Form and Structure of Periodic Reports for Pension Funds Implementing Sharia-Based Pension Programs

To:

Management of Employer Pension Funds based on Sharia Principles;
Management of Financial Institution Pension Funds based on Sharia Principles;
Management of Employer Pension Funds that have a Sharia Unit; and
Management of Financial Institution Pension Funds that sell Sharia investment packages,
at their respective locations.

COPY
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 4 /SEOJK.05/2019 CONCERNING THE FORM AND STRUCTURE OF PERIODIC REPORTS OF PENSION FUNDS IMPLEMENTING PENSION PROGRAMS BASED ON SHARIA PRINCIPLES

In relation to the mandate of the provisions of Article 13 and Article 14 paragraph (3) of 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 provisions on the form, structure, and manner of submission of periodic reports of pension funds implementing 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 meant:

Pension Fund is a legal entity that manages and runs a program promising pension benefits, including Pension Funds that implement all or part of their business with Sharia principles.
Sharia Principles are Islamic legal provisions based on fatwas and/or Sharia conformity statements from the National Sharia Council of the Indonesian Ulema Council.
Sharia-Based Pension Program is a Pension Program implemented based on Sharia Principles.
Sharia-Based Pension Fund, hereinafter referred to as Sharia Pension Fund, is a Pension Fund whose entire activities are implemented based on Sharia Principles.
Employer Pension Fund, hereinafter abbreviated as DPPK, is a Pension Fund formed by a person or entity that employs employees, as the founder, to implement a defined benefit pension program or a defined contribution pension program, 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 formed by a bank or life insurance company to implement a defined contribution pension program for individuals, whether employees or self-employed workers, separate from the DPPK for employees of the respective bank or life insurance company.
Sharia Unit is a unit formed by a DPPK to implement a Sharia-Based Pension Program.
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 implementation of Sharia-Based Pension Programs.
Sharia Investment Package is a collection of investment types based on Sharia Principles offered by a DPLK.
Periodic Report is a report compiled by a Pension Fund for the benefit of the Financial Services Authority for a certain period.
Monthly Report is a report compiled by a Pension Fund for the benefit of the Financial Services Authority, covering the period from January 1 to the end of the relevant month.
Annual Report is a report compiled by a Pension Fund for the benefit of the Financial Services Authority, covering the period from January 1 to the end of the relevant year.
Other Reports are reports compiled by a Pension Fund for the benefit of the Financial Services Authority other than Monthly Reports and Annual Reports, submitted during a certain period.

II. FORM AND STRUCTURE OF PERIODIC REPORTS FOR PENSION FUNDS IMPLEMENTING SHARIA-BASED PENSION PROGRAMS

Periodic Reports of Pension Funds consist of:
a. Monthly Reports; b. Annual Reports; and
c. Other Reports.
Annual Reports as referred to in item 1 letter b consist of:
a. annual financial reports; and b. technical reports.
Annual financial reports as referred to in item 2 letter a consist of:
a. annual financial reports audited by a public accountant; and b. electronic data.
Periodic Reports for Sharia Pension Funds consist of Periodic Reports as referred to in item 1.
Periodic Reports for Sharia Units consist of Monthly Reports as referred to in item 1 letter a and Annual Reports in the form of annual financial reports as referred to in item 2 letter a.
Annual financial reports audited by a public accountant as referred to in item 3 letter a follow the applicable financial accounting standards in Indonesia.
For DPPK based on Sharia Principles including Sharia Units, the form and structure of Periodic Reports as referred to in item 1 are as stated 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 item 1 letter a and annual financial reports in the form of electronic data as referred to in item 3 letter b, for DPPK based on Sharia Principles including Sharia Units, implementing defined benefit pension programs, are as stated in Format IA; b. the form and structure of Monthly Reports as referred to in item 1 letter a and annual financial reports in the form of electronic data as referred to in item 3 letter b, for DPPK based on Sharia Principles including Sharia Units, implementing defined contribution pension programs, are as stated in Format IB;
c. the form and structure of technical reports as referred to in item 2 letter b are as stated in Format IC; and
d. the form and structure of Other Reports as referred to in item 1 letter c are as stated in Format ID.
For DPLK based on Sharia Principles, the form and structure of Periodic Reports as referred to in item 1 are as stated 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 item 1 letter a and annual financial reports in the form of electronic data as referred to in item 3 letter b are as stated in Format IIA; b. the form and structure of technical reports as referred to in item 2 letter b are as stated in Format IIB; and
c. the form and structure of Other Reports as referred to in item 1 letter c are as stated in Format IIC.
For DPLK selling Sharia Investment Packages, the form and structure of Periodic Reports as referred to in item 1 follow the provisions in the OJK Circular 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 stated in Appendix III which is an integral part of this Financial Services Authority Circular Letter.

III. PROCEDURE FOR SUBMISSION OF PERIODIC REPORTS

Submission of Periodic Reports is done online 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 item 1 is not yet available, experiences technical problems, or experiences force majeure, Sharia Pension Funds and Sharia Units must submit Periodic Reports online via electronic mail to the Financial Services Authority.
In order to submit online via electronic mail as referred to in item 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 submitting Periodic Reports to the Financial Services Authority.
Sharia Pension Funds and Sharia Units submit Periodic Reports offline, in the event that submission online via electronic mail as referred to in item 2 cannot be done due to technical problems or force majeure.
Submission of Periodic Reports offline is done with written notification accompanied by supporting documents in the form of Periodic Reports either using compact disc (CD) media or other electronic data storage media, and sent to the Financial Services Authority via a letter signed by the management, and addressed to:
Financial Services Authority attn. Director of Sharia Non-Bank Financial Institutions Wisma Mulia 2 Building, 15th Floor Jalan Jenderal Gatot Subroto Number 42 Jakarta 12710.
Submission of Periodic Reports offline as referred to in item 5 is done in one of the following ways:
a. handed over directly; or b. sent through a courier service company.
Sharia Pension Funds and Sharia Units are deemed to have submitted Periodic Reports with the following provisions:
a. for submission online 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
proof of sending electronic mail against reports sent to the Financial Services Authority's email address, in the event that sending through the data communication network cannot be done; or
b. for submission offline, evidenced by:
a receipt letter from the Financial Services Authority, if the report is handed over directly; or
a shipping receipt from the courier service company, if the report is sent through a courier service company.

