds
(in full rupiah units)

DESCRIPTION
Business Plan (1)
Realization (2)
Achievement % (2)/(1)

ASSETS
INVESTMENTS
Bank Savings
On-call Deposits at Banks
Time Deposits at Banks
Bank Certificates of Deposit
Sharia-Compliant Securities issued by Bank Indonesia
Sharia-Compliant Government Securities
Sharia-Compliant Stocks listed on the Indonesia Stock Exchange
Corporate Sukuk listed on the Indonesia Stock Exchange
Regional Sukuk
Sharia Mutual Funds
Sharia MTN
Sharia Asset-Backed Securities
Sharia Real Estate Investment Funds in the form of collective investment contracts
Sharia Infrastructure Investment Funds in the form of collective investment contracts
Sharia Options Contracts and Sharia Derivative Contracts listed on the Indonesia Stock Exchange
REPO
Direct Participation
Land in Indonesia
Buildings in Indonesia
Land and Buildings in Indonesia
TOTAL INVESTMENTS
CURRENT ASSETS OUTSIDE INVESTMENTS
Cash and Banks

DESCRIPTION
Business Plan (1)
Realization (2)
Achievement % (2)/(1)

Contribution Receivables
- Normal Contributions from Employers
- Normal Contributions from Participants
- Voluntary Contributions from Participants
- Additional Contributions
Prepaid Expenses
Investment Receivables
Investment Income Receivables
Other Receivables
TOTAL CURRENT ASSETS OUTSIDE INVESTMENTS
OPERATIONAL ASSETS
Land and Buildings
Vehicles
Computer Equipment
Office Equipment
Other Operational Assets
TOTAL OPERATIONAL ASSETS
OTHER ASSETS
AVAILABLE ASSETS
LIABILITIES
Liabilities Outside Actuarial Present Value (PPMP)
Liabilities Outside Pension Benefit Liabilities (PPIP)
Pension Benefit and Other Benefits Payable
Voluntary Benefit Payables
Tazir Fund Payables
Investment Payables
Unearned Revenue

DESCRIPTION
Business Plan (1)
Realization (2)
Achievement % (2)/(1)

Expenses to be Paid
Other Payables
Total Liabilities Outside Actuarial Present Value / Pension Benefit Liabilities
TOTAL LIABILITIES
NET ASSETS

Net Asset Change Report Realization
(in full rupiah units)

DESCRIPTION
Business Plan (1)
Realization (2)
Achievement % (2)/(1)

ADDITIONS
Investment Income
Profit Sharing/Dividends
Dividends
Rent
Gain (Loss) on Investment Disposal
Other Investment Income
Total Investment Income
Increase (Decrease) in Investment Value
Due Contributions:
- Normal Contributions from Employers
- Normal Contributions from Participants
- Voluntary Contributions from Participants
- Additional Contributions

DESCRIPTION
Business Plan (1)
Realization (2)
Achievement % (2)/(1)

Income Outside Investments
Transfer of Funds from Other Pension Funds
Total Additions
REDUCTIONS
Investment Expenses
Operational Expenses
Expenses Outside Investments and Operations
Pension Benefits and Other Benefits
Income Tax
Transfer of Funds to Other Pension Funds
Total Reductions
INCREASE (DECREASE) IN NET ASSETS
NET ASSETS AT THE BEGINNING OF THE PERIOD
NET ASSETS AT THE END OF THE PERIOD

Realization of Assumptions Used

No
DESCRIPTION
Business Plan (1)
Realization (2)
Deviation (2)-(1)

Actuarial Interest Rate Assumption (specific for PPMP) (%)
Actuarial Calculation Method Assumptions
Mortality Rate Assumptions
Target Investment Return Rate in Investment Directives (%)

Realization of Ratios and Other Specific Items

DESCRIPTION
Business Plan (1)
Realization (2)
Achievement % (2)/(1)

Investment Income Ratio (ROI)
Investment Income Ratio against Assets (ROA)
Operating Expense Ratio (BOPO)
Funding Ratio (Specific for PPMP)
Solvency Ratio (Specific for PPMP)

Other Information
...............................................................................................................................
...............................................................................................................................
...............................................................................................................................
...............................................................................................................................
...............................................................................................................................
.............................................................

Filled with an explanation regarding the achievement of other information in the Business Plan and the comparison of the plan and its realization.

Follow-up on Business Plan Achievement
...............................................................................................................................
...............................................................................................................................
............................
etc. (other relevant assumptions)

G. Business Plan Supervision Report

The Business Plan Supervision Report is in accordance with the provisions of Article 15 paragraph (1) of POJK Number 24/POJK.05/2019 concerning Business Plans for Non-Bank Financial Service Institutions, with a submission deadline of at most 1 (one) month after the relevant semester ends.

BUSINESS PLAN SUPERVISION REPORT
Year ...............................
(fill in the name and address of the Pension Fund) , 20xx

Supervisory Board
(Pension Fund Stamp)
Full Name
Position

This copy is in accordance with the original Legal Director 1 Legal Department signed Mufli Asmawidjaja
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
.........................................................
(fill in the Supervisory Board's assessment of the implementation of the Business Plan, including an assessment of quantitative and qualitative aspects of the Business Plan realization, including an assessment of good corporate governance factors for the Pension Fund, risk profile, profitability, and funding, and efforts to improve the Pension Fund's performance, if according to the assessment, the Pension Fund's performance shows a decline).

Determined in Jakarta on January 21, 2021 CHIEF EXECUTIVE OF THE SUPERVISOR OF INSURANCE, PENSION FUNDS, FINANCING INSTITUTIONS, AND OTHER FINANCIAL SERVICE INSTITUTIONS FINANCIAL SERVICES AUTHORITY REPUBLIC OF INDONESIA, signed RISWINANDI

APPENDIX II
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY REPUBLIC OF INDONESIA NUMBER 5 /SEOJK.05/2021 CONCERNING THE FORM AND STRUCTURE OF PERIODIC REPORTS OF PENSION FUNDS THAT ADMINISTER PENSION PROGRAMS BASED ON SHARIA PRINCIPLES

FORMAT II A
To
Yth. Director of Islamic Non-Bank Financial Institutions Financial Services Authority MONTHLY REPORT / ELECTRONIC DATA SHARIA-BASED FINANCIAL INSTITUTION PENSION FUNDS / Sharia Unit Per DD-MM-YYYY

General Data
Reporting Date
Pension Fund Code
Pension Fund Name
Reporting Period
Reporting Month
Fiscal Year
Type of Reporting Period Annual Report/Monthly Report Management Name Management Position SID Number Audit Data Auditor License Number Audit Type Auditor Code Auditor Name Opinion Audit Executor Audit Date Report Preparer Officer Name Division Phone Fax E-mail Person in Charge of Acting Management Person in Charge Name Position Phone Fax E-mail Pension Fund Address

Description
Code
Percentage

Investment
Pension Benefit Program
Other Benefits Program
Combined

ASSETS
SHARIA INVESTMENTS
Bank Savings 1101
On-call Deposits at Banks 1102
Time Deposits at Banks 1103
Bank Certificates of Deposit 1104
Sharia-Compliant Securities issued by Bank Indonesia 1105 Sharia-Compliant Government Securities 1106 Sharia-Compliant Stocks listed on the Indonesia Stock Exchange 1107 Corporate Sukuk listed on the Indonesia Stock Exchange 1109 Regional Sukuk 1110 Sharia Mutual Funds 1111 Sharia MTN 1112 Sharia Asset-Backed Securities 1113 Sharia Real Estate Investment Funds in the form of collective investment contracts 1114 Sharia Infrastructure Investment Funds in the form of collective investment contracts 1115 Sharia Options Contracts and Sharia Derivative Contracts listed on the Indonesia Stock Exchange 1116 REPO 1117 Direct Participation 1118 Land in Indonesia Buildings in Indonesia Land and Buildings in Indonesia TOTAL INVESTMENTS CURRENT ASSETS OUTSIDE INVESTMENTS Cash and Banks 1201 Prepaid Expenses 1204 Investment Receivables 1205 Investment Income Receivables 1206 Other Receivables 1207 TOTAL CURRENT ASSETS OUTSIDE INVESTMENTS AVAILABLE ASSETS LIABILITIES Liabilities Outside Pension Benefit Liabilities Pension Benefit and Other Benefits Payable 1501 Voluntary Benefit Payables 1502 Investment Payables 1503 Unearned Revenue 1504 Expenses to be Paid 1505 Other Payables 1506 TOTAL LIABILITIES OUTSIDE PENSION BENEFIT LIABILITIES NET ASSETS PENSION CONTRIBUTION PROGRAM NET ASSET REPORT Per DD-MM-YYYY

Pension Benefit Program
Other Benefits Program
Combined

ADDITIONS
Investment Income
Profit Sharing
Dividends
Rent
Gain (Loss) on Investment Disposal
Other Investment Income
Total Investment Income
Increase (Decrease) in Investment Value 401 Contributions 402 Income Outside Investments 403 Transfer of Funds from Other Pension Funds 404 Total Additions REDUCTIONS Investment Expenses 405 Operational Expenses 406 Expenses Outside Investments and Operations 407 Pension Benefits and Other Benefits Income Tax 408 Transfer of Funds to Other Pension Funds 409 Contribution Withdrawals Total Reductions INCREASE (DECREASE) IN NET ASSETS NET ASSETS AT THE BEGINNING OF THE PERIOD NET ASSETS AT THE END OF THE PERIOD PENSION CONTRIBUTION PROGRAM NET ASSET CHANGE REPORT Accumulated up to DD-MM-YYYY

Description
Code
Accumulated up to DD-MM-YYYY

ASSETS
INVESTMENTS (Historical Value)
Bank Savings
On-call Deposits at Banks
Time Deposits at Banks
Bank Certificates of Deposit
Sharia-Compliant Securities issued by Bank Indonesia Sharia-Compliant Government Securities Sharia-Compliant Stocks listed on the Indonesia Stock Exchange Corporate Sukuk listed on the Indonesia Stock Exchange Regional Sukuk Sharia Mutual Funds Sharia MTN Sharia Asset-Backed Securities Sharia Real Estate Investment Funds in the form of collective investment contracts Sharia Infrastructure Investment Funds in the form of collective investment contracts Sharia Options Contracts and Sharia Derivative Contracts listed on the Indonesia Stock Exchange REPO Direct Participation Land in Indonesia Buildings in Indonesia Land and Buildings in Indonesia Accumulated Depreciation of Buildings TOTAL INVESTMENTS INVESTMENT VALUATION DIFFERENCES CURRENT ASSETS OUTSIDE INVESTMENTS Cash and Banks Prepaid Expenses Investment Receivables Investment Income Receivables Other Receivables TOTAL CURRENT ASSETS OUTSIDE INVESTMENTS TOTAL ASSETS LIABILITIES PENSION BENEFIT LIABILITIES Accumulated Contributions Business Results Transfer of Funds from Other Pension Funds TOTAL PENSION BENEFIT LIABILITIES LIABILITIES OUTSIDE PENSION BENEFIT LIABILITIES Pension Benefit and Other Benefits Payable Voluntary Benefit Payables Investment Payables Unearned Revenue Expenses to be Paid Other Payables TOTAL LIABILITIES OUTSIDE PENSION BENEFIT LIABILITIES TOTAL LIABILITIES PENSION CONTRIBUTION PROGRAM BALANCE SHEET Per DD-MM-YYYY

Description
Pension Benefit Program
Other Benefits Program
Combined

Pension Benefit Program
Other Benefits Program
Combined

INVESTMENT INCOME
Profit Sharing
Dividends
Rent
Gain (Loss) on Investment Disposal
Other Investment Income
Total Investment Income
INVESTMENT EXPENSES
Transaction Expenses
Land and Building Maintenance Expenses
Building Depreciation Expenses
Investment Manager Expenses
Custodian Expenses
Other Investment Expenses
Total Investment Expenses
INVESTMENT BUSINESS RESULTS
OPERATIONAL EXPENSES
Fees to Founders
Total Operational Expenses
OTHER INCOME AND EXPENSES
Other Income Outside Investments
Other Expenses Outside Investments and Operations Total Other Income and Expenses PROFIT BEFORE TAX INCOME TAX PROFIT AFTER TAX PENSION CONTRIBUTION PROGRAM INCOME STATEMENT Accumulated up to DD-MM-YYYY

Description
Accumulated up to DD-MM-YYYY

Pension Benefit Program
Other Benefits Program
Combined

CASH FLOWS FROM INVESTMENT ACTIVITIES
Receipts from Profit Sharing
Dividend Receipts
Rent Receipts
Other Investment Income
Investment Disposal
Investment Placements
Payment of Investment Expenses
Net Cash Flows from Investment Activities CASH FLOWS FROM OPERATIONAL ACTIVITIES Payment of Operational Expenses Other Income Outside Investments Other Expenses Outside Investments and Operations Income Tax Net Cash Flows from Operational Activities CASH FLOWS FROM FINANCING ACTIVITIES Contribution Receipts Receipts from Transfer of Funds from Other Pension Funds Payments for Transfer of Funds to Other Pension Funds Payment of Pension Benefits and Other Benefits Contribution Withdrawals Net Cash Flows from Financing Activities INCREASE (DECREASE) IN NET CASH CASH AT THE BEGINNING OF THE PERIOD CASH AT THE END OF THE PERIOD

Description
PENSION CONTRIBUTION PROGRAM
CASH FLOW STATEMENT
Accumulated up to DD-MM-YYYY
Accumulated up to DD-MM-YYYY

(1) Active Participants a. Individuals b. Groups (2) Inactive Participants (Entitled to Deferred Pension Benefits) a. Individuals b. Groups (3) Total DPLK Participants (1) + (2) (4) Total number of all employers (companies) that include their employees in DPLK PENSION FUND MEMBERSHIP Per DD-MM-YYYY

Description
Pension Benefit Program
Other Benefits Program
Total

Bank Savings
On-call Deposits at Banks
Time Deposits at Banks
Bank Certificates of Deposit
Sharia-Compliant Securities issued by Bank Indonesia Sharia-Compliant Government Securities Sharia-Compliant Stocks listed on the Indonesia Stock Exchange Corporate Sukuk listed on the Indonesia Stock Exchange Regional Sukuk Sharia Mutual Funds Sharia MTN Sharia Asset-Backed Securities Sharia Real Estate Investment Funds in the form of collective investment contracts Sharia Infrastructure Investment Funds in the form of collective investment contracts Sharia Options Contracts and Sharia Derivative Contracts listed on the Indonesia Stock Exchange REPO Direct Participation Land in Indonesia Buildings in Indonesia Land and Buildings in Indonesia TOTAL INVESTMENTS Apr Nov Dec Sep Oct PENSION CONTRIBUTION PROGRAM INVESTMENT RECAPITULATION Per DD-MM-YYYY May Jun Jul Aug

Description
Jan
Feb
Mar

Bank Savings
Time Deposits
Certificates of Deposit
SBI Sharia
SBSN a b c d e f g
Life Cycle Fund
Per DD-MM-YYYY

Investment Assets
Total Participants
Total Funds

Profit Sharing
Dividends
Rent
Gain/Loss
Disposal
Others

Bank Savings
On-call Deposits at Banks
Time Deposits at Banks
Bank Certificates of Deposit
Sharia-Compliant Securities issued by Bank Indonesia Sharia-Compliant Government Securities Sharia-Compliant Stocks listed on the Indonesia Stock Exchange Corporate Sukuk listed on the Indonesia Stock Exchange Regional Sukuk Sharia Mutual Funds Sharia MTN Sharia Asset-Backed Securities Sharia Real Estate Investment Funds in the form of collective investment contracts Sharia Infrastructure Investment Funds in the form of collective investment contracts Sharia Options Contracts and Sharia Derivative Contracts listed on the Indonesia Stock Exchange REPO Direct Participation Land in Indonesia Buildings in Indonesia Land and Buildings in Indonesia Total Note:
the Unrealized Investment Results column uses data according to the Increase/Decrease in Investment Value account on the LPAN sheet. PENSION CONTRIBUTION PROGRAM INVESTMENT RESULTS REPORT Per DD-MM-YYYY