IV. CLOSING PROVISIONS

The provisions in this Financial Services Authority Circular Letter shall take effect on May 1, 2019.
At the time this Financial Services Authority Circular Letter takes effect:
a. The Appendix in Financial Services Authority Circular Letter Number 5/SEOJK.05/2018 concerning the Report on the Results of Supervision by the Sharia Supervisory Board on Pension Funds Implementing Sharia-Based Pension Programs is revoked and declared invalid; and

This copy is in accordance with the original Director of Legal Affairs 1 Legal Department signed Yuliana

b. Appendix X in Financial Services Authority Circular Letter Number 10/SEOJK.05/2016 concerning Guidelines for the Implementation of Risk Management and Reports on the Results of Self-Assessment of Risk Management Implementation for Non-Bank Financial Service Institutions is declared invalid for Pension Funds that implement all or part of their business based on Sharia principles.

Determined in Jakarta on March 5, 2019 EXECUTIVE HEAD OF SUPERVISOR FOR INSURANCE, PENSION FUNDS, LENDING INSTITUTIONS, AND OTHER FINANCIAL SERVICE INSTITUTIONS FINANCIAL SERVICES AUTHORITY, signed RISWINANDI

APPENDIX I
FINANCIAL SERVICES AUTHORITY CIRCULAR LETTER NUMBER 4 /SEOJK.05/2019 CONCERNING THE FORM AND STRUCTURE OF PERIODIC REPORTS OF PENSION FUNDS THAT IMPLEMENT PENSION PROGRAMS BASED ON SHARIA PRINCIPLES

FORMAT IA
To
Yth. Directorate of Statistics and Information of Non-Bank Financial Institutions Financial Services Authority MONTHLY REPORT / ANNUAL FINANCIAL REPORT ELECTRONIC DATA DEFINED BENEFIT PENSION PROGRAM Per DD-MM-YYYY EMPLOYER PENSION FUND BASED ON SHARIA PRINCIPLES / 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 Audit Type Auditor Code Auditor Name Opinion Audit Executor Audit Date Report Compiler Officer Name Division Phone Fax Email Management Person in Charge Person in Charge Name Position Phone Fax E-mail Pension Fund Address

Description Details
Code
Percentage
Defined Benefit Pension Program Other Benefits Combined ASSETS SHARIA INVESTMENTS Bank Savings 1101 Call Deposits at Banks 1102 Time Deposits at Banks 1103 Bank Deposit Certificates 1104 Sharia-Based Securities Issued by Bank Indonesia 1105 Government Sharia Securities 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 Sharia Infrastructure Investment Funds in the form of Collective Investment Contracts 1115 Options Contracts and Forward Contracts for Sharia Securities Listed on the Indonesia Stock Exchange 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 Contribution Receivables

Normal Employer Contributions
Normal Participant Contributions
Voluntary Participant Contributions
Additional Contributions
Prepaid Expenses 1204
Investment Receivables 1205
Investment Income Receivables 1206 Other Receivables 1207 TOTAL CURRENT ASSETS OUTSIDE 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 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 ASSET REPORT Per DD-MM-YYYY

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

Normal Employer Contributions
Normal Participant Contributions
Voluntary Participant Contributions
Additional Contributions
Income Outside Investments 403
Transfer of Funds from Other Pension Funds 404 Total Additions DEDUCTIONS 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 Total Deductions INCREASE (DECREASE) IN NET ASSETS NET ASSETS AT BEGINNING OF PERIOD NET ASSETS AT END OF PERIOD Details Code DEFINED BENEFIT PENSION PROGRAM NET ASSET CHANGE REPORT Per DD-MM-YYYY Description Accumulated to DD-MM-YYYY

Defined Benefit Pension Program Other Benefits Combined ASSETS INVESTMENTS (Historical Value) Bank Savings Call Deposits at Banks Time Deposits at Banks Bank Deposit Certificates Sharia-Based Securities Issued by Bank Indonesia Government 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 in the form of Collective Investment Contracts Sharia Infrastructure Investment Funds in the form of 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 Accumulated Depreciation of Buildings TOTAL INVESTMENTS INVESTMENT VALUATION DIFFERENCES CURRENT ASSETS OUTSIDE INVESTMENTS Cash and Banks Contribution Receivables

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 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 Accumulated to DD-MM-YYYY

PPMP_LPHU
Defined Benefit Pension Program Other Benefits Combined INVESTMENT INCOME Profit Sharing Dividends Rent Gain (Loss) on Disposal of Investments Other Investment Income Total Investment Income INVESTMENT EXPENSES Transaction Expenses Land and Building Maintenance Expenses Building Depreciation Expenses Investment Manager Expenses Custody Expenses Other Investment Expenses Total Investment Expenses INVESTMENT BUSINESS RESULTS OPERATIONAL EXPENSES Salaries/Honorary Fees 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 Gain (Loss) on Sale of Operational Assets Gain (Loss) on Sale of Other Assets Other Income Outside Investments Other Expenses Outside Investments and Operations Total Other Income and Expenses INCOME BEFORE TAX INCOME TAX INCOME AFTER TAX Description DEFINED BENEFIT PENSION PROGRAM INCOME STATEMENT Per DD-MM-YYYY Accumulated to DD-MM-YYYY

Defined Benefit Pension Program Other Benefits Combined CASH FLOWS FROM INVESTMENT ACTIVITIES Receipts of Profit Sharing Receipts of Dividends Receipts of Rent Other Investment Income Disposal of Investments Investment Placements 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 Payments of Ta'zir Funds Other Income Outside Investments Other Expenses Outside Investments and Operations Income Tax Net Cash from Operational Activities CASH FLOWS FROM FINANCING ACTIVITIES Receipts of Normal Employer Contributions Receipts of Normal Participant Contributions Receipts of Voluntary Participant Contributions Receipts of Additional Contributions Receipts of Transfer of Funds from Other Pension Funds Payments of Transfer of Funds to Other Pension Funds Payments of Pension Benefits and Other Benefits Net Cash 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 Per DD-MM-YYYY Accumulated to DD-MM-YYYY

Children
Deferred Pensions
(3) Total Participants (1) + (2)
Widows/Widowers
Children
Deferred Pensions
b. Founder Partners
Pensioners
Widows/Widowers
Pensioners
PENSION FUND PARTICIPATION
Per DD-MM-YYYY
Description Defined Benefit Pension Program Other Benefits Total (1) Active Participants a. Founders b. Founder Partners (2) Inactive Participants a. Founders

Value
Net Asset Value based on Audited Financial Reports* 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 reports only for annual Total Total Deductions Funding Wealth Wealth for Funding Description Deductions Total Total Assets in court dispute, or controlled or seized by competent authorities Contributions, which on the actuarial valuation date have not been paid for more than 3 (three) months since the due date Total Per DD-MM-YYYY

Bank Savings
Call Deposits at Banks
Time Deposits at Banks
Bank Deposit Certificates
Sharia-Based Securities Issued by Bank Indonesia Government 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 in the form of Collective Investment Contracts Sharia Infrastructure Investment Funds in the form of 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 Description Jan Feb Mar Apr DEFINED BENEFIT PENSION PROGRAM Nov Dec Sep Oct INVESTMENT RECAP Per DD-MM-YYYY May Jun Jul Aug

Profit Sharing Dividends Rent Gain/Loss Disposal Others Bank Savings Call Deposits at Banks Time Deposits at Banks Bank Deposit Certificates Sharia-Based Securities Issued by Bank Indonesia Government 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 in the form of Collective Investment Contracts Sharia Infrastructure Investment Funds in the form of 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 DEFINED BENEFIT PENSION PROGRAM INVESTMENT INCOME REPORT Per DD-MM-YYYY Investment Type Realized Investment Income Average Investment Net Investment Income Investment Expenses Unrealized Investment Income

Profit Sharing Dividends Rent Gain/Loss Disposal Others Bank Savings Call Deposits at Banks Time Deposits at Banks Bank Deposit Certificates Sharia-Based Securities Issued by Bank Indonesia Government 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 in the form of Collective Investment Contracts Sharia Infrastructure Investment Funds in the form of 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 DEFINED BENEFIT PENSION PROGRAM OTHER BENEFITS INVESTMENT INCOME REPORT Per DD-MM-YYYY Investment Type 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 Call Deposits at Banks Time Deposits at Banks Bank Deposit Certificates Sharia-Compliant Securities Issued by Bank Indonesia Sharia-Compliant 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 Sharia Infrastructure Investment Funds in the Form of Collective Investment Contracts Sharia-Compliant Options Contracts and Futures 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 and Banks 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 Pension Benefits and Other Benefits Payable Due Voluntary Benefits Payable Ta'zir Fund Payables Investment Payables Unearned Income Expenses Incurred but Not Yet Paid Other Payables Total Liabilities Excluding Actuarial Present Value H. Total Liabilities (F+G)
I. Difference between Total Assets and Total Liabilities (E-H)
J. Percentage (%) of Fund Sufficiency Ratio Total DEFINITE CONTRIBUTION PENSION PROGRAM ASSET AND LIABILITY SUMMARY As of DD-MM-YYYY (in Rupiah) Due >= 10 Years Due < 1 Year 1 Year <= Due < 5 Years 5 Year <= Due < 10 Years

Type Quantity Percentage of Total Investment ab c d e f g … Details of Investments with a Single Counterparty No Counterparty Name Investment Limitations in Investment Guidelines Investment Limitations In Accordance with Regulations As of DD-MM-YYYY

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 Fund/Project Recipient Issuer Balance Name Type Investment Security 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 ASSET-BACKED SECURITIES OTHER INVESTMENTS FOR INFRASTRUCTURE PROJECT FINANCING

Investment Income Ratio (ROI)
A. Investment Income after Deducting Investment Operational Expenses B. Average Investment
C. Ratio (a:b)
Investment Income Ratio to Assets (ROA) A. Investment Income + Other Income - Investment and Non-Investment Expenses B. Total Available Assets
C. Ratio (a:b)
Operational Expense Ratio (BOPO) A. Operational Expenses B. Total Available Assets
C. Ratio (a:b)
FINANCIAL RATIOS
As of DD-MM-YYYY
Description Other Benefit Pension Program Total

No. Investment Manager Name Contract Number Contract Date Agreement Period Type of Investment Amount of Funds Managed (Rp) 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 the services of an Investment Manager Investment Manager Disclosure Format Use of Investment Managers As of DD-MM-YYYY Total etc.

ab c d e f g h
…
Total
DETAILS OF BANK SAVINGS
Duration Return Rate Description Bank Name Acquisition Date No Nominal Value Pension Program/ Other Benefits

ab c d e f g h
…
Total
Nominal Value Duration Return Rate DETAILS OF CALL DEPOSITS No Bank Name Acquisition Date Description Pension Program/ Other Benefits

ab c d e f gh
…
Total
Nominal Value Duration Return Rate DETAILS OF TIME DEPOSITS No Bank Name Acquisition Date Description Pension Program/ Other Benefits

ab c d e f g h
…
Total
Nominal Value Pension Program/
Other Benefits
Description No Bank Name Acquisition Date Duration Return Rate

Fair Value % ab c d e f g h i j k l … Total Description Fair Value Acquisition Value Investment Valuation Difference DETAILS OF BANK INDONESIA SHARIA CERTIFICATES No Security Code Acquisition Date Nominal Value Maturity Date Coupon (%) Pension Program/ Other Benefits

Fair Value % ab c d e f g h i j k l m … Total Valuation Difference Investment DETAILS OF SHARIA-COMPLIANT GOVERNMENT SECURITIES Pension Program/ Other Benefits Description Accounting Method Valuation Difference Investment No Security Code Acquisition Date Nominal Value Maturity Date Acquisition Value Fair Value Coupon (%)

Fair Value % ab c d e f g h i j k l … Total Valuation Difference Investment DETAILS OF SHARIA STOCKS No Stock Code Issuer/Issuer Name Acquisition Date Number of Shares Economic Sector Description Acquisition Value Market Value Pension Program/ Other Benefits