Investment Type
Realized Investment Results
Unrealized Investment Results
Investment Expenses
Net Investment Results
Average Investment
ROI

Profit Sharing
Dividends
Rent
Gain/Loss
Disposal
Others

Bank Savings
On-call Deposits at Banks
Time Deposits at Banks
Bank Certificates of Deposit
Sharia-Compliant Securities issued by Bank Indonesia Sharia-Compliant Government Securities Sharia-Compliant Stocks listed on the Indonesia Stock Exchange Corporate Sukuk listed on the Indonesia Stock Exchange Regional Sukuk Sharia Mutual Funds Sharia MTN Sharia Asset-Backed Securities Sharia Real Estate Investment Funds in the form of collective investment contracts Sharia Infrastructure Investment Funds in the form of collective investment contracts Sharia Options Contracts and Sharia Derivative Contracts listed on the Indonesia Stock Exchange REPO Direct Participation Land in Indonesia Buildings in Indonesia Land and Buildings in Indonesia Total Note:
the Unrealized Investment Results column uses data according to the Increase/Decrease in Investment Value account on the LPAN sheet. PENSION CONTRIBUTION PROGRAM INVESTMENT RESULTS REPORT FOR OTHER BENEFITS PROGRAM Per DD-MM-YYYY

Investment Type
Realized Investment Results
Unrealized Investment Results
Investment Expenses
Net Investment Results
Average Investment
ROI

Rupiah
Non-Rupiah
Total
Rupiah
:---
Non-Rupiah
Total
Rupiah
:---
Non-Rupiah
Total
Rupiah
:---
Non-Rupiah
Total
Rupiah
:---
Non-Rupiah
Total

A. Investment Assets
Bank Savings
On-call Deposits at Banks
Time Deposits at Banks
Bank Certificates of Deposit
Sharia-Compliant Securities issued by Bank Indonesia Sharia-Compliant Government Securities Sharia-Compliant Stocks listed on the Indonesia Stock Exchange Corporate Sukuk listed on the Indonesia Stock Exchange Regional Sukuk Sharia Mutual Funds Sharia MTN Sharia Asset-Backed Securities Sharia Real Estate Investment Funds in the form of collective investment contracts Sharia Infrastructure Investment Funds in the form of collective investment contracts Sharia Options Contracts and Sharia Derivative Contracts listed on the Indonesia Stock Exchange REPO Direct Participation Land in Indonesia Buildings in Indonesia Land and Buildings in Indonesia Total Investments B. Current Assets Outside Investments Cash & Banks Prepaid Expenses Investment Receivables Investment Income Receivables Other Receivables Total Current Assets Outside Investments
C. Total Assets (A+B)
D. Pension Benefit Liabilities
Accumulated Contributions
Business Results
Transfer of Funds from Other Pension Funds E. Liabilities Outside Pension Benefit Liabilities Pension Benefit and Other Benefits Payable Voluntary Benefit Payables Investment Payables Unearned Revenue Expenses to be Paid Other Payables Total Liabilities Outside Pension Benefit Liabilities F. Total Liabilities (D+E) G. Difference between Total Assets and Total Liabilities (E-H) H. Percentage (%) Funding Adequacy Ratio Total PENSION CONTRIBUTION PROGRAM ASSET AND LIABILITY RECAPITULATION Per DD-MM-YYYY (in rupiah)

Maturity >= 10 Years
Description
Maturity < 1 year
1 year <= Maturity < 5 years
5 years <= Maturity < 10 years

Type
Quantity
Percentage Against Total Investment
a b c d e f g
…

Details of Investments with One Party
No

Name of Party
Investment
Limit in Investment Directives
Investment Limit According to Regulations

Type
Quantity
Percentage Against Total Investment
a b c d e f g
…

Details of Investments with Affiliated Parties Per DD-MM-YYYY No

Name of Party
Investment
Affiliation Relationship
Notes

Type
Quantity
Percentage Against Total Investment
a b c d e f g
…

Note:
a. Sharia-Compliant Stocks with issuers indicated to be bankrupt b. Sharia Mutual Funds indicated to be traded abnormally Problematic investments can be obtained from the investment balance with identified problematic parties from the Sharia Pension Fund Financial Report / Sharia unit. Information on investees experiencing problems (default risk) can be obtained from among others from the investee's financial statements, media disclosures, and/or from
c. Bond issuers or deposit-issuing banks that record losses.
d. There is a downgrade of bond instrument ratings below investment grade. e. There is a delay in coupon payments for Corporate Sukuk or profit sharing for Deposits. f. Bond issuers or deposit issuers involved in legal cases or indicated fraud. g. Restructured bonds h. Ownership of Land and/or Buildings not yet in the name of the Pension Fund

Details of Identified Problematic Investments Per DD-MM-YYYY No

Name of Party
Investment
Problematic Category
Notes

Investment Income Ratio (ROI)
A. Total Investment Income – Investment Expenses B. Average Investments
C. Ratio (A:B)

Investment Income to Assets Ratio (ROA)
A. (Total Investment Income + Non-Investment Income) - (Investment Expenses + Operational Expenses + Non-Investment and Operational Expenses) B. Average Available Assets
C. Ratio (A:B)

Operational Expense Ratio (BOPO)
A. Operational Expenses
B. Investment Income + Non-Investment Income
C. Ratio (A:B)

Accounts Receivable for Contributions Age Ratio (RUPI) A. Accounts Receivable for Contributions (OVERDUE) x Number of Current Months B. Overdue Contributions (OVERDUE)
C. Ratio (A:B)

Investment to Net Assets Ratio (RITA)
A. Total Investments x 100%
B. Total Net Assets
C. Ratio (A:B)

Investment Receivables and Investment Yield Receivables to Total Investments A. Investment Receivables + Investment Yield Receivables B. Total Investments
C. Ratio (A:B)

Investment Growth Ratio
A. (Total Investments t1 - Total Investments t0) x 100% B. Total Investments t0
C. Ratio (A:B)

Market Price Changes of Pension Fund Assets A. (SPI_n - SPI_n-1) x 100% B. SPI_n-1
C. Ratio (A:B)

SPI compared to Total Income
A. SPI
B. Total Income
C. Ratio (A:B)

SPI compared to Net Assets
A. SPI
B. Net Assets
C. Ratio (A:B)

Minimum Liquidity Ratio / Cash Ratio
A. Current Assets or Investments for Minimum Liquidity Fulfillment B. Operational Costs + Investment Costs + Pension Benefits and Other Benefits Due within One Year
C. Ratio (A:B)

Cash Inflows compared to Cash Outflows
A. Cash Inflows from Investment, Operational, and Financing Activities B. Cash Outflows from Investment, Operational, and Financing Activities
C. Ratio (A:B)

Accounts Receivable for Contributions to Net Assets Ratio A. Accounts Receivable for Contributions B. Net Assets
C. Ratio (A:B)

Growth Ratio of Founder's Accounts Receivable for Contributions (Employer Contributions + Additional Contributions) A. (Total Founder's Accounts Receivable for Contributions t1 - Total Founder's Accounts Receivable for Contributions t0) X 100% B. Total Founder's Accounts Receivable for Contributions t0
C. Ratio (A:B)

Long-Term Assets to Long-Term Liabilities Ratio A. Total Long-Term Assets x 100% B. Total Long-Term Liabilities
C. Ratio (A:B)

Income to Expenditure Ratio
A. Operational Expenses + Investment Expenses + Pension Benefit Payments B. Total Income
C. Ratio (A:B)

Interest Rate Spread
A. Investment Income Ratio (ROI)
B. Actuarial Interest Rate
C. Ratio (A-B)

Current Assets to Total Assets Ratio
A. Current Assets
B. Total Assets
C. Ratio (A:B)

Current Liabilities to Total Liabilities Ratio A. Current Liabilities B. Total Liabilities
C. Ratio (A:B)

Operating Expense Ratio
A. Operational Expenses + Investment Expenses B. Investment Income
C. Ratio (A:B)

The comparison between long-term assets and long-term liabilities is derived from the Pension Fund Financial Statements.
Assets with a maturity > 1 year are as per the information stated in the Pension Fund Financial Statements.
Liabilities with a maturity > 1 year are as per the information stated in the Pension Fund Financial Statements.
Current assets are assets with a maturity of less than 1 year (excluding operational assets and other assets) as presented in the Pension Fund Financial Statements.
Total assets are available assets as presented in the Pension Fund Financial Statements.
Current liabilities are liabilities with a maturity of less than 1 year as presented in the Pension Fund Financial Statements.
Total Liabilities are the Actuarial Present Value for PPMP (Pension Benefit Programs) and Pension Benefit Liabilities for PPIP (Pension Insurance Programs).
Operational expenses are as presented in the Statement of Changes in Net Assets.
Investment expenses are as presented in the Statement of Changes in Net Assets.
Investment income includes realized and unrealized investment income as presented in the Statement of Changes in Net Assets.
Total Investment Income is as presented in the Statement of Changes in Net Assets.
Investment Expenses are as presented in the Statement of Changes in Net Assets.
For the calculation of average investments, use the average investment assets throughout the year.
Total Investment Income is Income that is already realized and unrealized. Total Investment Income is as presented in the Statement of Changes in Net Assets.
Non-Investment Income is as presented in the Statement of Changes in Net Assets.
Investments are as presented in the Net Assets Statement.
For the calculation of Operational Expenses, refer to the Statement of Changes in Net Assets.
For the calculation of total available assets, use the average assets throughout the year. Total Available Assets are as presented in the Net Assets Statement.
Operational expenses as stated in the statement of changes in net assets.
Investment Income is realized income as stated in the statement of changes in net assets.
Non-Investment Income as stated in the statement of changes in net assets.
SPI is Investment Valuation Difference for instruments exposed to market risk that are actively traded.
Example: investments in the capital market and foreign currency-denominated deposits.
Total Income is total realized and unrealized income on the statement of changes in net assets.
SPI is Investment Valuation Difference for instruments exposed to market risk that are actively traded.
Example: investments in the capital market and foreign currency-denominated deposits.
Cash Flows from investment activities are all investment activities except for the placement and release of investments as presented in the financial statements.
Cash Flows from operational activities are all operational activities except for the placement and release of operational assets and other assets as presented in the financial statements.
Cash Flows from financing activities are as presented in the financial statements.

FINANCIAL RATIOS
Per DD-MM-YYYY
Description of Pension Program / Other Benefits Total Notes

No. Investment Manager Name Contract Number Contract Date Agreement Period Investment Type Amount of Fair Value of Funds Managed (Rp) Acquisition Value (managed by Investment Manager) Investment Valuation Difference Return (%) Net Investment Yield (Rp) Total Management Fees Charged (Rp) Affiliated with Pension Fund (Yes/No) 1. 2.
3. etc
1.
2.
3. etc
1.
2.
3. etc
*: if using an Investment Manager
Total etc.

Fund Management Contract (KPD) Format by Investment Manager* Pension Fund ….. Use of Investment Manager Per DD-MM-YYYY

Self-Managed / KPD
Investment Manager Name a b c d e f g h i j k … Total Notes

SAVINGS DETAILS
No. Bank Name Branch Bank Code Acquisition Date Nominal Value Interest Rate/Mudarabah Rate Pension Program / Other Benefits Management

Self-Managed / KPD
Investment Manager Name a b c d e f g h i j k l … Total Notes

ON-CALL DEPOSIT DETAILS
No. Bank Name Branch Bank Code Acquisition Date Nominal Value Maturity Period Interest Rate/Mudarabah Rate Pension Program / Other Benefits Management

Self-Managed / KPD
Investment Manager Name a b c d e f g h i j k l … Total Notes

TIME DEPOSIT DETAILS
No. Bank Name Branch Bank Code Acquisition Date Nominal Value Maturity Period Interest Rate/Mudarabah Rate Pension Program / Other Benefits Management

a b c d e f g h i j k l m n o p
…
Total

FOREIGN CURRENCY TIME DEPOSIT DETAILS
No. Bank Name Branch Bank Code Acquisition Date Nominal Value Fair Value Investment Valuation Difference Maturity Period Interest Rate/Mudarabah Rate Pension Program / Other Benefits Management Notes Value % Self-Managed / KPD Investment Manager Name Currency Type

Self-Managed / KPD
Investment Manager Name a b c d e f g h i j k l … Total Notes

CERTIFICATE OF DEPOSIT DETAILS
No. Bank Name Branch Bank Code Acquisition Date Nominal Value Maturity Period Interest Rate/Mudarabah Rate Pension Program / Other Benefits Management

Value %
Self-Managed / KPD Investment Manager Name a b c d e f g h i j k l m n … Total Pension Program / Other Benefits Notes Management

SHARIA INDONESIAN FINANCIAL CERTIFICATE DETAILS No.
Securities Code
Date
Acquisition
Nominal Value Coupon (%)
Maturity Date
Acquisition Value Fair Value
Investment Valuation Difference

Value %
Self-Managed / KPD
Investment Manager Name a b c d e f g h i j k l m n o … Total Pension Program / Other Benefits Recording Method Notes Management

SHARIA STATE SECURITIES DETAILS
No.
Securities Code
Date Acquisition Nominal Value Coupon (%) Maturity Date Acquisition Value Fair Value Investment Valuation Difference

Value % Self-Managed / KPD Investment Manager Name a b c d e f g h i j k l m n … Total Pension Program / Other Benefits Notes Management

SHARIA STOCK DETAILS
No. Stock Code
Issuer Name
/Issuer
Date
Acquisition
Number of Shares Acquisition Value Market Value Investment Valuation Difference Economic Sector

Economic Sector
Start End Value % Self-Managed / KPD
Investment Manager Name a b c d e f g h i j k l m n o p q r s t … Total Notes Management

CORPORATE SUKUK DETAILS
No.
Issuer Name
/Issuer
Sukuk Code Sukuk Name Date Acquisition Nominal Value Coupon (%) Maturity Date Rating Acquisition Value Fair Value Investment Valuation Difference Pension Program / Other Benefits Recording Method

Economic Sector
Start End Value % Self-Managed / KPD
Investment Manager Name a b c d e f g h i j k l m n o p q r s t … Total Notes Management

REGIONAL SUKUK DETAILS
No.
Issuer Name
/Issuer
Regional Sukuk Code
Regional Sukuk Name
Date Acquisition Nominal Value Coupon (%) Maturity Date Rating Acquisition Value Fair Value Investment Valuation Difference Pension Program / Other Benefits Recording Method

Value % Self-Managed / KPD Investment Manager Name a b c d e f g h i j k l m n o … Total *) letter d:
Filled with Fund Type is Money Market Fund/Fixed Income Fund/Mixed Fund/Stock Fund/Protected Fund/Guaranteed Fund/Index Fund/Contractual Collective Investment Fund Limited Partnership/and Funds/Units that are Traded on the Stock Exchange Management

SHARIA MUTUAL FUND DETAILS
No. Code Product Name
Sharia Fund Type *)
Investment Manager Date Acquisition Number of Units Acquisition Value Fair Value Investment Valuation Difference Pension Program / Other Benefits Notes

Economic Sector
Start End Value % Self-Managed / KPD Investment Manager Name a b c d e f g h i j k l m n o p q r s … Total

SHARIA MTN DETAILS
No. Code Product Name Issuer Name Date Acquisition Nominal Value Coupon (%) Maturity Date Rating Acquisition Value Fair Value Investment Valuation Difference Pension Program / Other Benefits Notes Management