Economic Sector
Beginning End Fair Value % ab c d e f g h i j k l m n o p q r … Total Description Acquisition Value Fair Value Valuation Difference Investment DETAILS OF CORPORATE SUKUK No Issuer/Issuer Name Sukuk Code Sukuk Name Acquisition Date Nominal Value Maturity Rating Coupon (%) Accounting Method Pension Program/ Other Benefits

Economic Sector
Beginning End Fair Value % ab c d e f g h i j k l m n o p q r … Total Acquisition Value Fair Value Valuation Difference Description DETAILS OF REGIONAL SUKUK No Issuer Name Regional Sukuk Code Regional Sukuk Name Acquisition Date Nominal Value Maturity Rating Coupon (%) Accounting Method Pension Program/ Other Benefits

Fair Value % ab c d e f g h i j k l m … Total *) letter d:
Filled with Type of Sharia Mutual Funds: Money Market Mutual Funds/Fixed Income Mutual Funds/Mixed Mutual Funds/Equity Mutual Funds/Protected Mutual Funds/Guaranteed Mutual Funds/Index Mutual Funds/Collective Investment Contract Limited Participation Mutual Funds/Sharia Mutual Funds/Unit Participation Mutual Funds Traded on the Indonesia Stock Exchange Fair Value Valuation Difference Investment DETAILS OF SHARIA MUTUAL FUNDS No Code Product Name Type of Sharia Mutual Funds *) Investment Manager Acquisition Date Number of Units Description Acquisition Value Pension Program/ Other Benefits

Economic Sector
Beginning End Fair Value % ab c d e f g h i j k l m n o p q … Total Acquisition Value Fair Value Valuation Difference Issuer Name DETAILS OF SHARIA MTN No Code Product Name Acquisition Date Maturity Date Description Nominal Value Rating Coupon (%) Pension Program/ Other Benefits

Economic Sector
Beginning End Fair Value % ab c d e f g h i j k l m n o p q … Total DETAILS OF SHARIA ASSET-BACKED SECURITIES No Code Product Name Issuer Name Acquisition Date Nominal Value Maturity Date Rating Description Acquisition Value Fair Value Valuation Difference Coupon (%) Pension Program/ Other Benefits

Fair Value % ab c d e f g h i j k l … Total 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 Description Valuation Difference Investment Pension Program/ Other Benefits

Fair Value % ab c d e f g h i j k l … Total Description 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 Valuation Difference Investment Pension Program/ Other Benefits

Fair Value % ab c d e f g h i j k … Total Fair Value Valuation Difference Investment DETAILS OF SHARIA OPTIONS CONTRACTS AND FUTURES CONTRACTS LISTED ON THE INDONESIA STOCK EXCHANGE No Issuer Name Buyer Name Acquisition Date Duration Description Acquisition Value Pension Program/ Other Benefits

Beginning End Nominal % Fair Value % ab c d e f g h i j k l m n op q r … Total Selling Price Valuation Difference Investment Description Rating DETAILS OF REPO Category (KSEI/BIS4) Type of Collateral (SBSN/SBIS) Counterparty No Acquisition Date Collateral Value Duration Pension Program/ Other Benefits Acquisition Value Amortized Cost Margin

Economic Sector
Name Position Date % Ownership Total % Ownership Total Date % Ownership Total Fair Value % ab c d e f g h i j k l m n o p q r s … Total *) letter e:
Filled with Domestic LJK/Non-Domestic LJK/Foreign LJK/Non-Foreign LJK Appraisal/Fair Value DETAILS OF DIRECT PARTICIPATION Valuation Difference Investment Description No Company Name Category Participation *) Acquisition Date Initial Placement Acquisition Value As of Report Date Pension Fund Representative Pension Program/ Other Benefits

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

No Cash/Bank Name Account Number Nominal Value Pension Program/ Other Benefits Description (Purpose of use) ab c d e f … Total DETAILS OF CASH AND BANKS 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 ab c d e f g h i j k l m n … Total DETAILS OF CONTRIBUTION RECEIVABLES Description No Contribution Receivables Voluntary Participant Contributions Employer Name (Founder/Co-Founder) Employer Contribution Receivables Participant Contribution Receivables Additional Contribution Receivables Pension Program/ Other Benefits

No Type of Expense Quantity Pension Program/ Other Benefits Description ab c d e … Total DETAILS OF PREPAID EXPENSES

No Type of Investment Receivables Nominal Value Pension Program/ Other Benefits Description ab c d e … Total DETAILS OF INVESTMENT RECEIVABLES

No
Type of Investment Income Receivables Nominal Value Pension Program/ Other Benefits Description ab c d e … Total DETAILS OF INVESTMENT INCOME RECEIVABLES

No
Type of Other Receivables
*)
Nominal Value Pension Program/
Other Benefits
Description ab c d e
…
Total
*) Including Ta'zir Fund Receivables DETAILS OF OTHER RECEIVABLES

No Name of Land and/or
Buildings
Certificate Number Address Location Acquisition Date Acquisition Value Accumulated Depreciation Book Value Acquisition Value on Report Date Description ab 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 Description ab c d e f g h … Total DETAILS OF VEHICLES

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

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

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

No Type of Other Assets Acquisition Date Asset Value Description ab c d e … Total Other Assets Details

<= 1 Year >1 Year Total ab c d e f … Total DETAILS OF DUE PENSION BENEFITS PAYABLES Description Quantity No Pension Program/ Other Benefits

<= 1 Year >1 Year Total ab c d e … Total No Quantity DETAILS OF DUE VOLUNTARY PENSION BENEFITS PAYABLES Description

Quantity Description
1 Recipient Name 1
2 Recipient Name 2
3 … etc.
D. Ending Balance (A+B-C)
DETAILS OF TA'ZIR FUND PAYABLES Details A. Beginning Balance B. Additions in Current Year
C. Usage in Current Year

No Type of Investment Value Pension Program/ Other Benefits Description ab c d e … Total DETAILS OF INVESTMENT PAYABLES

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

No
Details of Expenses Incurred but Not Yet Paid Counterparty Value Pension Program/ Other Benefits Description ab c d e f … Total DETAILS OF EXPENSES INCURRED BUT NOT YET PAID

No Type of Other Payables Counterparty Value Pension Program/ Other Benefits Description ab c d e f … Total DETAILS OF OTHER PAYABLES

No. Type of Investment Valuation Difference Investment Increase/ Decrease Pension Program/ Other Benefits Description ab c d e f ... Total Details of Increase/Decrease in Investments

% Quantity % Quantity ab c d e f g h i j k l m n o p r s ... Total Pension Program/ Other Benefits Description Details of Due Contributions Additional Contributions Additional Contributions Additional Contributions Voluntary Participant Contributions Voluntary Participant Contributions No. Founder Name/ Co-Founder PhDP Over/Under Payment Contribution Receipts Due Contributions Normal Contributions Participants Normal Contributions Employers Normal Contributions Participants Normal Contributions Employers Normal Contributions Employers Normal Contributions Participants

No.
Type of Income Outside
Investment
Quantity Pension Program/ Other Benefits Description ab c d e ... Total Details of Income Outside Investments

No.
Pension Fund Name
Transferring Quantity Pension Program/ Other Benefits Details of Other Benefits *) Description ab 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 Benefits Funds

No. Type of Expense Quantity Pension Program/ Other Benefits Description ab c d e ... Total Details of Investment Expenses

No. Type of Expense Quantity Pension Program/ Other Benefits Description ab c d e ... Total Details of Operational Expenses

No. Type of Expense Quantity Pension Program/ Other Benefits Description ab c d e ... Total Details of Expenses Outside Investments and Operations

No.
Type of Income Tax
Quantity Pension Program/ Other Benefits Description ab c d e … Total Details of Income Tax

No.
Pension Fund Receiving
Transfers Quantity Pension Program/ Other Benefits Details of Other Benefits *) Description ab 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 Benefits Funds

FORMAT I B
To
Directorate of Statistics and Information IKNB Financial Services Authority MONTHLY REPORT / ANNUAL FINANCIAL STATEMENTS ELECTRONIC DATA EMPLOYER PENSION FUNDS BASED ON SHARIA PRINCIPLES / SHARIA UNIT DEFINITE 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 Management Name Management Position SID Number Audit Data Auditor License SK Type of Audit Auditor Code Auditor Name Opinion Audit Executor Audit Date Report Compiler Officer Name Division Telephone Fax Email Management Responsible Person Responsible Person Name Position Telephone Fax E-mail Pension Fund Address

Description Details Code Percentage Investment Pension Program Other Benefits Combined INVESTMENT ASSETS SHARIA INVESTMENT ASSETS Bank Savings 1101 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 (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 Sharia Infrastructure Investment Funds in the Form of Collective Investment Contracts 1115 Sharia-Compliant Options Contracts and Futures 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 Banks 1201 Contribution Receivables 1202 ‐ Normal Contributions from Employers ‐ Normal Contributions from Participants ‐ Voluntary Participant Contributions 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 Excluding Pension Benefit Liabilities Pension Benefits and Other Benefits Payable Due 1501 Voluntary Benefits Payable 1502 Ta'zir Fund Payables 1507 Investment Payables 1503 Unearned Income 1504 Expenses Incurred but Not Yet Paid 1505 Other Payables 1506 Total Liabilities Excluding Pension Benefit Liabilities TOTAL LIABILITIES NET ASSETS DEFINITE CONTRIBUTION PENSION PROGRAM NET ASSET REPORT As of DD-MM-YYYY

Pension Program Other Benefits Combined 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 Participant Contributions Income Outside Investments 403 Transfers 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 Transfers of Funds to Other Pension Funds 409 Total Reductions INCREASE (DECREASE) IN NET ASSETS BEGINNING NET ASSETS OF PERIOD ENDING NET ASSETS OF PERIOD Details Code NET ASSET CHANGE REPORT Description Accumulated as of DD-MM-YYYY DEFINITE CONTRIBUTION PENSION PROGRAM As of DD-MM-YYYY

Pension Program Other Benefits Combined ASSETS INVESTMENT (Historical Value) Bank Savings Call Deposits at Banks Time Deposits at Banks Bank Deposit Certificates Sharia-Compliant Securities Issued by Bank Indonesia Sharia-Compliant 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 Sharia Infrastructure Investment Funds in the Form of Collective Investment Contracts Sharia-Compliant Options Contracts and Futures 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 DIFFERENCE CURRENT ASSETS EXCLUDING INVESTMENTS Cash and Banks Contribution Receivables ‐ Normal Contributions from Employers ‐ Normal Contributions from Participants ‐ Voluntary Participant Contributions 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 EXCLUDING PENSION BENEFIT LIABILITIES Pension Benefits and Other Benefits Payable Due Voluntary Benefits Payable Ta'zir Fund Payables Investment Payables Unearned Income Expenses Incurred but Not Yet Paid Other Payables TOTAL LIABILITIES EXCLUDING PENSION BENEFIT LIABILITIES TOTAL LIABILITIES Description DEFINITE CONTRIBUTION PENSION PROGRAM As of DD-MM-YYYY Accumulated as of DD-MM-YYYY BALANCE SHEET

PPMP_LPHU
Pension Program Other Benefits Combined 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/Honorary Fees 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 Income Outside Investments Expenses Outside Investments and Operations Total Other Income and Expenses OPERATING RESULTS BEFORE TAX INCOME TAX OPERATING RESULTS AFTER TAX Description DEFINITE CONTRIBUTION PENSION PROGRAM As of DD-MM-YYYY Accumulated as of DD-MM-YYYY INCOME STATEMENT

Pension Program Other Benefits Combined CASH FLOWS FROM INVESTMENT ACTIVITIES Receipts from Profit Sharing Receipts from Dividends Receipts from Rent Other Investment Income Investment Disposal Investment Placement Payment of Investment Expenses Net Cash Flows 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 from Ta'zir Funds Payments from Ta'zir Funds Other Income Outside Investments Expenses Outside Investments and Operations Income Tax Net Cash Flows 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 Payments of Fund Transfers to Other Pension Funds Payment of Pension Benefits & Other Benefits Net Cash Flows from Financing Activities INCREASE (DECREASE) IN NET CASH CASH AT BEGINNING OF PERIOD CASH AT END OF PERIOD Description DEFINITE CONTRIBUTION PENSION PROGRAM Cash Flow Statement Accumulated as of DD-MM-YYYY As of DD-MM-YYYY