Economic Sector
Start End Value % Self-Managed / KPD Investment Manager Name a b c d e f g h i j k l m n o p q r s … Total

SHARIA ASSET-BACKED SECURITIES DETAILS
No. Code Product Name Issuer Name Date Acquisition Nominal Value Coupon (%) Maturity Date Rating Acquisition Value Fair Value Investment Valuation Difference Pension Program / Other Benefits Notes Management

Value % Self-Managed / KPD Investment Manager Name a b c d e f g h i j k l m n … Total Pension Program / Other Benefits Notes Management

SHARIA REAL ESTATE INVESTMENT FUND DETAILS IN COLLECTIVE INVESTMENT CONTRACT FORM No. Code Product Name Investment Manager Date Acquisition Number of Units Acquisition Value Fair Value Investment Valuation Difference

Value % Self-Managed / KPD Investment Manager Name a b c d e f g h i j k l m n … Total Pension Program / Other Benefits Notes Management

INFRASTRUCTURE INVESTMENT FUND DETAILS IN COLLECTIVE INVESTMENT CONTRACT FORM No. Code Product Name Investment Manager Date Acquisition Number of Units Acquisition Value Net Asset Value Investment Valuation Difference

Value % Self-Managed / KPD Investment Manager Name a b c d e f g h i j k l m … Total Notes Management

DETAILS OF SHARIA OPTIONS CONTRACTS AND SECURITIES FUTURES CONTRACTS RECORDED ON THE INDONESIAN STOCK EXCHANGE No. Issuer Name Buyer Name Date Acquisition Maturity Period Acquisition Value Fair Value Investment Valuation Difference Pension Program / Other Benefits

Start End Nominal % Value % Self-Managed / KPD Investment Manager Name a b c d e f g h i j k l m n o p q r s t … Total Notes Management

REPO DETAILS
No. Counterparty
Collateral Type
(SBSN/SBIS)
Date Acquisition Collateral Value
Rating
Maturity Period
Category
(KSEI/BIS4)
Acquisition Value
Margin
Amortized Cost Sale Value
Investment Valuation Difference Pension Program / Other Benefits

Name Position Date % Ownership Total % Ownership Total Date % Ownership Total Value % a b c d e f g h i j k l m n o p q r … Total Self-Managed / KPD Investment Manager Name Pension Fund Founder Partner Founder Board of Trustees Beneficiary Trade Unions whose Members are DP Participants Others Founder Partner Founder Beneficiary Trade Unions whose Members are DP Participants Others s t u v w x y z a1 b1 c1 d1 e1 f1 g1 h1 i1 j1 k1 … Total *) letter e:
Filled with Domestic LJK/Non-Domestic LJK/Foreign LJK/Non-Foreign LJK

DIRECT PARTICIPATION DETAILS
No.
Management
No.
Company Name
(1)
Pension Fund Representative
Participation Category*)
Date Acquisition
Initial Placement Acquisition Value As of Report Date Appraisal/Fair Value Investment Valuation Difference Economic Sector Pension Program / Other Benefits Ownership Percentage (e1) Notes Total Paid-Up Capital Ownership Percentage (v) Subsidiaries of Direct Participation (2) Total Paid-Up Capital Subsidiaries of Direct Participation

Object Type
(Land/Building/Land&Building) Value % Self-Managed / KPD Investment Manager Name a b c d e f g h i j k l m n o p q r s t u … Total

DETAILS OF LAND, BUILDINGS, OR LAND AND BUILDINGS IN INDONESIA No. Address Location (City,Province) Area Type of Proof Ownership Ownership Document Number Date Acquisition Acquisition Value Accumulated Depreciation Pension Program / Other Benefits Notes Management Book Value Appraisal Value/ Fair Value Appraisal Year Appraiser Name Public/Independent KJPP Name Investment Valuation Difference

No. Cash/Bank Name Branch Bank Code Account Number Nominal Pension Program / Other Benefits Notes (Usage Purpose) a b c d e f g h … Total

CASH AND BANK DETAILS

No. Expense Type Amount
Pension Program /
Other Benefits
Notes a b c d e
…
Total

PREPAID EXPENSES DETAILS

No. Investment Receivable Type Counterparty Nominal Pension Program / Other Benefits Notes a b c d e f … Total

INVESTMENT RECEIVABLES DETAILS

No.
Investment Yield Receivable Type
Counterparty Nominal
Pension Program /
Other Benefits
Notes a b c d e f
…
Total

INVESTMENT YIELD RECEIVABLES DETAILS

No. Other Receivable Type Counterparty Nominal Pension Program / Other Benefits Notes a b c d e f … Total

OTHER RECEIVABLES DETAILS

<= 1 year >1 year Total a b c d e f
…
Total

DUE PENSION BENEFIT LIABILITIES DETAILS
No.
Amount Pension Program /
Other Benefits
Notes

<= 1 year >1 year Total a b c d e
…
Total

DUE VOLUNTARY PENSION BENEFIT DEBT DETAILS No.
Amount Notes

No. Investment Type Counterparty Value
Pension Program /
Other Benefits
Notes a b c d e f
…
Total

INVESTMENT DEBT DETAILS

No.
Details of Income Received in Advance
Counterparty Value
Pension Program /
Other Benefits
Notes a b c d e f
…
Total

ADVANCED INCOME DETAILS

No.
Details of Expenses Still Payable
Counterparty Value
Pension Program /
Other Benefits
Notes a b c d e f
…
Total

EXPENSES STILL PAYABLE DETAILS

No. Other Debt Type Counterparty Value
Pension Program /
Other Benefits
Notes a b c d e f
…
Total

OTHER DEBTS DETAILS

No. Investment Type Investment Valuation Difference Increase/ Decrease Pension Program / Other Benefits Notes a b c d e f ... Total Details of Investment Increase/Decrease

Normal Participant Contributions Normal Employer Contributions a b c d e f g ... Total Contribution Details No. Group/Individual Name PhDP Contribution Receipts Pension Program / Other Benefits Notes

No.
Type of Other Investment Income
Amount
Pension Program /
Other Benefits
Notes a b c d e
...
Total
Details of Non-Investment Income

No.
Name of Pension Fund transferring
Amount
Pension Program /
Other Benefits
Details of Other Benefits *)
Notes a b c d e f
...
Total
*) letter e:
Details of Transfers from Other Pension Funds Filled with Education Funds/Housing Funds/Religious Worship Funds/Disability Benefits/Death Benefits/Health Funds/Severance Funds/Additional Benefit Funds

No. Expense Type Amount
Pension Program /
Other Benefits
Notes a b c d e
...
Total
Details of Investment Expenses

No. Expense Type Amount
Pension Program /
Other Benefits
Notes a b c d e
...
Total
Details of Non-Investment and Operational Expenses

No.
Type of Income Tax
Amount
Pension Program /
Other Benefits
Notes a b c d e
Total
Details of Income Tax

No.
Pension Fund receiving Transfer
Amount
Pension Program /
Other Benefits
Details of Other Benefits *) Notes a b c d e f ...
Total
*) letter e:
Details of Transfers to Other Pension Funds Filled with Education Funds/Housing Funds/Religious Worship Funds/Disability Benefits/Death Benefits/Health Funds/Severance Funds/Additional Benefit Funds

FORMAT II B
FORM AND STRUCTURE OF ANNUAL REPORTS FOR TECHNICAL REPORTS OF FINANCIAL INSTITUTIONS OPERATING PENSION PROGRAMS BASED ON SHARIA PRINCIPLES
I. Pension Fund Profile
A. General Profile
Pension Fund Name :
General Register Book Number
(NBDU)
: SID Number :
Taxpayer Identification Number (NPWP) :
Address :
a. Building/Floor/Room/Street :
b. City :
Postal Code :
c. Province :
d. Telephone 1 (area code-telephone) :
e. Telephone 2 (area code-telephone) :
f. Telephone 3 (area code-telephone) :
g. Facsimile (area code - facsimile)
: h. Email :
i. Website :
B. Founder
Founder Name :
Address :
a. Building/Floor/Room/Street :
b. City :
Postal Code :
c. Province :
d. Telephone 1 (area code-telephone) :
e. Telephone 2 (area code-telephone) :
f. Telephone 3 (area code-telephone) :
g. Facsimile (area code - facsimile)
: h. Email :
i. Website :
j. Founder's Business Field k. Founder's Ownership Status (SOE/Non-SOE)
C. Administration

Management
a. Are there changes to the Acting Board of Trustees or extension of the term of office of the Acting Board of Trustees during the activity period?

If Yes, has this been reported to OJK? b. Does the Acting Board of Trustees have a basic knowledge certificate in the field of Pension Funds?
c. Does the Acting Board of Trustees who has a basic knowledge certificate in the field of Pension Funds meet the minimum continuing education points?
d. Does the Acting Board of Trustees have proof of expertise in the field of Sharia finance? e. Are there changes to the Supervisory Board or extension of the term of office of the Supervisory Board during the activity period? If Yes, has this been reported to OJK? f. Are there changes to the Sharia Supervisory Board or extension of the term of office of the Sharia Supervisory Board during the activity period? If Yes, has this been reported to OJK? g. Does the Sharia Supervisory Board have a recommendation letter from DSNMUI? h. Does the Sharia Supervisory Board have a Founder's Decision Letter regarding the appointment?
i. Are the number and composition of the Acting Board of Trustees, Supervisory Board, and Sharia Supervisory Board in accordance with the PDP and relevant regulations on Pension Funds?
j. Does the Acting Board of Trustees have a certificate

Investment Field and/or
Risk Management?
2. Number of Pension Fund Employees Based on Education Level
SD :
SMP :
SMA :
Diploma :
S1 :
S2 :
S3 :
Total :
3. List of Names and Positions of Pension Fund Employees Under the Structure of the Acting Board of Trustees
No. Name Position
4. Third-Party Service Users:
a. Does the Pension Fund use the services of others to manage membership administration? If Yes, fill in the name of the Membership Administration Manager:
5 etc b. Does the Pension Fund use the services of others to deposit ownership documents of wealth? If Yes, fill in the name of the beneficiary used 5 etc
c. Does the Pension Fund use the services of an Investment Manager?
If Yes, fill in the list of names of Investment Managers used (sorted by the proportion of assets managed)

5 etc d. Does the Pension Fund use the services of an Appraiser? If Yes, fill in the list of Appraisers used:
5 etc
5. Contributions
a. Does the Employer pay the exact amount of contributions? b. Does the Employer pay contributions on time?
c. Are there voluntary contributions from Participants?
6. Other Benefits
Does the Pension Fund operate an Other Benefits program for Participants?
7. Investments
a. Are investment activities during the reporting period in accordance with relevant regulations? b. Has information regarding investments been communicated to participants?
8. Governance
a. Does the Pension Fund have a Pension Fund Governance Guideline? b. Has the Pension Fund implemented Pension Fund Governance?
c. Information on the Number and Date/Month/Year of the Governance Guideline Determination
D. Pension Fund Membership

Number of Active Pension Fund Employee Participants at the end of the activity period::
Group Participants / from
Employer (persons)
: a. Pension Program :
b. Other Benefits :
Self-Participants (persons) :
a. Pension Program :
b. Other Benefits :

Total (persons) :
a. Pension Program :
b. Other Benefits :
2. Total number of all participants entitled to deferred pension programs at the end of the activity period
: 3. Active Participant Age Structure of Pension Programs a. Number of Active Participants up to 20 :
20 to 30 :
30 to 40 :
40 to 50 :
above 50 :
b. Number of Participants entitled to deferred pension programs up to 20 :
20 to 30 :
30 to 40 :
40 to 50 :
above 50 :
Estimated number of pension program participants entering normal retirement age in the next activity period : 4. Total number of all employers who include their employees in DPLK at the end of the activity period : E. Pensioners and Parties Entitled to Pension Programs Description Amount ≤ Rp 1,600,000,

Rp
1,600,000,
≤ Rp
500,000,000,
Rp
500,000,000,

Number of Benefit Recipients -
a. Number of Pension Benefit Recipients monthly at the end of the activity period (including those who choose the first payment maximum 20%) -
i. Pensioners

ii. Widows/Widowers
iii. Children
iv. Parties designated by
Participants or pensioners if
Participants or pensioners are not married and do not have children b. Number of Pension Benefit Recipients who receive a lump-sum payment during the activity period for reasons:
i. Monthly pension
benefit is below the minister's regulation limit
ii. Reasons other than
clause b (i)
c. Number of Pension Benefit Recipients
who purchase annuities during the period
2. Distribution of the number of
pension benefit recipients based on the category of pension benefit amounts received monthly at the end of the activity period
i. Pensioners
(persons)
ii. Widows/Widowers
iii. Children
iv. Parties designated by
Participants or pensioners if Participants or pensioners are not married and do not have children

Acting Board of Trustees Statement
We, the Acting Board of Trustees of the Pension Fund, declare that all data and information we provide in this technical report are true data and in accordance with the actual conditions of the Pension Fund. If it is later discovered that there is data/information that does not correspond to the actual conditions, we are willing to be responsible in accordance with relevant regulations. Place, Date (date/month/year) (signature) Clear Name Position

II. Report on the Implementation of Good Corporate Governance for Pension Funds Implementing All or Part of Their Operations Based on Sharia Principles

Transparency of Good Corporate Governance Implementation for Pension Funds Implementing All or Part of Their Operations Based on Sharia Principles

a. Acting Board of Trustees

Number, job titles, criteria, appointment dates, terms of office, nationality, and domicile of Acting Board of Trustees members

No. Name Job Title Criteria Appointment Date Term of Office Nationality Domicile Last Formal Education and Professional Degree Competency and Propriety Test 1. 2. Etc.

Concurrent positions of Acting Board of Trustees members

No. Name Position in Pension Fund Position in Other Pension Fund Position in Other Companies and/or Institutions

1. 1.

Etc. Etc. Etc.

Frequency of Acting Board of Trustees meetings held within 1 (one) month.

No. Name Job Title Number of Acting Board of Trustees Meetings (... meetings) Attendance % Physical Attendance Teleconference/Video Conference/Other Electronic Media 1. 2. Etc.

Family relationships between Acting Board of Trustees members and other Acting Board of Trustees members, and/or the Supervisory Board of the Pension Fund Supervisory Agency (DPLK) where the Acting Board of Trustees member in question holds office.

No. Name Family Relationship with Other Acting Board of Trustees Members (Yes/No/Note*) Family Relationship with DPLK Supervisory Board Members (Yes/No/Note*) 1. 2. Etc.

Note:

Family relationship types: spouse/children/parents/siblings/in-laws, etc.

b. Supervisory Board

Number, job titles, criteria, appointment dates, terms of office, nationality, and domicile of Supervisory Board members

No. Name Job Title Criteria Appointment Date Term of Office Nationality Domicile Last Formal Education and Professional Degree Competency and Propriety Test 1. 2. Etc.

Concurrent positions of Supervisory Board members

No. Name Position in Pension Fund Position in Other Pension Fund Position in Other Companies and/or Institutions

1. 1.

Etc. Etc. Etc.

Frequency of Supervisory Board meetings held within 1 (one) month.

No. Name Job Title Number of Supervisory Board Meetings (... meetings) Attendance % Physical Attendance Teleconference/Video Conference/Other Electronic Media 1. 2. Etc.

Family relationships between Supervisory Board members and other Supervisory Board members and/or DPLK Acting Board of Trustees members where the Supervisory Board member in question holds office.

No. Name Family Relationship with Other Supervisory Board Members (Yes/No/Note*) Family Relationship with DPLK Acting Board of Trustees Members (Yes/No/Note*) 1. 2. Etc.

Note:

Family relationship types: spouse/children/parents/siblings/in-laws, etc.

c. Sharia Supervisory Board

Number, job titles, criteria, appointment dates, terms of office, nationality, and domicile of Sharia Supervisory Board members

No. Name Job Title Criteria Appointment Date Term of Office Nationality Domicile Last Formal Education and Professional Degree Competency and Propriety Test 1. 2. Etc.

Concurrent positions of Sharia Supervisory Board members

No. Name Position in Pension Fund Position in Other Pension Fund Position in Other Companies and/or Institutions

1. 1.

Etc. Etc. Etc.

Frequency of Sharia Supervisory Board meetings held within 3 (three) months.

No. Name Job Title Number of Sharia Supervisory Board Meetings (... meetings) Attendance % Physical Attendance Teleconference/Video Conference/Other Electronic Media 1. 2. Etc.

Family relationships between Sharia Supervisory Board members and other Sharia Supervisory Board members, DPLK Acting Board of Trustees members, and/or Supervisory Board members where the Sharia Supervisory Board member in question holds office.

No. Name Family Relationship with Other Sharia Supervisory Board Members (Yes/No/Note*) Family Relationship with DPLK Acting Board of Trustees Members (Yes/No/Note*) Family Relationship with Supervisory Board Members (Yes/No/Note*) 1. 2. Etc.

Note:

Family relationship types: spouse/children/parents/siblings/in-laws, etc.

d. Supervisory Board Supervision Results Report

Supervisory Board activity report on the implementation of Good Corporate Governance for Pension Funds

Supervision Results Recommendations

Filled with the Supervisory Board's detailed assessment of the implementation of Good Corporate Governance for Pension Funds, comprising quantitative and qualitative assessments of Good Corporate Governance for Pension Funds and factors affecting performance, as well as efforts to improve Pension Fund performance, if according to the assessment there is a decline in Pension Fund performance.

e. Committees

Functions under the DPLK Acting Board of Trustees

No. Name Function Member Name Position* Length of Service Appointment Decree Number of Meetings in One Year

Internal Audit Function 1.
Risk Management Function 2.
Compliance Function Etc.

Committees under the Supervisory Board

No. Name Committee Member Name Position* Length of Service Appointment Decree Number of Meetings in One Year

Audit Committee 1.
Risk Monitoring Committee 2.
Nomination and Remuneration Committee Etc.

f. Implementation of external audit functions.

No. Description Year n-2 Year n-1 Year n

Name of Public Accounting Firm
Name of Public Accountant
Audit Period
Appointment by Supervisory Board *)

Note:

Date of Appointment by the Supervisory Board

g. Implementation of remuneration policies and other facilities for Acting Board of Trustees members, Supervisory Board members, and Employees. The number of Acting Board of Trustees, Supervisory Board, Sharia Supervisory Board, and Employees receiving remuneration packages in 1 (one) year, grouped by income level as follows:

Remuneration Amount per Person in 1 Year *) Number of Acting Board of Trustees Members Number of Supervisory Board Members Number of Sharia Supervisory Board Members Employees Above Rp2 billion Above Rp1 billion to Rp2 billion Above Rp500 million to Rp1 billion Below Rp500 million

Note:

Received in cash

h. Outsourcing of Investment Management *)

No. Type of Investment Name of Outsourcing Company Investment Value Agreement Number % of Total Investment Portfolio 1.
2. Etc.

Note:

Pension Funds only conduct Outsourcing of Investment Management in the form of KPD (Sharia Investment Management Agreement).

i. Disclosure of other important matters

No. Description Checklist *) If Yes, Explain Yes No

Resignation or dismissal of external audit
Material transactions with related parties )
Ongoing Conflicts of Interest
Other material information regarding the Pension Fund
Pension Fund has a compliance function
Pension Fund has an internal audit function
Pension Fund has a risk management function
Pension Fund has an investment management function/unit
Pension Fund has a special work unit and/or appoints a PJK official responsible for the implementation of APU and PPT *)

Select one answer by placing a "√" mark
Related Parties are individuals or companies/entities that have a controlling relationship with the Pension Fund, directly or indirectly, through ownership, management, and/or financial relationships.
Explain and include the Information Number and Date/Month/Year of the APU PPT Guideline Determination.

Self-Assessment on the Implementation of Good Corporate Governance for Pension Funds

The completion of the Good Corporate Governance Implementation questionnaire for Pension Funds is conducted by the respective Pension Fund. The completion of this questionnaire is done by providing answers to the questions/statements in the said questionnaire.

Completion Method:
Generally, answers to the said Questions/Statements consist of 5 criteria as follows (except for answers requiring different criteria):

A = The respective Pension Fund DOES NOT HAVE written policies regarding the said Question/Statement. B = The respective Pension Fund HAS written policies regarding the said Question/Statement, but the policy has NOT been implemented. C = The respective Pension Fund HAS written policies regarding the said Question/Statement, but the policy has NOT been implemented CONSISTENTLY. D = The respective Pension Fund HAS written policies regarding the said Question/Statement, the policy is IMPLEMENTED CONSISTENTLY but has NOT BEEN UPDATED periodically. E = The respective Pension Fund HAS written policies regarding the said Question/Statement and the policy is IMPLEMENTED CONSISTENTLY and UPDATED periodically.

Interpretation of Results
An assessment is required to interpret the number obtained in answering the questions of this Questionnaire, the majority of whose answers consist of 5 (five) scales from the lowest assessment (A/No) to the highest assessment (E/Yes).

Specifically for the answer "A/No" on assessment criteria that have been required by statutory regulations (mandatory), a minus number is given.

For groups of Questions/Statements skipped due to "None" and which are not "not applicable", in the result interpretation, they must still be considered by giving the same score as the answer "A/No".

A. BUSINESS ETHICS AND CODE OF CONDUCT

The Pension Fund has a Vision, Mission, and Values.
A B C D E
The Pension Fund has a Business Ethics Policy which includes:
2.1. General policies directing towards applicable statutory regulations and applicable codes of ethics.
A B C D E
2.2. Policies for Pension Fund organs.
A B C D E
2.3. Policies for employees.
A B C D E
2.4. Policies for Participants and/or persons entitled to pension benefits.
A B C D E
2.5. Policies for business partners.
A B C D E
2.6. Policies for other pension funds.
A B C D E
The Pension Fund has a Code of Conduct which is an elaboration of Values and Business Ethics.
A B C D E
The Code of Conduct includes guidelines on:
4.1. Conflicts of interest.
A B C D E
4.2. Gifts and donations.
A B C D E
4.3. Compliance with regulations.
A B C D E
4.4. Information confidentiality.
A B C D E
4.5. Reporting of violations and protection for whistleblowers.
A B C D E
In carrying out their duties, the Acting Board of Trustees, Supervisory Board, and Pension Fund employees:
5.1. Make a "no conflict of interest" statement regarding every decision taken by the authorized party.
No Yes
5.2. Make an annual statement regarding the implementation of the Code of Conduct established by the Pension Fund.
No Yes
5.3. Make an annual statement not to receive or give anything that can influence decision-making.
No Yes
The Pension Fund correctly records its assets, liabilities, and equity using generally accepted accounting principles or special accounting principles applicable to pension funds.
No Yes
Has a complaint system regarding violations of the Code of Conduct, Pension Fund regulations, and statutory regulations, as well as matters related to Participants, which guarantees protection for the Whistleblower.
A B C D E

B. PENSION FUND ORGANS

a. Founder
The Founder, according to its function, has carried out the following:
1.1. Internal control.
A B C D E
1.2. Risk management.
A B C D E
1.3. GCG implementation.
A B C D E
1.4. Following up audit findings and recommendations from units carrying out the Pension Fund's internal audit function, external audit of the Pension Fund, and/or supervision results from the Financial Services Authority.
A B C D E

b. Acting Board of Trustees

Composition of Appointment and Dismissal of Acting Board of Trustees
1.1. The DPLK Founder acts as the Board of Trustees and in its management, the DPLK Founder must appoint an Acting Board of Trustees.
No Yes
1.2. The number of Acting Board of Trustees members has been adjusted to the complexity of the Pension Fund while still considering the effectiveness of decision-making.
No Yes
1.3. The Acting Board of Trustees consists of members who collectively possess competencies*) such as:
1.3.a Investment field.
No Yes
1.3.b Risk Management field.
No Yes
Requirements for Acting Board of Trustees Members
2.1. Acting Board of Trustees members meet the articles of association requirements.
No Yes
2.2. Acting Board of Trustees members meet competency and propriety requirements according to the regulations of the supervisory authority.
No Yes
2.3. Acting Board of Trustees members must understand and implement Good Corporate Governance for Pension Funds.
A B C D E
2.4. Acting Board of Trustees members are prohibited from utilizing the Pension Fund for personal, family, business group, or other parties' interests that harm the Pension Fund's interests.
No Yes
2.5. Do not hold concurrent positions as Supervisory Board or DPS members in the same Pension Fund.
No Yes
2.6. Do not hold concurrent positions as directors or commissioners or equivalent in other companies and/or institutions, except in subsidiary companies where the pension fund holds shares, directly or indirectly.
No Yes
2.7. Acting Board of Trustees members do not hold concurrent positions as Board of Trustees, Acting Board of Trustees, Supervisory Board, or DPS members in other Pension Funds.
No Yes
Functions of the Acting Board of Trustees
3.1. Administration
3.1.1. The Acting Board of Trustees is fully responsible for the management of the Pension Fund.
A B C D E
3.1.2. The Acting Board of Trustees manages available resources effectively and efficiently, including ensuring the availability of human resources meeting specific qualifications to perform their functions.
A B C D E
3.1.3. The Acting Board of Trustees considers the fair interests of stakeholders.
A B C D E
3.1.4. The Acting Board of Trustees has and complies with meeting rules and work guidelines (charters) regulated in the Pension Fund Regulations (PDP) and statutory regulations in the Pension Fund field.
A B C D E
3.1.5. Acting Board of Trustees members overseeing the compliance function cannot be held concurrently by Acting Board of Trustees members overseeing funding, finance, or investment functions, except if the number of Acting Board of Trustees members is 2 (two), in which case the compliance function can be held concurrently by the Acting Board of Trustees member overseeing the finance function.
No Yes

3.2. Risk Management
3.2.1. The Acting Board of Trustees formulates and implements a Risk Management System covering all aspects of the Pension Fund's activities.
A B C D E
3.2.2. The Pension Fund has a Risk Monitoring Committee and a Risk Management Work Unit.
No Yes

3.3. Internal Control
3.3.1. The Pension Fund has an internal supervision function.
No Yes
3.3.2. Responsible for carrying out duties to the Founder.
No Yes

3.4. Information Technology
3.4.1. The Pension Fund has an integrated computerized administration system.
A B C D E
3.4.2. The Pension Fund has Standard Operating Procedures for the Information Technology section.
A B C D E

Accountability of the Acting Board of Trustees
4.1. The Acting Board of Trustees prepares an accountability report on Pension Fund management in the form of an Annual Report.
No Yes
4.2. Annual Report criteria include:
4.2.1. Containing at least:
a. Financial statements.
No Yes b. Pension Fund activity report.
No Yes
c. Report on the implementation of Good Corporate Governance for Pension Funds.
No Yes
4.2.2. Approved by the Founder.
No Yes
4.2.3. Specifically, financial statements must be ratified by the Founder.
No Yes

4.3. Acting Board of Trustees Meetings
4.3.1. Every strategic policy and decision must be decided through a DPLK Acting Board of Trustees meeting, considering supervision according to the duties and responsibilities of the Supervisory Board.
No Yes
4.3.2. The Acting Board of Trustees holds meetings periodically at least 1 (one) time in 1 (one) month.
No Yes
4.3.3. The Acting Board of Trustees establishes meeting rules.
No Yes
4.3.4. Minutes are made for every Acting Board of Trustees meeting.
No Yes
4.3.5. Meeting minutes include dissenting opinions with decisions taken in the meeting (if any).
A B C D E
4.3.6. Every Acting Board of Trustees member, whether attending or not attending the meeting, has the right to receive a copy of the Acting Board of Trustees Meeting Minutes.
No Yes

c. Supervisory Board

Composition, Appointment, and Dismissal of the Supervisory Board
1.1. The number of Supervisory Board members has been adjusted to the complexity of the Pension Fund while still considering the effectiveness of decision-making.
No Yes
1.2. The entire Supervisory Board consists of members who collectively possess competencies relevant to their positions.
No Yes
1.3. Do not hold concurrent positions as Acting Board of Trustees, or DPS in the same Pension Fund, or Supervisory Board, Board of Trustees, or DPS in other Pension Funds.
No Yes
Competency and Integrity of the Supervisory Board
2.1. Meet Fit and Proper Test requirements.
No Yes
2.2. Monitor the effectiveness of Good Corporate Governance implementation for Pension Funds.
A B C D E
2.3. Do not utilize the Pension Fund for personal, family, business group, or other parties' interests that can harm the Pension Fund.
No Yes
Supervisory Board Supervision Functions
3.1. Fully responsible for the supervision of the Pension Fund.
A B C D E
3.2. Carry out the duties and responsibilities of the Supervisory Board as regulated in the PDP and statutory regulations in the Pension Fund field independently.
No Yes
3.3. The Supervisory Board holds meetings periodically at least 1 (one) time in 3 (three) months.
No Yes
3.4. Minutes are made for every Supervisory Board meeting.
No Yes
3.5. Meeting minutes include dissenting opinions with decisions taken in the meeting.
A B C D E
3.6. Every Supervisory Board member, whether attending or not attending the meeting, has the right to receive a copy of the Supervisory Board meeting minutes.
No Yes

d. Sharia Supervisory Board

Composition, Appointment, and Dismissal of the Sharia Supervisory Board
1.1. The number of Sharia Supervisory Board members has been adjusted to the complexity of the Pension Fund while still considering the effectiveness of decision-making.
No Yes
1.2. Is a Sharia expert appointed by the Founder based on the recommendation of the National Sharia Board of the Indonesian Ulema Council, and their appointment must be clearly stated in the Founder's decision letter.
No Yes
1.3. The entire Sharia Supervisory Board consists of members who collectively possess competencies relevant to their positions.
No Yes
1.4. Do not hold concurrent positions as Acting Board of Trustees or Supervisory Board in the same Pension Fund.
No Yes
1.5. DPS members are prohibited from holding concurrent positions as DPS members in more than 4 (four) other Sharia financial service institutions.
No Yes
Competency and Integrity of the Sharia Supervisory Board
2.1. Meet Fit and Proper Test requirements.
No Yes
2.2. Monitor the effectiveness of Good Corporate Governance implementation for Pension Funds.
A B C D E
2.3. Do not utilize the Pension Fund for personal, family, business group, or other parties' interests that can harm the Pension Fund.
No Yes
Sharia Supervisory Board Supervision Functions
3.1. Fully responsible for the supervision of the Pension Fund.
A B C D E
3.2. Carry out the duties and responsibilities of the Sharia Supervisory Board as regulated in the PDP and statutory regulations in the Pension Fund field independently.
A B C D E
3.3. The Sharia Supervisory Board holds meetings periodically at least 1 (one) time in 3 (three) months.
No Yes
3.4. Minutes are made for every Sharia Supervisory Board meeting.
No Yes
3.5. Meeting minutes include dissenting opinions with decisions taken in the meeting.
A B C D E
3.6. Every Sharia Supervisory Board member, whether attending or not attending the meeting, has the right to receive a copy of the Sharia Supervisory Board meeting minutes.
No Yes
3.7. The number of DPS meetings held and the attendance of each DPS member must be included in the report on the implementation of Good Corporate Governance for Pension Funds.
No Yes
3.8. In the event that the number of DPS is 1 (one) person, the DPS meeting is conducted together with the Pension Fund Supervisory Board meeting.
No Yes
Supervisory Board Committees (answered if applicable)
4.1. Audit Committee
No Yes
Continue to 4.1.7.
The Audit Committee serves as a facilitator for the Supervisory Board to ensure the following:
4.1.1. The Pension Fund's internal control structure is implemented well.
A B C D E
4.1.2. Internal audit is carried out according to applicable audit standards.
A B C D E
4.1.3. Follow-up on internal audit findings is implemented by management.
A B C D E
4.1.4. External audit has been carried out according to applicable audit standards.
No Yes
4.1.5. Follow-up on external audit findings is implemented by management.
A B C D E
4.1.6. Audit Committee members consist of:
a. Supervisory Board members.
No Yes b. Parties outside the Pension Fund who do not have financial, management, and/or family relationships with the Supervisory Board, Acting Board of Trustees of the Pension Fund, and/or Founder, or other relationships that can affect their ability to act independently. No Yes
4.1.7. For Pension Funds that do not have an Audit Committee, there are Supervisory Board members who specifically serve to ensure the following:
a. The Pension Fund's internal control structure has been implemented well. A B C D E b. Internal audit is carried out according to applicable audit standards. A B C D E
c. Follow-up on internal audit findings is implemented by management.
A B C D E d. External audit has been carried out according to applicable audit standards. No Yes e. Follow-up on external audit findings is implemented by management. A B C D E