‐ Children
‐ Deferred Pensions
(3) Total DPPK Participants (1) + (2) Other Benefits ‐ Widows/Widowers ‐ Children ‐ Deferred Pensions b. Co-Founders ‐ Pensioners ‐ Widows/Widowers (1) Active Participants a. Founders b. Co-Founders (2) Inactive Participants a. Founders ‐ Pensioners PENSION FUND PARTICIPATION Description Pension Program Quantity As of DD-MM-YYYY

Bank Savings
Call Deposits at Banks
Time Deposits at Banks
Bank Deposit Certificates
Sharia-Compliant Securities Issued by Bank Indonesia Sharia-Compliant 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 Sharia Infrastructure Investment Funds in the Form of Collective Investment Contracts Sharia-Compliant Options Contracts and Futures 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 DEFINITE CONTRIBUTION PENSION PROGRAM As of DD-MM-YYYY May Jun Jul Aug Description Jan Feb Mar Apr Nov Dec INVESTMENT SUMMARY

Bank Savings Time Deposits Bank Deposit Certificates Sharia-Compliant Bank Indonesia Securities (SBI Syariah) SBSN ab c d e f g Investment Assets Total Participants Asset Life Cycle Fund Total Funds As of DD-MM-YYYY

Profit Sharing Dividends Rent Profit/Loss Disposal Others Bank Savings Call Deposits at Banks Time Deposits at Banks Bank Deposit Certificates Sharia-Compliant Securities Issued by Bank Indonesia Sharia-Compliant 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 Sharia Infrastructure Investment Funds in the Form of Collective Investment Contracts Sharia-Compliant Options Contracts and Futures Contracts Listed on the Indonesia Stock Exchange REPO Direct Participation Land in Indonesia Buildings in Indonesia Land and Buildings in Indonesia Total DEFINITE CONTRIBUTION PENSION PROGRAM INVESTMENT INCOME REPORT Type of Investment Realized Investment Return As of DD-MM-YYYY ROI Average Investment Net Investment Return Investment Expenses Realized Investment Return Unrealized Investment Return