4.2. Risk Monitoring Committee
No Yes
Continue to 4.2.4.
The Risk Monitoring Committee serves as a facilitator for the Supervisory Board for the following:
4.2.1. Assess the quality of risk management policies.
A B C D E
4.2.2. Assess the effectiveness of risk management applied by the Pension Fund, including assessing the risk tolerance taken by the Acting Board of Trustees.
A B C D E
4.2.3. Risk Monitoring Committee members consist of:
a. Supervisory Board members representing Participants.
No Yes b. Other parties.
No Yes
4.2.4. For Pension Funds that do not have a Risk Monitoring Committee, there are Supervisory Board members who specifically serve to:
a. Assess the quality of risk management policies.
A B C D E b. Assess the effectiveness of risk management applied by the Pension Fund, including assessing the risk tolerance taken by the Acting Board of Trustees. A B C D E

4.3. Nomination and Remuneration Committee
No Yes
Continue to 4.3.4.
The Nomination and Remuneration Committee serves as a facilitator for the Supervisory Board for the following:
4.3.1. Facilitator for the Supervisory Board in helping the Founder establish criteria and select candidates for the Supervisory Board.
A B C D E

Supervisors and Executors
Duties of the Pension Fund Board.
4.3.2. Facilitator for the Supervisory Board in assisting the Founder to establish the remuneration system.
A B C D E
4.3.3. Members of the Nomination and Remuneration Committee consist of:
a. members of the Supervisory Board.
No Yes b. other parties. No Yes
4.3.4. For Pension Funds that do not have a Nomination and Remuneration Committee, there are members of the Supervisory Board who have specific duties as follows:
a. Assist the Founder in establishing criteria and selecting candidates for the Supervisory Board and Executors. Duties of the Pension Fund Board. A B C D E b. Assist the Founder in establishing the remuneration system. A B C D E
C. HEALTHY BUSINESS PRACTICES
External Auditor

External Auditor (public accounting firm) conducts independent examinations of the truthfulness of the Pension Fund's financial reports.
No Yes
The appointed public accounting firm (KAP) is registered with the Financial Services Authority (OJK).
No Yes
Action Plan
No.
Action
Corrective Action
Target Completion
Completion Obstacles
Remarks
etc.
Implementation of Anti-Fraud Strategy
Name of Pension Fund..............................
FRAUD CONTROL REPORT AND ANTI-FRAUD STRATEGY IMPLEMENTATION YEAR …… a. Inventory of Fraud Incidents and Follow-up Type Fraud a) Date Fraud occurred Division/Section Fraud occurred Parties involved b) Position Loss in rupiah c) Action by Pension Fund d) Weakness/ Cause of Fraud e) Follow- up/ Correction f) Chronol- ogy of Fraud g) b. Progress of Anti-Fraud Strategy Implementation

Prevention:
……………………………………………………………………………………………
……………………………………………………………………………………………
……………………………………………………………………………………………
Detection:
……………………………………………………………………………………………
……………………………………………………………………………………………
……………………………………………………………………………………………
Investigation, Reporting, and Sanctions:
……………………………………………………………………………………………
……………………………………………………………………………………………
……………………………………………………………………………………………
Monitoring, Evaluation, and Follow-up:
……………………………………………………………………………………………
……………………………………………………………………………………………
……………………………………………………………………………………………
EXPLANATION FOR FILLING OUT THE REPORT:
a) Types of Fraud include, among others, fraud, deception, asset embezzlement, information leakage, criminal acts of the Pension Fund, or others. b) Parties involved include all parties indicated to be involved/participating in the Fraud. If more than 1 (one) party is involved, the role of each party is explained. c) Losses are filled with actual losses or estimated losses. d) The Pension Fund's action is the Pension Fund's response to the Fraud incident, whether actions against the perpetrator, the aggrieved party, or other actions. Actions against the Fraud perpetrator include, among others, administrative personnel sanctions and/or compensation obligations. Actions against the aggrieved party include, among others, compensation for losses and/or efforts to restore reputation. Other

Format 4: Vision, Mission, and Business Strategy

Pension Fund Vision *
...............................................................................................................................
...............................................................................................................................
.......

Vision is a depiction of the Pension Fund's condition in the future and represents the Pension Fund's aspiration. Vision is a statement to answer the question of the Pension Fund's direction moving forward.

Pension Fund Mission
...............................................................................................................................
...............................................................................................................................
..........

Mission is the elaboration of the vision, where the mission elaborates a careful analysis of the benefits desired by Participants. The mission also elaborates on existing environmental and market conditions and the Pension Fund's anticipation for the future.

Pension Fund Business Strategy
No. Target Policy Strategy
a) 1)

b) 1)
c) etc. etc.

a) 1)

b) 1)
c) etc.

(Plan regarding the implementation of business activities previously carried out by the Pension Fund with reference to regulations concerning the implementation of Pension Funds. Can be added with reasons and considerations in compiling the said plan and strategies to realize the said plan)

Format 6: Plan for Business Development or Expansion No.
Type of Business Activity
General Description of Business Activity Time of Implementation of Business Activity Objective of New Business Activity Connection of New Business Activity with Company Business Strategy Risks of Implementation of New Business Activity Risk Mitigation for Implementation of New Business Activity Reasons and Strategic Considerations

Note:
a. The Plan for Business Development or Expansion includes the plan for the implementation of the Pension Fund's business activities, investment packages, Other Benefits based on approval from the Financial Services Authority (OJK), and plans for business activities that must be reported to the Financial Services Authority (OJK). b. In accordance with the POJK regarding Contributions, Pension Benefits, and Other Benefits Organized by Pension Funds, it can be filled in regarding other benefits. Pension Fund business activities categorized as a form of business development or expansion are business activities that:
a. have never been previously carried out by the Pension Fund, such as the implementation of other benefit programs for Pension Funds that have not yet implemented other benefit programs or the periodic payment of pension benefits by Pension Funds implementing defined contribution programs; or b. have been previously carried out by the Pension Fund, but involve development that changes or increases certain Risk exposures in the Pension Fund, such as changes in the investment package offering for Multi-Pillar Pension Funds (DPLK).

Format 7: Investment Plan

Investment Composition

Based on Acquisition Value
No. Investment Type
Actual as of Sept 30, 20XX-1
Projection as of Dec 31, 20XX-1
As of June 30, 20XX
As of Dec 31, 20XX
Nominal % Nominal % Nominal % Nominal %

Bank Savings
On-call Bank Deposits
Term Bank Deposits
Bank Certificates of Deposit
Sharia-Compliant Securities issued by Bank Indonesia
State Sharia Securities
Sharia Stocks listed on the Indonesia Stock Exchange
Corporate Sukuk listed on the Indonesia Stock Exchange
Regional Sukuk
Sharia Mutual Funds
Sharia MTN
Sharia Asset-Backed Securities
Sharia Real Estate Investment Funds

Based on Fair Value

Collective Investment Contract Sharia Real Estate Investment Funds
Sharia Option Contracts and Sharia Equity Derivative Contracts listed on the Indonesia Stock Exchange
REPO
Direct Participation
Land in Indonesia
Buildings in Indonesia
Land and Buildings in Indonesia

No. Investment Type
Actual as of Sept 30, 20XX-1
Projection as of Dec 31, 20XX-1
As of June 30, 20XX
As of Dec 31, 20XX
Nominal % Nominal % Nominal % Nominal %

Bank Savings
On-call Bank Deposits
Term Bank Deposits
Bank Certificates of Deposit
Sharia-Compliant Securities issued by Bank Indonesia
State Sharia Securities
Sharia Stocks listed on the Indonesia Stock Exchange
Corporate Sukuk listed on the Indonesia Stock Exchange
Regional Sukuk
Sharia Mutual Funds
Sharia MTN
Sharia Asset-Backed Securities
Sharia Real Estate Investment Funds
Collective Investment Contract Sharia Real Estate Investment Funds
Sharia Option Contracts and Sharia Equity Derivative Contracts listed on the Indonesia Stock Exchange
REPO
Direct Participation
Land in Indonesia
Buildings in Indonesia
Land and Buildings in Indonesia
Investment Return Plan
No. Investment Type
Actual as of Sept 30, 20XX-1
Projection as of Dec 31, 20XX-1
As of June 30, 20XX
As of Dec 31, 20XX
Investment Return
Real Investment Return
Unrealized Investment Return
Investment Expenses
Net Investment Return
Real Investment Return
Unrealized Investment Return
Investment Expenses
Net Investment Return
Real Investment Return
Unrealized Investment Return
Investment Expenses
Net Investment Return
Real Investment Return
Unrealized Investment Return
Investment Expenses
Net Investment Return a b c d=(a+b)-c a b c d=(a+b)-c a b c d=(a+b)-c a b c d=(a+b)-c
Bank Savings
On-call Bank Deposits
Term Bank Deposits
Bank Certificates of Deposit
Sharia-Compliant Securities issued by Bank Indonesia
State Sharia Securities
Sharia Stocks listed on the Indonesia Stock Exchange
Corporate Sukuk listed on the Indonesia Stock Exchange
Regional Sukuk
Sharia Mutual Funds
Sharia MTN
Sharia Asset-Backed Securities
Sharia Real Estate Investment Funds
Collective Investment Contract Sharia Real Estate Investment Funds
Sharia Option Contracts and Sharia Equity Derivative Contracts listed on the Indonesia Stock Exchange
REPO
Direct Participation
Land in Indonesia
Buildings in Indonesia
Land and Buildings in Indonesia
Considerations Underlying the Investment Plan
........................................................................................................................................
........................................................................................................................................
........................................
(Filled with considerations or assumptions used by the Board of Trustees as the basis for determining the investment plan in accordance with the POJK regarding Pension Fund Investments)

Format 8: Funding Plan
(Funding plan generally derived from contributions or the results of its development. Contributions can be made by the employer alone or jointly between the employer and workers (participants))

Contribution Projection
Description
Actual as of Sept 30, 20XX-1
Projection as of Dec 31, 20XX-1
As of June 30, 20XX
As of Dec 31, 20XX
Employer Contribution
Participant Contribution
Total Contribution Fund

Note:
X-1: year of report compilation.
X: year of business plan position.

Participant Number Projection

Participant Number Table
Description
Actual as of Sept 30, 20XX-1
Projection as of Dec 31, 20XX-1
As of June 30, 20XX
As of Dec 31, 20XX
Pension Program Participants
Other Benefit Participants
Total Participants

Note:
X-1: year of report compilation.
X: year of business plan position.

Reasons and Considerations *
.........................................................................................................................
.........................................................................................................................
...................

filled with an explanation of participants who are the target, whether individual or group participants, and the distribution of target regions.

Strategy *
.........................................................................................................................
.........................................................................................................................
...................

filled with strategies to achieve the target participant number.

Format 9: Plan for Office Network and/or Distribution Channel Development and/or Changes (Plan for office network and/or distribution channel development and/or changes at least includes plans for opening and merging offices outside the head office.)

Note:
1 Filled with the month of the planned implementation time. No. Office Network Change Implementation Time 1 Location 2 Note 3 A. Opening 1. 2. B. Merging 1. 2.
C. Address Change
1.
2.
D. Office Closure
1.
2.

2 For locations in the DKI Jakarta region, at least mention the province name DKI Jakarta. For locations outside the DKI Jakarta region, at least include the Regency/City name. 3 Detailed notes can be attached in a separate sheet.

Format 10: Plan for Organizational Development, Human Resources, and/or Information Technology

Organizational Development Plan

Description Regarding Organizational Development Plan*
.........................................................................................................................
.........................................................................................................................
...................

Filled with an explanation regarding the organizational development plan, including plans for the formation of work units/divisions, plans for changing work units/divisions, and plans for forming committees, adjusted to the size and complexity of the Pension Fund's business.

Reasons and Considerations*
.........................................................................................................................
.........................................................................................................................
...................

Filled with reasons/considerations in compiling the organizational development plan.

Strategy*
.........................................................................................................................
.........................................................................................................................
...................

Filled with strategies to realize the organizational development plan.

Human Resources Fulfillment Plan

Description Regarding Human Resources Fulfillment Plan
No. Level
Position
Number of HR as of Sept 30, 20XX-1
Quarter IV 20XX-1
Quarter I 20XX
Quarter II 20XX
Quarter III 20XX
Quarter IV 20XX
(+)* (-)* (+) (-) (+) (-) (+) (-) (+) (-) 1.

Dst.

Total

Filled with additions and reductions in the number of employees.

Reasons and Considerations*
.........................................................................................................................
.........................................................................................................................
...................

Filled with reasons/considerations in compiling the human resources fulfillment plan.

Strategy*
.........................................................................................................................
.........................................................................................................................
...................

Filled with strategies to realize the human resources fulfillment plan.

Plan for Human Resources Education and Training for Trustees, Trustees' Task Executors, Supervisory Board, and Employees

Human Resources Development Plan Table
No. Material/Topic
Participant Name
Position
Certification Already Held
Training Time

Dst.

Reasons and Considerations
.........................................................................................................................
.........................................................................................................................
...................

Filled with reasons/considerations in compiling the human resources development plan.

Strategy
.........................................................................................................................
.........................................................................................................................
...................

Filled with strategies to realize the human resources development plan.

Plan for Utilization of Outsourced Labor

Outsourced Labor Utilization Plan Table
No. Field of Work
Reason for Outsourced Labor Utilization
Number of Outsourced Labor
Name of Outsourced Labor Provider Company (if any) Contract Period with Outsourced Labor Provider Company 1. 2. 3. ...
Reasons and Considerations*
.........................................................................................................................
.........................................................................................................................
...................

Filled with reasons/considerations in compiling the outsourced labor utilization plan.

Strategy*
.........................................................................................................................
.........................................................................................................................
...................

Filled with strategies to realize the outsourced labor utilization plan.

Information Technology System Development Plan

Information Technology System Utilization Plan Table
No. Type/Name of Application
Ownership (In-house/vendor)
Vendor Name
Application Function

Filled with plans for fundamental information technology development and procurement, including: significant changes to information technology configuration or core applications, procurement of new core applications, cooperation with information technology service providers, and/or other fundamental information technology development and procurement that can add and/or increase the Pension Fund's risk. Additionally, information regarding information technology development and maintenance costs must be filled in.

Reasons and Considerations*
.........................................................................................................................
.........................................................................................................................
...................

Filled with reasons/considerations in compiling the fundamental information technology development and procurement plan.