Dividend Profit Sharing, Rental Profit/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 State 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 Sharia Infrastructure Investment Funds in the form of Collective Investment Contracts Sharia Equity Options and Forward Contracts listed on the Indonesia Stock Exchange REPO Direct Participation Land in Indonesia Buildings in Indonesia Land and Buildings in Indonesia Total DEFINED CONTRIBUTION PENSION PROGRAM INVESTMENT RESULTS REPORT - OTHER BENEFITS As of 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 State 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 Sharia Infrastructure Investment Funds in the form of Collective Investment Contracts Sharia Equity Options 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 & Banks Contribution Receivables Normal Contributions from Employers Normal Contributions from Participants Voluntary Contributions from Participants Prepaid Expenses Investment Receivables Investment Results 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 Outside Pension Benefit Liabilities Due Pension Benefits and Other Benefits Voluntary Benefit Liabilities Ta'zir Fund Liabilities Investment Liabilities Deferred Income Accrued Expenses Other Liabilities Total Liabilities Outside Pension Benefit Liabilities H. Total Liabilities (F+G)
I. Difference between Total Assets and Total Liabilities (E-H)
J. Percentage (%) Fund Adequacy Ratio DEFINED CONTRIBUTION PENSION PROGRAM Total ASSET AND LIABILITY RECAPITULATION (in Rupiah) Due >= 10 Years Maturity Details of Maturity < 1 year 1 year <= Maturity < 5 years 5 year <= Maturity < 10 years As of DD-MM-YYYY Type Quantity Percentage of Total Investment ab c d e f g … Details of Investments with One Counterparty No. Counterparty Name Investment Limit in Investment Guidelines Investment Limit According to Regulations As of DD-MM-YYYY Name Type Investment Balance Name Type Investment Security Series Ownership Type 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 Ownership Type Rating Balance Name Type Investment Balance ….. Total SHARIA MUTUAL FUNDS WITH LIMITED PARTICIPATION ASSET-BACKED SECURITIES OTHER INVESTMENTS FOR PROJECT FINANCING GOVERNMENT INFRASTRUCTURE MUTUAL FUNDS SHARIA MUTUAL FUNDS UNDERLYING SBSN DETAILS OF COMPLIANCE WITH REGULATIONS REGARDING GOVERNMENT SECURITIES INVESTMENT No. Government Securities (SBN) Sukuk Infrastructure Investment Income Ratio (ROI) A. Investment Income after deducting operational investment expenses B. Average Investment
C. Ratio (a:b)
Investment Income Ratio against Assets (ROA) A. Investment Income + Other Income - Investment and Non-Investment Expenses B. Total Available Assets
C. Ratio (a:b)
Operational Expense Ratio (BOPO) A. Operational Expenses B. Total Available Assets
C. Ratio (a:b)
Details
FINANCIAL RATIOS
As of DD-MM-YYYY
Pension Program Other Benefits Total (in millions of Rupiah) Bill Number Nominal Due Date Acquisition Value Fair Value Due Date Total PENSION FUND PERIODIC PENSION BENEFIT INVESTMENT REPORT Bank Name/Serial Number SBN SBN Deposits Total Number of Participants Periodic MP Simultaneous MP Initial Reserve (20%) Notes No. Investment Manager Name Contract Number Contract Date Contract Period Type of Investment Amount of Funds Managed (Rp) Net Investment Income Rate (Rp) Amount of 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 Total etc. Investment Manager Disclosure Format Use of Investment Manager As of DD-MM-YYYY Yield ab c d e f g … Total DETAILS OF SAVINGS No. Bank Name Acquisition Date Nominal Value Notes Pension Program/ Other Benefits ab c d e f g h … Total DETAILS OF ON-CALL DEPOSITS No. Bank Name Acquisition Date Nominal Value Term Yield Notes Pension Program/ Other Benefits ab c d e f g h … Total DETAILS OF TIME DEPOSITS No. Bank Name Acquisition Date Nominal Value Term Yield Notes Pension Program/ Other Benefits ab c d e f g h i j … Total DETAILS OF BANK CERTIFICATES OF DEPOSIT No. Bank Name Acquisition Date Nominal Value Acquisition Value Redemption Value Term Yield Notes Pension Program/ Other Benefits Value % ab c d e f g h i j k l … Total Notes DETAILS OF SHARIA BANK INDONESIA CERTIFICATES No. Security Code Acquisition Date Nominal Value Due Date Acquisition Value Fair Value Investment Valuation Difference Coupon % Pension Program/ Other Benefits Value % ab c d e f g hi j k lm … Total Notes DETAILS OF SHARIA STATE SECURITIES No. Security Code Acquisition Date Nominal Value Due Date Acquisition Value Fair Value Investment Valuation Difference Coupon (%) Pension Program/ Other Benefits Accounting Method Value % ab c d e f g h i j k l … Total Notes DETAILS OF SHARIA STOCKS No. Stock Code Issuer/Issuer Name Acquisition Date Number of Shares Acquisition Value Market Value Investment Valuation Difference Economic Sector Pension Program/ Other Benefits Economic Sector Beginning End Value % ab c d e f g h i j k l m n o p q r … Total Acquisition Value Fair Value Investment Valuation Difference Notes DETAILS OF CORPORATE SUKUK No. Issuer/Issuer Name Sukuk Code Sukuk Name Acquisition Date Nominal Value Due Date Rating Coupon (%) Accounting Method Pension Program/ Other Benefits Economic Sector Beginning End Value % ab c d e f g h i j k l m n o p q r … Total Acquisition Value Fair Value Investment Valuation Difference Notes DETAILS OF REGIONAL SUKUK No. Issuer Name Regional Sukuk Code Regional Sukuk Name Acquisition Date Nominal Value Due Date Rating Coupon (%) Accounting Method Pension Program/ Other Benefits Value % ab c d e f g h i j k l m … Total *) letter d:
Filled with Type of 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 Funds/ and Mutual Funds whose Shares/Participation Units are Traded on the Indonesia Stock Exchange Investment Valuation Difference Notes 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 Pension Program/ Other Benefits Economic Sector Beginning End Value % ab c d e f g h i j k l m n o p q … Total Acquisition Value Fair Value Investment Valuation Difference Notes DETAILS OF SHARIA MTN No. Code Product Name Issuer Name Acquisition Date Nominal Value Due Date Rating Coupon (%) Pension Program/ Other Benefits Economic Sector Beginning End Value % ab c d e f g h i j k l m n o p q … Total DETAILS OF SHARIA ASSET-BACKED SECURITIES No. Code Product Name Issuer Name Acquisition Date Nominal Value Notes Coupon (%) Due Date Rating Acquisition Value Investment Valuation Difference Pension Program/ Other Benefits Fair Value Value % ab c d e f g h i j k l … Total Notes 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 Pension Program/ Other Benefits Value % ab c d e f g h i j k l … Total Notes 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 Pension Program/ Other Benefits Value % ab c d e f g h i j k … Total DETAILS OF SHARIA EQUITY OPTIONS AND FORWARD CONTRACTS LISTED ON THE INDONESIA STOCK EXCHANGE No. Issuer Name Buyer Name Acquisition Date Term Acquisition Value Fair Value Investment Valuation Difference Notes Pension Program/ Other Benefits Beginning End Nominal % Value % ab c d e f g h i j k l m n op q r … Total Pension Program/ Other Benefits Notes DETAILS OF REPO No. Counterparty Type of Collateral (SBSN/SBIS) Acquisition Date Collateral Value Rating Term Category (KSEI/BIS4) Acquisition Value Margin Amortized Cost Sale Value Investment Valuation Difference Economic Sector Name Position Date % Ownership Total % Ownership Total Date % Ownership Total Value % ab c d e f g h i j k l m n o p q r s … Total *) letter e:
Filled with Domestic LJK/Non-Domestic LJK/Foreign LJK/Non-Foreign LJK DETAILS OF DIRECT PARTICIPATION No. Company Name Category of Participation *) Acquisition Date Initial Placement Acquisition Value As of Report Date Appraisal/Fair Value Investment Valuation Difference Notes Pension Fund Representation Pension Program/ Other Benefits Object Type (Land/Building/Land&Building) Value % a b cde f gh i j k lm n opq r s … Total DETAILS OF LAND, BUILDINGS, LAND AND BUILDINGS IN INDONESIA No. Address Location (City,Province) Area Type Proof of Ownership Ownership Document Number Acquisition Date Acquisition Value Accumulated Depreciation Book Value Appraisal/Fair Value Name of Public/Independent Appraiser Pension Program/ Other Benefits Name of Appraisal Office (KJPP) Investment Valuation Difference Year of Appraisal Notes No. Cash/Bank Name Account Number Nominal Pension Program/ Other Benefits Notes (Purpose of use) ab c d e f … Total DETAILS OF CASH AND BANKS Age of Receivables <=3 Months Age of Receivables >3 Months Total Age of Receivables <=3 Months Age of Receivables >3 Months Total ab c d e f g h l m n … Total DETAILS OF CONTRIBUTION RECEIVABLES No. Employer Name (Founder/Co-Founder) Employer Contribution Receivables Participant Contribution Receivables Voluntary Participant Contribution Receivables Notes Pension Program/ Other Benefits No. Type of Expense Quantity Pension Program/ Other Benefits Notes ab c d e … Total DETAILS OF PREPAID EXPENSES No. Type of Investment Receivables Nominal Pension Program/ Other Benefits Notes ab c d e … Total DETAILS OF INVESTMENT RECEIVABLES No. Type of Investment Results Receivables Nominal Pension Program/ Other Benefits Notes ab c d e … Total DETAILS OF INVESTMENT RESULTS RECEIVABLES No. Type of Other Receivables *) Nominal Pension Program/ Other Benefits Notes ab c d e … Total *) Including Ta'zir Fund Receivables DETAILS OF OTHER RECEIVABLES No. Name of Land and/or Buildings Certificate Number Address Location Acquisition Date Acquisition Value Accumulated Depreciation Book Value Acquisition Value as of report date Notes ab c d e f g h i j … Total DETAILS OF LAND AND BUILDINGS No. Vehicle Plate Number Vehicle Type Acquisition Date Acquisition Value Accumulated Depreciation Book Value Notes ab c d e f g h … Total DETAILS OF VEHICLES No. Type of Computer Equipment Acquisition Date Acquisition Value Accumulated Depreciation Book Value Notes ab c d e f g … Total DETAILS OF COMPUTER EQUIPMENT No. Type of Office Equipment Acquisition Date Acquisition Value Accumulated Depreciation Book Value Notes ab 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 ab c d e f g … Total DETAILS OF OTHER OPERATIONAL ASSETS No. Type of Other Assets Acquisition Date Asset Value Notes ab c d e … Total Details of Other Assets <= 1 year >1 year Total ab c d e f … Total DETAILS OF DUE PENSION BENEFIES No. Quantity Notes Pension
Program/ Other Benefits <= 1 year >1 year Total ab c d e … Total DETAILS OF DUE VOLUNTARY PENSION BENEFIES No. Quantity Notes Quantity Notes 1 Recipient Name 1 2 Recipient Name 2 3 … etc. D. Final 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. Type of Investment Value Pension Program/ Other Benefits Notes ab c d e … Total DETAILS OF INVESTMENT LIABILITIES No. Details of Income Received in Advance Party Value Pension Program/ Other Benefits Notes ab c d e f … Total DETAILS OF DEFERRED INCOME No. Details of Accrued Expenses Party Value Pension Program/ Other Benefits Notes ab c d e f … Total DETAILS OF ACCRUED EXPENSES No. Type of Other Liabilities Party Value Pension Program/ Other Benefits Notes ab c d e f … Total DETAILS OF OTHER LIABILITIES No. Type of Investment Investment Valuation Difference Increase/ Decrease Pension Program/ Other Benefits Notes ab c d e f ... Total Details of Increase/Decrease in Investments % Quantity % Quantity ab c d e f g h i j k l m n o ... Total Pension Program/ Other Benefits Notes Details of Due Contributions No. Founder Name/ Co-Founder PhDP Due Contributions Contribution Receipts Over/Under Payment Normal Participant Contributions Normal Employer Contributions Normal Participant Contributions Normal Employer Contributions No. Type of Other Investment Income Quantity Pension Program/ Other Benefits Notes ab c d e ... Total Details of Income Outside Investments No. Name of Pension Fund Transferring Quantity Pension Program/ Other Benefits Details of Other Benefits *) Notes ab 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 Benefits/Severance Pay Funds/Additional Benefits No. Type of Expense Quantity Pension Program/ Other Benefits Notes ab c d e ... Total Details of Investment Expenses No. Type of Expense Quantity Pension Program/ Other Benefits Notes ab c d e ... Total Details of Operational Expenses No. Type of Expense Quantity Pension Program/ Other Benefits Notes ab c d e ... Total Details of Expenses Outside Investments and Operational No. Type of Income Tax Quantity Pension Program/ Other Benefits Notes ab c d e Total Details of Income Tax No. Pension Fund Receiving Transfer Quantity Pension Program/ Other Benefits Details of Other Benefits *) Notes ab 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 Benefits/Severance Pay Funds/Additional Benefits FORMAT I C FORM AND STRUCTURE OF ANNUAL REPORTS FOR TECHNICAL REPORTS OF EMPLOYER PENSION FUNDS OPERATING PENSION PROGRAMS BASED ON SHARIA PRINCIPLES
I. Pension Fund Profile
A. General Profile
Pension Fund Name :
General Register Book Number (NBDU) :
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 :
C. Administration