Strategy*
.........................................................................................................................
.........................................................................................................................
...................

Filled with strategies to realize the fundamental information technology development and procurement plan.

Format 11: Report on Plans and Realization of Activities to Improve Financial Literacy and Inclusion for Consumers and/or the Public

Plan for Activities to Improve Financial Literacy for Consumers and/or the Public
The format for the Report on Plans and Realization of Activities to Improve Financial Literacy for Consumers and/or the Public as referred to in the Financial Services Authority Regulation regarding the Improvement of Financial Literacy and Inclusion in the Financial Services Sector for Consumers and/or the Public refers to the format contained in the Appendix of the Financial Services Authority Circular Letter regarding the Implementation of Activities to Improve Financial Literacy in the Financial Services Sector.

Report on Plan for Activities to Improve Financial Literacy
PLAN REPORT FOR ACTIVITIES TO IMPROVE FINANCIAL LITERACY PERIOD: January to December ... (filled with year) … (filled with financial services business actor name)

No. Plan Component

Activity Name
…................................
(filled with the name of the activity describing the activity)
Activity Objective
….................................
(filled with the objective of the activity to be achieved by the Financial Services Business Actor)
Form of Implementation
Financial Education
☐ Socialization
☐ Workshop
☐ Consultation
☐ Assistance
☐ Simulation
☐ Training of Community
☐ Outreach program
☐ Others: … (specify)
Infrastructure Development
☐ Training of trainers
☐ Training of facilitators
☐ E-learning development
☐ Website development
☐ Mobile application development
☐ Compilation/development of Financial Education modules/materials ☐ Others: … (specify) (put a mark on one of the choices) Category ☐ New ☐ Continuation (put a mark on one of the choices)
Implementation Method and Measurement Method and Tools
Implementation Method
Direct
☐ Face-to-face
☐ Live broadcast with tools: … (specify) ☐ Others: … (specify)

Measurement Method
Financial Education
☐ Comparing results before and after activity implementation (pre and post test) ☐ Opinion polls for specific segments regarding:
☐ Benefits,
☐ Ease of understanding material,
☐ Suitability with target,
☐ Others: … (specify)
☐ Surveys to determine individual/group financial literacy levels ☐ Others: … (specify) (can be filled with more than one)

Tools
☐ Written
☐ Electronic media
☐ Online system
☐ Others: … (specify)

Infrastructure Development
HR
☐ Comparing results before and after activity implementation (pre and post test) ☐ Others: … (specify) Non-HR ☐ Observation of infrastructure development completion ☐ Others: … (specify) ☐ Test of suitability of infrastructure function development for specific targets ☐ Others: … (specify) (can be filled with more than one)

Implementation Method
Indirect, via media
☐ Electronic: … (specify)
☐ Print
☐ Others: … (specify)

Measurement Method
Financial Education
Comparing results before and after activity implementation (pre and post test) ☐ Opinion polls for specific segments regarding:
☐ Benefits,
☐ Ease of understanding material,
☐ Suitability with target,
☐ Others: … (specify)
☐ Surveys to determine individual/group financial literacy levels ☐ Others: … (specify) (can be filled with more than one)

Tools
☐ Written
☐ Electronic media
☐ Online system
☐ Others: … (specify)

Infrastructure Development
HR
☐ Comparing results before and after activity implementation (pre and post test) ☐ Others: … (specify) Non-HR ☐ Observation of infrastructure development completion ☐ Test of suitability of infrastructure function development for specific targets ☐ Others: … (specify) (can be filled with more than one)

Category
☐ New
☐ Continuation
(put a mark on one of the choices)

Material
a. Financial Management, including:
☐ Identification of personal/company financial health ☐ Financial management objectives ☐ Stages in financial management ☐ Recording of owned assets ☐ Recording of income and expenses (budgeting), including taxation, identification of income and regular/non-regular monthly/annual expenses ☐ Planning programs for future financial goals ☐ Others: … (specify) b. Types of financial services industry and characteristics of financial services products and/or services Types of financial services industry:
☐ Banking
☐ Capital Market
☐ Insurance
☐ Pension Funds
☐ Financing Institutions
☐ Guarantee Institutions
☐ Pawnshops
☐ Other financial services institutions: … (specify) (can be filled with more than one) Characteristics of financial services products and/or services, including:
☐ Benefits
☐ Costs
☐ Risks
☐ Consumer rights
☐ Consumer obligations
☐ How to access or obtain
☐ Transaction mechanism information
☐ Complaint handling and dispute resolution mechanisms ☐ Others … (specify)
c. Taxation
☐ Taxation related to financial services products and/or services Category ☐ New ☐ Continuation (put a mark on one of the choices)
Target
☐ Informal workers
☐ Farmers
☐ Fishermen
☐ Teachers
☐ Lecturers
☐ Educators
☐ Professionals: … (specify)
☐ Employees
☐ Merchants
☐ MSME Actors
☐ Women
☐ Students
☐ University Students
☐ Youth
☐ Pensioners
☐ Indonesian Workers (TKI)
☐ Prospective Indonesian Workers (CTKI)
☐ Families of Indonesian Workers (KTKI)
☐ Persons with Disabilities
☐ Social Welfare Problem Community Groups (PMKS): … (specify) ☐ Underdeveloped, remote, and outermost region communities ☐ Communities: … (specify) ☐ General public ☐ Others: … (specify) (put a mark on one of the choices) Category ☐ New ☐ Continuation (for individual/group community participants; does not apply to General Public Target) (put a mark on one of the choices)
Number of Participants
… people
(filled with the number of participants)
Implementation Schedule
: Started … finished …
(filled with planned date and/or month of implementation)
Implementation Area
Province
☐ Aceh
☐ Bali
☐ Banten
☐ Bengkulu
☐ Gorontalo
☐ DKI Jakarta
☐ Jambi
☐ West Java
☐ Central Java
☐ East Java
☐ West Kalimantan
☐ South Kalimantan
☐ Central Kalimantan
☐ East Kalimantan
☐ North Kalimantan
☐ Bangka Belitung Islands
☐ Riau Islands
☐ Lampung
☐ Maluku
☐ North Maluku
☐ West Nusa Tenggara
☐ East Nusa Tenggara
☐ Papua
☐ West Papua
☐ Riau
☐ West Sulawesi
☐ South Sulawesi
☐ Central Sulawesi
☐ Southeast Sulawesi
☐ North Sulawesi
☐ West Sumatra
☐ South Sumatra
☐ North Sumatra
☐ DI Yogyakarta
☐ All of Indonesia
(filled if implemented domestically and can be filled with more than one) Regency/City … (filled if applicable) Other Areas … (filled if applicable) Category ☐ New ☐ Continuation (put a mark on one of the choices)
Implementation Frequency
… times
Cost Source
☐ Financial education budget
☐ CSR budget
☐ Other budget: … (specify)
(put a mark on one of the choices)
Cost Amount (in rupiah)
…
(filled with the planned amount of cost allocated for each activity)
Monitoring Parameters:
Financial Education
☐ Suitability of activity form
☐ Suitability of material
☐ Suitability of participant target
☐ Suitability of participant number
☐ Others: … (specify)
(can be filled with more than one)

Infrastructure Development
HR
☐ Suitability of activity form
☐ Suitability of material
☐ Suitability of participant target
☐ Suitability of participant number
☐ Others: … (specify)
Non-HR
☐ Suitability of infrastructure development stages

☑ Compliance with the implementation of the infrastructure development scope of work ☑ Others: … (specify) (can be filled in more than one)

Form of Monitoring
(refers to monitoring parameters completed with the form of monitoring) ☑ Direct visit ☑ Others: … (specify) (can be filled in more than one)
Evaluation Parameters
Financial Education
☑ Knowledge
☑ Skills
☑ Confidence
☑ Attitude
☑ Behavior
☑ Others: … (specify)
(can be filled in more than one)

Infrastructure Development
Human Resources (HR)
☑ Ability of trainers/facilitators to deliver teaching materials ☑ Others: … (specify)

Non-HR
☑ Availability of infrastructure in the form of: … (specify) ☑ Compliance of infrastructure function with the purpose of infrastructure development ☑ Others: … (specify) (can be filled in more than one)

Form of Evaluation
☑ Considering administrative data such as activity reports, implementation documentation, and/or results of interviews with participants and/or activity staff ☑ Considering data and reports from previous periods to know trends and patterns ☑ Conducting an analysis of success or achievement through comparison between activity planning and realization ☑ Analyzing information regarding the compliance of activities aimed at increasing Financial Literacy with the determined targets ☑ Others: … (specify) (can be filled in more than one)
Notes
☑ Role of each party in terms of Financial Institution Entities (PUJK) collaborating with other PUJK:
… (party 1 name)
… (description of party 1's role),
… (party 2 name)
… (description of party 2's role), etc.
☑ Working together with other parties:
… (party 1 name)
… (description of party 1's role),
… (party 2 name)
… (description of party 2's role), etc.

Additional Information:
This is additional information considered necessary to further explain the Financial Literacy activities conducted by the PUJK. ... (description)

Compliance with Financial Literacy Principles No. Principle Compliance with Principle

Planned and Measurable
Automatically filled if the PUJK fills table 1 numbers 3 – 12 and/or 13 – 14 and/or 15 – 16
Achievement-Oriented
Automatically filled if the PUJK fills table 1 numbers 2, 6, 7, and 11
Sustainable
Automatically filled if the PUJK fills the "Continuing" Category in one of table 1 numbers 3, 4, 5, 6, and 9
Collaboration
Automatically filled if the PUJK fills table 1 number 17 with a description of cooperation with PUJK and/or other parties.

Activity Realization Report in the Context of Increasing Financial Literacy

ACTIVITY REALIZATION REPORT
IN THE CONTEXT OF INCREASING FINANCIAL LITERACY PERIOD: January to December ... (filled with the year) … (filled with the name of the financial services business entity)

No. Component Realization Notes

Activity Name
…................................
(filled with the name of the activity describing the activity)
Activity Objective
….................................
(filled with the objective of the activity achieved by the PUJK)
Form of Implementation
Financial Education
☑ Socialization
☑ Workshop
☑ Consultation
☑ Assistance
☑ Simulation
☑ Training of Community
☑ Outreach program
☑ Others: … (specify)

Infrastructure Development
☑ Training of trainers
☑ Training of facilitators
☑ E-learning development
☑ Website development
☑ Mobile application development
☑ Preparation/development of Financial Education modules/materials ☑ Others: … (specify) (check one option)

Category
☑ New
☑ Continuing
(check one option)

Implementation Method and Measurement Method and Tools
Implementation Method
Direct
☑ Face-to-face
☑ Live broadcast with tools: … (specify) ☑ Others: … (specify)

Measurement Method
Financial Education
☑ Comparing results before and after activity implementation (pre and post test) ☑ Opinion polls for specific segments regarding:
☑ benefits,
☑ ease of material understanding,
☑ compliance with targets,
☑ others: … (specify)

Measurement Tools
☑ Written
☑ Electronic media
☑ Online system
☑ Others: … (specify)

☑ Surveys to determine the financial literacy level of specific individuals/groups ☑ Others: … (specify) (can be filled in more than one)

Infrastructure Development
HR
☑ Comparing results before and after activity implementation (pre and post test) ☑ Others: … (specify)

Non-HR
☑ Observation of infrastructure development completion ☑ Testing the compliance of infrastructure function development for specific targets ☑ Others: … (specify) (can be filled in more than one)

Implementation Method
Indirect, via media
☑ Electronic: … (specify)
☑ Printed
☑ Others: … (specify)

Measurement Method
Financial Education
Comparing results before and after activity implementation (pre and post test) ☑ Opinion polls for specific segments regarding:
☑ benefits,
☑ ease of material understanding,
☑ compliance with targets,
☑ others: … (specify)

Measurement Tools
☑ Written
☑ Electronic media
☑ Online system
☑ Others: … (specify)

☑ Surveys to determine the financial literacy level of specific individuals/groups ☑ Others: … (specify) (can be filled in more than one)

Infrastructure Development
HR
☑ Comparing results before and after activity implementation (pre and post test) ☑ Others: … (specify)

Category
☑ New
☑ Continuing
(check one option)

Materials
a. Financial Management, including:
☑ Identification of personal/company financial health ☑ Financial management objectives ☑ Stages in financial management ☑ Recording of owned assets/wealth ☑ Recording of income and expenses (budgeting), including taxation, identification of income and regular/non-regular monthly/annual expenses ☑ Planning programs for future financial goals ☑ Others: … (specify) (can be filled in more than one)

b. Types of financial services industry and characteristics of financial services products and/or services Types of financial services industry:
☑ Banking
☑ Capital market
☑ Insurance
☑ Pension funds
☑ Financing institutions
☑ Guarantee institutions
☑ Pawnshops
☑ Other financial services institutions: … (specify) (can be filled in more than one)

Characteristics of financial services products and/or services, including:
☑ Benefits
☑ Costs
☑ Risks
☑ Consumer rights
☑ Consumer obligations
☑ How to access or obtain
☑ Information on transaction mechanisms
☑ Mechanism for handling complaints and dispute resolution ☑ Others … (specify) (can be filled in more than one)

c. Taxation
☑ Taxation related to financial services products and/or services Category ☑ New ☑ Continuing (check one option)

Targets
☑ Informal workers
☑ Farmers
☑ Fishermen
☑ Teachers
☑ Lecturers
☑ Educators
☑ Professionals: … (specify)
☑ Employees
☑ Merchants
☑ MSME Actors
☑ Women
☑ Students
☑ University Students
☑ Youth
☑ Pensioners
☑ Indonesian Workers (TKI)
☑ Prospective Indonesian Workers (CTKI)
☑ Families of Indonesian Workers (KTKI)
☑ Persons with Disabilities
☑ Social Welfare Issue Community Groups (PMKS): … (specify) ☑ Communities in underdeveloped, remote, and outermost regions ☑ Communities: … (specify) ☑ General public ☑ Others: … (specify) (check one option)

Category
☑ New
☑ Continuing (for individual/group participants of the same community; does not apply to General Public Targets) (check one option)

Number of Participants
… people
(filled with the number of participants)
Implementation Schedule
: Started … finished …
(filled with the planned date and/or month of implementation)
Implementation Area
Province
☑ Aceh
☑ Bali
☑ Banten
☑ Bengkulu
☑ Gorontalo
☑ DKI Jakarta
☑ Jambi
☑ West Java
☑ Central Java
☑ East Java
☑ West Kalimantan
☑ South Kalimantan
☑ Central Kalimantan
☑ East Kalimantan
☑ North Kalimantan
☑ Bangka Belitung Islands
☑ Riau Islands
☑ Lampung
☑ Maluku
☑ North Maluku
☑ West Nusa Tenggara
☑ East Nusa Tenggara
☑ Papua
☑ West Papua
☑ Riau
☑ West Sulawesi
☑ South Sulawesi
☑ Central Sulawesi
☑ Southeast Sulawesi
☑ North Sulawesi
☑ West Sumatra
☑ South Sumatra
☑ North Sumatra
☑ Special Region of Yogyakarta
☑ All of Indonesia
(filled if implemented within the country and can be filled in more than one)

Regency/City
…
(filled if applicable)

Other Areas
…
(filled if applicable)

Category
☑ New
☑ Continuing
(check one option)

Implementation Frequency
… times
Source of Funds
☑ Financial education budget
☑ CSR budget
☑ Other budgets: … (specify)
(check one option)
Cost Amount
(in rupiah)
…
(filled with the realized amount of funds allocated for each activity)
Monitoring Parameters:
Financial Education
☑ Compliance of activity form
☑ Compliance of materials
☑ Compliance of participant targets
☑ Compliance of participant numbers
☑ Others: … (specify)
(can be filled in more than one)

Infrastructure Development
HR
☑ Compliance of activity form
☑ Compliance of materials
☑ Compliance of participant targets
☑ Compliance of participant numbers
☑ Others: … (specify)
(can be filled in more than one)

Non-HR
☑ Compliance of infrastructure development stages ☑ Compliance with the implementation of the infrastructure development scope of work ☑ Others: … (specify) (can be filled in more than one)

Form of Monitoring
(refers to monitoring parameters completed with the form of monitoring) ☑ Direct visit ☑ Others: … (specify) (can be filled in more than one)
Evaluation Parameters
Financial Education
☑ Knowledge
☑ Skills
☑ Confidence
☑ Attitude
☑ Behavior
☑ Others: … (specify)
(can be filled in more than one)

Infrastructure Development
HR
☑ Ability of trainers/facilitators to deliver teaching materials ☑ Others: … (specify)

Form of Evaluation
☑ Considering administrative data such as activity reports, implementation documentation, and/or results of interviews with participants and/or activity staff ☑ Considering data and reports from previous periods to know trends and patterns ☑ Conducting an analysis of success or achievement through comparison between activity planning and realization ☑ Analyzing information regarding the compliance of activities aimed at increasing Financial Literacy with the determined targets ☑ Others: … (specify) (can be filled in more than one)
Measurement Results
(systematically refers to the measurement method used, completed with measurement results) Financial Education ☑ Comparing results before and after activity implementation (pre and post test) ☑ Increased, ...% ☑ Unchanged ☑ Decreased, ...% ☑ ...% results of opinion polls (according to the topic of the opinion poll conducted) ☑ ...% results of surveys on the financial literacy level of specific individuals/groups (according to the determined group) ☑ ... (filled with other measurement results)

Infrastructure Development HR
☑ Comparing results before and after activity implementation (pre and post test) ☑ Increased, ...% ☑ Unchanged ☑ Decreased, ...% ☑ Others: ...(specify)

Non-HR
☑ ...% completion of infrastructure development ☑ ...% results of assessments of specific targets in testing the compliance of infrastructure function development results ☑ Others: ... (filled with other measurement results)

Monitoring Results
Monitoring Results
(systematically refers to monitoring parameters completed with adjustment options) ☑ Compliant with plans, ... (description) ☑ Not compliant with plans, ... (description)
Evaluation Results ... (description of measurement results linked with analysis of opportunities and challenges of activity implementation)
Evaluation Results
(systematically refers to evaluation parameters completed with adjustment options) Financial Education ☑ Increased, ... (description) ☑ Unchanged, ... (description) ☑ Decreased, ... (description)

Infrastructure Development HR
☑ Ability of trainers/facilitators to deliver teaching materials ☑ Good, ... (description) ☑ Fairly good, ... (description) ☑ Poor ... (description) ☑ Others: ... (specify)

Non-HR
☑ Infrastructure availability:
☑ Available in the form of: ... (specify) ☑ Not available ☑ Compliance of infrastructure function:
☑ Compliant: ... (description)
☑ Not compliant
☑ Others: ... (specify)

Notes
☑ Role of each party in terms of Financial Institution Entities (PUJK) collaborating with other PUJK:
… (party 1 name)
… (description of party 1's role),
… (party 2 name)
… (description of party 2's role), etc.
☑ Working together with other parties:
… (party 1 name)
… (description of party 1's role),
… (party 2 name)
… (description of party 2's role), etc.

Additional Information:
This is additional information considered necessary to further explain the Financial Literacy activities conducted by the PUJK. ... (description)

Compliance with Financial Literacy Principles No. Principle Compliance with Principle

Planned and Measurable
Automatically filled if the PUJK fills table 1 numbers 3 –12 and/or 13 –14 and/or 15 –16
Achievement-Oriented
Automatically filled if the PUJK fills table 1 numbers 2, 6, 7, and 11
Sustainable
Automatically filled if the PUJK fills the "Continuing" Category in one of table 1 numbers 3, 4, 5, 6, and 9
Collaboration
Automatically filled if the PUJK fills table 1 number 20 with a description of cooperation with PUJK and/or other parties.
Activity Planning and Realization Report in the Context of Increasing Financial Inclusion for Consumers and/or the Community

The form of the Activity Planning and Realization Report in the context of Increasing Financial Inclusion for Consumers and/or the Community as referred to in the Financial Services Authority Regulation regarding the Enhancement of Financial Literacy and Inclusion in the Financial Services Sector for Consumers and/or the Community refers to the form as stated in the Appendix of the Financial Services Authority Circular Letter regarding the Implementation of Activities in the Context of Increasing Financial Inclusion in the Financial Services Sector.

Activity Planning Report in the Context of Increasing Financial Inclusion

ACTIVITY PLANNING REPORT
IN THE CONTEXT OF INCREASING FINANCIAL INCLUSION PERIOD: January to December ... (filled with the year) … (filled with the name of the financial services business entity)

No. Component Plan

Scope of Activity
☑ Expansion of Access
☑ Provision of financial services products and/or services (check one option)
Activity Name
…
(filled with the name of the activity describing the activity)
Form of Implementation
Expansion of Access
☑ Addition of office networks
☑ Addition of cooperation with other parties ☑ Addition of infrastructure that can support the expansion of public financial access: … (specify) ☑ Addition of distribution channels for financial services products and/or services: … (specify) ☑ Facilities for community groups with special needs: … (specify) ☑ Others: … (specify)

Provision of financial services products and/or services ☑ Creation of schemes: … (specify) ☑ Development of financial services products and/or services: … (specify) ☑ Others: … (specify) (check one option)

Category
☑ New
☑ Continuing
(check one option)

Targets
☑ Informal workers
☑ Farmers
☑ Fishermen
☑ Educational institutions
☑ Professionals
☑ Employees
☑ Merchants
☑ MSME Actors
☑ Women
☑ Students
☑ Youth
☑ Pensioners
☑ Indonesian Workers (TKI)
☑ Prospective Indonesian Workers (CTKI)
☑ Families of Indonesian Workers (KTKI)
☑ Persons with Disabilities
☑ Social Welfare Issue Community Groups (PMKS): … (specify) ☑ Communities in underdeveloped, remote, and outermost regions ☑ Communities: … (specify) ☑ General public ☑ Others: … (specify) (check one option)

Category
☑ New
☑ Continuing
(check one option)

Target Users
Number ... users
(filled with the number of users)
Schedule
Started … finished …
(filled with the date and/or month of implementation)
Area
Province
☑ Aceh
☑ Bali
☑ Banten
☑ Bengkulu
☑ Gorontalo
☑ DKI Jakarta
☑ Jambi
☑ West Java
☑ Central Java
☑ East Java
☑ West Kalimantan
☑ South Kalimantan
☑ Central Kalimantan
☑ East Kalimantan
☑ North Kalimantan
☑ Bangka Belitung Islands
☑ Riau Islands
☑ Lampung
☑ Maluku
☑ North Maluku
☑ West Nusa Tenggara
☑ East Nusa Tenggara
☑ Papua
☑ West Papua
☑ Riau
☑ West Sulawesi
☑ South Sulawesi
☑ Central Sulawesi
☑ Southeast Sulawesi
☑ North Sulawesi
☑ West Sumatra
☑ South Sumatra
☑ North Sumatra
☑ Special Region of Yogyakarta
☑ All of Indonesia
(filled if implemented within the country and can be filled in more than one)

Regency/City
…
(filled if applicable)

Other Areas
…
(filled if applicable)

Category
☑ New
☑ Continuing
(check one option)

Parameters
Increase in access to institutions, financial services products and/or services ☑ Addition of office networks ☑ Addition of cooperation with other parties ☑ Addition of infrastructure that can support the expansion of public financial access ☑ Addition of distribution channels for financial services products and/or services ☑ Others: … (specify)

Increase in the availability of financial services products and/or services ☑ Addition of types of financial services products and/or services available according to community needs and capabilities at various distribution channels ☑ Others: … (specify)

Increase in the use of financial services products and/or services ☑ Addition of the number of savings/credit/financing/securities/pension fund accounts ☑ Addition of the number of transactions ☑ Addition of the number of insurance policies ☑ Addition of the number of guarantee certificates ☑ Addition of the number of business pairs and/or venture capital debtors ☑ Addition of the number of pawn transactions ☑ Others: … (specify)

Increase in the quality of use of financial services products and services according to community needs and capabilities ☑ Increase in the number of Consumers who not only use similar financial services products and/or services, but also use other financial services products and/or services ☑ Increase in Consumer capabilities that can measure and analyze financial services products and/or services that can encourage an increase in the frequency of utilization of financial services products and/or services and, if needed, are able to utilize complaint/ dispute resolution services appropriate to the financial management goals to be achieved ☑ Others: … (specify) (can be filled in more than one)

Form of Monitoring
Form of Monitoring
(refers to monitoring parameters completed with the form of monitoring) ☑ Field ☑ Via reports ☑ Others: … (specify) (can be filled in more than one)

done by
(refers to the form of monitoring)
☑ Monthly
☑ Quarterly
☑ Yearly
☑ Other periods: … (specify)
(can be filled in more than one)

Evaluation
☑ Considering administrative data such as activity reports and implementation documentation ☑ Considering data and reports from previous periods ☑ Conducting an analysis of success or achievement through comparison of planning and realization of activities ☑ Analyzing information regarding the compliance of activities aimed at increasing Financial Inclusion with the determined targets ☑ Others: … (specify) (can be filled in more than one)
Notes
☑ Role of each party in terms of Financial Institution Entities (PUJK) collaborating with other PUJK:
… (party 1 name)
… (description of party 1's role),
… (party 2 name)
… (description of party 2's role), etc.
(filled if applicable)

☑ Working together with other parties:

… (party 1 name)
… (description of party 1's role),
… (party 2 name)
… (description of party 2's role), etc.

Additional Information:
This is additional information considered necessary to further explain the Financial Literacy activities conducted by the PUJK. ... (description)

Compliance with Financial Inclusion Principles No. Principle Compliance with Principle

Measurable
Automatically filled if the PUJK fills table 1 numbers 5, 8, and 9 and/or 10
Affordable
Automatically filled if the PUJK fills table 1 numbers 3 and 8
Targeted
Automatically filled if the PUJK fills table 1 numbers 3, 4, and 5
Sustainable
Automatically filled if the PUJK fills the "Category" in table 1 number 3 completely, 4, and 7

Activity Realization Report in the Context of Increasing Financial Inclusion

ACTIVITY REALIZATION REPORT
IN THE CONTEXT OF INCREASING FINANCIAL INCLUSION PERIOD: January to December ... (filled with the year) … (filled with the name of the financial services business entity)

No. Component Plan Notes

Scope of Activity
☑ Expansion of Access
☑ Provision of financial services products and/or services (check one option)
Activity Name
…
(filled with the name of the activity describing the activity)
Form of Implementation
Expansion of Access
☑ Addition of office networks
☑ Addition of cooperation with other parties ☑ Addition of infrastructure that can support the expansion of public financial access: … (specify) ☑ Addition of distribution channels for financial services products and/or services: … (specify) ☑ Facilities for community groups with special needs: … (specify) ☑ Others: … (specify)

Category
☑ New
☑ Continuing
(check one option)

Targets
☑ Informal workers
☑ Farmers
☑ Fishermen
☑ Educational institutions
☑ Professionals
☑ Employees
☑ Merchants
☑ MSME Actors
☑ Women
☑ Students
☑ Youth
☑ Pensioners
☑ Indonesian Workers (TKI)
☑ Prospective Indonesian Workers (CTKI)
☑ Families of Indonesian Workers (KTKI)
☑ Persons with Disabilities
☑ Social Welfare Issue Community Groups (PMKS): … (specify) ☑ Communities in underdeveloped, remote, and outermost regions ☑ Communities: … (specify) ☑ General public ☑ Others: … (specify) (check one option)

Category
☑ New
☑ Continuing
(check one option)

Target Users
... users
(filled with the number of users)
Schedule
Started … finished …
(filled with the date and/or month of implementation)
Area
Province
☑ Aceh
☑ Bali
☑ Banten
☑ Bengkulu
☑ Gorontalo
☑ DKI Jakarta
☑ Jambi
☑ West Java
☑ Central Java
☑ East Java
☑ West Kalimantan
☑ South Kalimantan
☑ Central Kalimantan
☑ East Kalimantan
☑ North Kalimantan
☑ Bangka Belitung Islands
☑ Riau Islands
☑ Lampung
☑ Maluku
☑ North Maluku
☑ West Nusa Tenggara
☑ East Nusa Tenggara
☑ Papua
☑ West Papua
☑ Riau
☑ West Sulawesi
☑ South Sulawesi
☑ Central Sulawesi
☑ Southeast Sulawesi
☑ North Sulawesi
☑ West Sumatra
☑ South Sumatra
☑ North Sumatra
☑ Special Region of Yogyakarta
☑ All of Indonesia
(filled if implemented within the country and can be filled in more than one)

Regency/City
…
(filled if applicable)

Other Areas
…
(filled if applicable)

Category
☑ New
☑ Continuing
(check one option)

Parameters
Increase in access to institutions, financial services products and/or services ☑ Addition of office networks ☑ Addition of cooperation with other parties ☑ Addition of infrastructure that can support the expansion of public financial access ☑ Addition of distribution channels for financial services products and/or services ☑ Others: … (specify)

Form of Monitoring
Form of Monitoring
(refers to monitoring parameters completed with the form of monitoring) ☑ Field ☑ Via reports ☑ Others: … (specify) (can be filled in more than one)

done by
(refers to the form of monitoring)
☑ Monthly
☑ Quarterly
☑ Yearly
☑ Other periods: … (specify)
(can be filled in more than one)

Evaluation
☑ Considering administrative data such as activity reports and implementation documentation ☑ Considering data and reports from previous periods ☑ Conducting an analysis of success or achievement through comparison of planning and realization of activities ☑ Analyzing information regarding the compliance of activities aimed at increasing Financial Inclusion with the determined targets ☑ Others: … (specify) (can be filled in more than one)
Notes
☑ Role of each party in terms of Financial Institution Entities (PUJK) collaborating with other PUJK:
… (party 1 name)
… (description of party 1's role),
… (party 2 name)
… (description of party 2's role), etc.
(filled if applicable)

☑ Working together with other parties:

… (party 1 name)
… (description of party 1's role),
… (party 2 name)
… (description of party 2's role), etc.

Additional Information:
This is additional information considered necessary to further explain the Financial Literacy activities conducted by the PUJK. ... (description)

☐ Addition of types of products and/or financial services available according to the needs and capabilities of the community through various distribution channels ☐ Others: … (specify)

Increase in the use of products and/or financial services ☐ Increase in the number of savings/credit/financing/securities/pension fund accounts ☐ Increase in the number of transactions ☐ Increase in the number of insurance policies ☐ Increase in the number of guarantee certificates ☐ Increase in the number of business partners and/or venture capital debtors ☐ Increase in the number of pawn transactions ☐ Others: … (specify)

Increase in the quality of use of products and financial services according to the needs and capabilities of the community ☐ Increase in the number of Consumers who not only use similar products and/or financial services, but also use other products and/or financial services ☐ Increase in Consumer ability to measure and analyze products and/or financial services that can drive an increase in the frequency of utilization of products and/or financial services and, when needed, the ability to utilize complaint/dispute resolution services appropriate for the financial management goals to be achieved ☐ Others: … (specify) (can be filled in more than one)

Monitoring Form
Monitoring Form
(referring to monitoring parameters, supplemented with monitoring forms) ☐ Field ☐ Through reports ☐ Others: … (specify) (can be filled in more than one)

Conducted
(referring to the monitoring form)
☐ Monthly
☐ Quarterly
☐ Annually
☐ Other periods: … (specify)
(can be filled in more than one)

Evaluation
☐ Considering administrative data such as activity reports and implementation documentation ☐ Considering data and reports from previous periods ☐ Conducting analysis of success or achievement through comparison of planning and activity realization ☐ Analyzing information regarding the suitability of activities aimed at increasing Financial Inclusion with the set targets ☐ Others: … (specify) (can be filled in more than one)
Monitoring Results
Monitoring Results and/or
Evaluation
(systematically refers to parameters supplemented with monitoring results)

Increase in access to institutions, products and/or financial services Before After ☐ Number of office networks …(filled with number) …(filled with number) ☐ Number of collaborations with other parties …(filled with number) …(filled with number) ☐ Addition of infrastructure that can support the expansion of community financial access …(filled with number) …(filled with number) ☐ Addition of distribution channels for products and/or financial services …(filled with number) …(filled with number) ☐ Others: ... (specify) …(filled with number/percentage) …(filled with number/percentage)

Increase in the availability of products and/or financial services Before After ☐ Number of types of products and/or financial services available according to the needs and capabilities of the community through various distribution channels …(filled with number) …(filled with number) ☐ Others: ... (specify) …(filled with number/percentage) …(filled with number/percentage)

Increase in the use of products and/or financial services Before After ☐ Addition of savings/credit/financing/securities/pension fund accounts …(filled with number) …(filled with number) ☐ Addition of the number of transactions …(filled with number) …(filled with number) ☐ Addition of the number of insurance policies …(filled with number) …(filled with number) ☐ Addition of the number of guarantee certificates …(filled with number) …(filled with number) ☐ Addition of the number of business partners and/or venture capital debtors …(filled with number) …(filled with number) ☐ Addition of pawn transactions …(filled with number) …(filled with number) ☐ Others: ... (specify) …(filled with number) …(filled with number)

Increase in the quality of use of products and financial services according to the needs and capabilities of the community Before After ☐ Increase in the number of Consumers who not only use similar products and/or financial services, but also use other products and/or financial services …(filled with number) …(filled with number) ☐ Increase in Consumer ability to measure and analyze products and/or financial services that can drive an increase in the frequency of utilization of products and/or financial services and, when needed, the ability to utilize complaint/dispute resolution services appropriate for the financial management goals to be achieved …(filled with condition) …(filled with condition) ☐ Others: ... (specify) …(filled with number/condition) …(filled with number/condition)

Evaluation Results
…
(description of the analysis of monitoring results linked to the opportunities and challenges of activity implementation)

Notes
☐ The role of each party in PUJK collaborating with other PUJK:
… (party 1 name)
… (description of party 1's role),
… (party 2 name)
… (description of party 2's role), etc.
☐ Collaboration with other parties:
… (party 1 name)
… (description of party 1's role),
… (party 2 name)
… (description of party 2's role), etc.

Other Information:
Additional information considered necessary to further explain the Financial Literacy activities conducted by PUJK. ... (description)

Fulfillment of Financial Inclusion Principles No. Principle Fulfillment of Principle

Measurable Automatically filled if PUJK fills table 1 numbers 5, 8, and 9 and/or 10
Affordable Automatically filled if PUJK fills table 1 numbers 3 and 8
Targeted Automatically filled if PUJK fills table 1 numbers 3, 4, and 5
Sustainable Automatically filled if PUJK fills the “Category” in table 1 number 3 completely, 4, and 7

Format 12: Financial Statement Projections

Net Asset Report Projection for Pension Funds
(in full rupiah units)

DESCRIPTION
Actual as of 30 Sept 20XX-1
Projection as of 31 Dec 20XX-1
As of 30 Jun 20XX
As of 31 Dec 20XX

ASSETS
INVESTMENTS
Bank Savings
On-call Deposits at Banks
Term Deposits at Banks
Bank Deposit Certificates
Sharia Securities issued by Bank Indonesia Sharia State Securities Sharia Stocks listed on the Indonesia Stock Exchange Corporate Sukuk listed on the Indonesia Stock Exchange Regional Sukuk Sharia Mutual Funds Sharia MTN Sharia Asset-Backed Securities Sharia real estate investment funds in the form of collective investment contracts Sharia infrastructure investment funds in the form of collective investment contracts Sharia option contracts and Sharia effect forward contracts listed on the Indonesia Stock Exchange REPO Direct Participation Land in Indonesia Buildings in Indonesia Land and Buildings in Indonesia TOTAL INVESTMENTS CURRENT ASSETS OUTSIDE INVESTMENTS Cash and Banks Prepaid Expenses Investment Receivables Investment Income Receivables Other Receivables TOTAL CURRENT ASSETS OUTSIDE INVESTMENTS AVAILABLE ASSETS LIABILITIES

DESCRIPTION
Actual as of 30 Sept 20XX-1
Projection as of 31 Dec 20XX-1
As of 30 Jun 20XX
As of 31 Dec 20XX

Liabilities outside Pension Benefit Liabilities Pension Benefit and Other Benefits Payable Due Voluntary Benefit Payables Investment Payables Unearned Revenue Expenses Still to be Paid Other Payables Total Liabilities outside Pension Benefit Liabilities

-
TOTAL LIABILITIES - -
NET ASSETS

Notes:

If the business plan submission is for the year 2020, then 20XX-1 is the year 2019 (current year), 20XX is the year 2020, etc.
Net Asset Nominal is equal to the Net Asset Nominal at the End of the Period in the Projection of the Statement of Changes in Net Assets.
Net Asset Nominal at the End of the Period is equal to Net Assets in the Projection of the Net Asset Report.

Projection of the Statement of Changes in Net Assets
(in full rupiah units)

DESCRIPTION
Actual as of 30 Sept 20XX-1
Projection as of 31 Dec 20XX-1
As of 30 Jun 20XX
As of 31 Dec 20XX

ADDITIONS

DESCRIPTION
Actual as of 30 Sept 20XX-1
Projection as of 31 Dec 20XX-1
As of 30 Jun 20XX
As of 31 Dec 20XX

Investment Income
Interest/Profit Sharing -
Dividends -
Rent -
Profit (Loss) on Investment Disposal -
Other Investment Income -
Total Investment Income
Increase (Decrease) in Investment Value
Contributions
Income Outside Investment
Transfer of Funds from Other Pension Funds Total Additions

DEDUCTIONS
Investment Expenses
Operational Expenses
Expenses Outside Investment and Operations Pension Benefits and Other Benefits Income Tax Transfer of Funds to Other Pension Funds Contribution Withdrawals Total Deductions

INCREASE (DECREASE) IN NET ASSETS
NET ASSETS AT THE BEGINNING OF THE PERIOD NET ASSETS AT THE END OF THE PERIOD

Notes:

If the business plan submission is for the year 2020, then 20XX-1 is the year 2019 (current year), 20XX is the year 2020, etc.
Net Asset Nominal at the End of the Period is equal to Net Assets in the Projection of the Net Asset Report.

Format 13: Projection of Ratios and Other Specific Items, and Assumptions Used

Ratios and Other Specific Items
(ratios in percentage)

DESCRIPTION
Actual as of 30 Sept 20XX-1
Projection as of 31 Dec 20XX-1
As of 30 Jun 20XX
As of 31 Dec 20XX

Investment Income Ratio (ROI)
Investment Income Ratio against Assets (ROA) Operational Expense Ratio (BOPO)

Notes:

If the business plan submission is for the year 2020, then 20XX-1 is the year 2019 (current year), 20XX is the year 2020, etc.

Assumptions Used
Notes:

If the business plan submission is for the year 2020, then 20XX-1 is the year 2019 (current year), 20XX is the year 2020, etc.

No. DESCRIPTION
Actual as of 30 Sept 20XX-1
Projection as of 31 Dec 20XX-1
As of 30 Jun 20XX
As of 31 Dec 20XX

Rupiah exchange rate
Inflation rate
Investment return rate
etc. (other relevant assumptions)

Format 14: Other Information
Other information must at least include information that needs to be submitted because it affects the business activities of the Pension Fund, which is not mentioned in the scope of the Business Plan. Examples:
a. dissolution plan; b. membership transfer plan;
c. plan to change business activities from non-Sharia principles to Sharia principles; and
d. Sustainable Finance Action Plan based on POJK regarding the Implementation of Sustainable Finance for Financial Service Institutions, Issuers, and Public Companies.

F. Pension Fund Business Plan Realization Report The Business Plan Realization Report is in accordance with the provisions of Article 14 paragraph (5) of POJK Number 24/POJK.05/2019 concerning Business Plans for Non-Bank Financial Service Institutions, with a submission deadline no later than 1 (one) month after the relevant semester ends.

BUSINESS PLAN REALIZATION REPORT
Year ...............................
(filled with the name and address of the Pension Fund)

Approved,
Supervisory Board
(Pension Fund Stamp)

Name Clearly
Position
, 20xx

Manager,
(Pension Fund Stamp)

Name Clearly
Position

Explanation Regarding Business Plan Achievement
Filled with an explanation regarding the achievement of the Business Plan, including the achievement of the Business Plan and the comparison of plans and realizations, which must at least include:
realization of business activity plans as referred to in Format 5 in the pension fund business plan;
realization of business plan development or expansion plans as referred to in Format 6 in the pension fund business plan;
realization of investment plans as referred to in Format 7 in the pension fund business plan;
realization of financing plans as referred to in Format 8 in the pension fund business plan;
realization of office network or distribution channel development and/or change plans as referred to in Format 9 in the pension fund business plan;
realization of organizational, human resources, and/or information technology development plans as referred to in Format 10 in the pension fund business plan;
realization of financial statement projections, as referred to in Format 12 in the pension fund business plan;
realization of projections of ratios and other specific items, and assumptions used, as referred to in Format 13 in the pension fund business plan; and
filling of the business plan based on the business plan report last submitted to the OJK.
Explanation Regarding Deviations from Business Plan Realization

Realization of the Net Asset Report for Pension Funds
(in full rupiah units)

DESCRIPTION
Business Plan (1)
Realization (2)
Achievement % (2)/(1)

Liabilities Outside Pension Benefit Liabilities Pension Benefit and Other Benefits Payable Due Voluntary Benefit Payables Investment Payables Unearned Revenue Expenses Still to be Paid Other Payables Total Liabilities Outside Pension Benefit Liabilities TOTAL LIABILITIES NET ASSETS

Realization of the Statement of Changes in Net Assets
(in full rupiah units)

DESCRIPTION
Business Plan (1)
Realization (2)
Achievement % (2)/(1)

ADDITIONS
Investment Income
Interest/Profit Sharing
Dividends
Rent
Profit (Loss) on Investment Disposal
Other Investment Income
Total Investment Income
Increase (Decrease) in Investment Value
Contributions
Income Outside Investment
Transfer of Funds from Other Pension Funds Total Additions

INCREASE (DECREASE) IN NET ASSETS
NET ASSETS AT THE BEGINNING OF THE PERIOD NET ASSETS AT THE END OF THE PERIOD

Realization of Assumptions Used
Realization of Ratios and Other Specific Items

DESCRIPTION
Business Plan (1)
Realization (2)
Achievement % (2)/(1)

Investment Income Ratio (ROI)

DESCRIPTION
Business Plan (1)
Realization (2)
Deviation (2)-(1)

Rupiah exchange rate
Inflation rate
Investment return rate
etc. (other relevant assumptions)

DESCRIPTION
Business Plan (1)
Realization (2)
Achievement % (2)/(1)

Investment Income Ratio against Assets (ROA) Operational Expense Ratio (BOPO) Financing Ratio Solvency Ratio

Other Information
...............................................................................................................................
...............................................................................................................................
...............................................................................................................................
...............................................................................................................................
...............................................................................................................................
.............................................................

Filled with an explanation regarding the achievement of other information in the Business Plan and the comparison of plans and realizations.

Follow-up on Business Plan Achievement
....................................................................................................................
....................................................................................................................
..................................................

G. Business Plan Supervision Report
The Business Plan Supervision Report is in accordance with the provisions of Article 15 paragraph (1) of POJK Number 24/POJK.05/2019 concerning Business Plans for Non-Bank Financial Service Institutions, with a submission deadline no later than 1 (one) month after the relevant semester ends.

BUSINESS PLAN SUPERVISION REPORT
Year ...............................
(filled with the name and address of the Pension Fund) , 20xx

Supervisory Board
(Pension Fund Stamp)

Name Clearly
Position

H. Report on Data Updating Activities Plan and Report on the Realization of Customer Data Updating as Referred to in the Financial Services Authority Regulation Regarding the Implementation of Anti-Money Laundering and Counter-Terrorism Financing Programs in the Financial Service Sector.

I. Proof of Announcement of Annual Financial Reports Audited by Public Accountants on the DPLK Website and/or in Daily Newspapers Circulated Nationally in the Indonesian Language.

Established in Jakarta on date

EXECUTIVE HEAD OF INSURANCE, PENSION FUND, LENDING INSTITUTION, AND OTHER FINANCIAL SERVICE INSTITUTIONS SUPERVISOR FINANCIAL SERVICES AUTHORITY REPUBLIC OF INDONESIA, RISWINANDI

....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
.................................................
(filled with the Supervisory Board's assessment of the implementation of the Business Plan, including an assessment of quantitative and qualitative aspects of the Business Plan realization, including an assessment of good corporate governance factors for the Pension Fund, risk profile, profitability, and financing, and efforts to improve the Pension Fund's performance, if according to the relevant assessment the Pension Fund's performance shows a decline.)

APPENDIX III
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY REPUBLIC OF INDONESIA NUMBER /SEOJK.05/ CONCERNING THE FORM AND STRUCTURE OF PERIODIC REPORTS FOR PENSION FUNDS ADMINISTERING PENSION PROGRAMS BASED ON SHARIA PRINCIPLES

Package A Package B Package C Package D etc.
Assets
Net Assets
Investments a. Bank Savings b. On-call Deposits at Banks
c. Term Deposits at Banks
d. Bank Deposit Certificates e. Sharia Securities issued by Bank Indonesia f. Sharia State Securities g. Sharia Stocks listed on the Indonesia Stock Exchange h. Corporate Sukuk listed on the Indonesia Stock Exchange
i. Regional Sukuk
j. Sharia Mutual Funds k. Sharia MTN
l. Sharia Asset-Backed Securities
m. Sharia real estate investment funds in the form of collective investment contracts n. Sharia infrastructure investment funds in the form of collective investment contracts o. Sharia option contracts and Sharia effect forward contracts listed on the Indonesia Stock Exchange p. REPO q. Direct Participation r. Land in Indonesia s. Buildings in Indonesia t. Land and Buildings in Indonesia Current Assets a. Cash and Banks b. Prepaid Expenses
c. Investment Receivables
d. Investment Income Receivables e. Other Receivables Liabilities Outside Pension Benefit Obligations a. Pension Benefit and Other Benefits Payable Due b. Voluntary Benefit Payables
c. Investment Payables
d. Unearned Revenue e. Expenses Still to be Paid f. Other Payables Investment Business Results Increase (Decrease) in Investment Value Number of Participants

Established in Jakarta on January 21, 2021

EXECUTIVE HEAD OF INSURANCE, PENSION FUND, LENDING INSTITUTION, AND OTHER FINANCIAL SERVICE INSTITUTIONS SUPERVISOR FINANCIAL SERVICES AUTHORITY REPUBLIC OF INDONESIA, signature RISWINANDI

Pension Fund
Investment Package Report
As of DD-MM-YYYY
Sharia Package Account Name
This copy is consistent with the original Legal Director 1 Legal Department signature Mufli Asmawidjaja

Form and Structure of Periodic Reports for Pension Funds Administering Sharia-Compliant Pension Programs

Lineage: Superseded

Timeline

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