Management
a. Are there changes to the management or extension of the management term during the activity period? If Yes, has this been reported to OJK? b. Has the Management obtained basic knowledge certificates in the field of Pension Funds?
c. Have the Management members who have obtained basic knowledge certificates in the field of Pension Funds met the minimum continuing education points?

d. Does the Management have proof of expertise in the field of Sharia finance? e. Are there changes to the Sharia Supervisory Board or extension of the Sharia Supervisory Board term during the activity period? If Yes, has this been reported to OJK? f. Does the Sharia Supervisory Board have a recommendation letter from DSN-MUI? g. Does the Sharia Supervisory Board have a Founder's Decision Letter regarding appointment?
2. Number of Pension Fund Employees
Based on Education Level
SD (Elementary) :
SMP (Junior High) :
SMU (Senior High) :
Diploma :
S1 (Bachelor) :
S2 (Master) :
S3 (Doctorate) :
Total :
3. Third-Party Service Users:
a. Does the Pension Fund use third-party services to manage membership administration? If Yes, fill in the name of the Membership Administration Manager:
5 etc b. Does the Pension Fund use third-party services to deposit ownership documents? If YES, fill in the name of the deposit recipient used 5 etc
c. Does the Pension Fund use Investment Manager services?
If YES, fill in the list of names of Investment Managers used (sorted by asset share managed) 5 etc d. Does the Pension Fund use Appraiser services? If YES, fill in the list of Appraisers used:
5 etc
4. Contributions
a. Does the Employer pay the correct amount of contributions? b. Does the Employer pay contributions on time?
5. Investments
a. Are investment activities during the reporting period in accordance with applicable regulations? b. Has information regarding investments been communicated to participants?
6. Governance
a. Does the Pension Fund have a Pension Fund Governance Guideline? b. Has the Pension Fund implemented Pension Fund Governance? D. Pension Fund Membership

Number of Active Pension Fund Employee Participants at the end of the activity period:
Founder (persons) :
Co-Founder (persons) :
Total (persons) :
Number of all participants entitled to deferred pensions at the end of the activity period
:
Active Participant Age Structure and
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 pensions up to 20 :

20 to 30 :
30 to 40 :
40 to 50 :
above 50 :
Estimated number of participants entering normal retirement age in one subsequent activity period :
4. Number of all employers who include their employees in
DPLK at the end of the activity period :
E. Pensioners and Entitled Parties Details Quantity < Rp. 750,000.00 Rp. 750,000.00 - Rp. < 2,000,000.00 Rp. 2,000,000.00

Rp.
5,000,000.00

Rp.
5,000,000.

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

i. Pensioners
ii. Widows/Widowers
iii. Children
b. Number of Benefit
Recipients Pensions receiving lump-sum payments during the activity period due to:
i. Monthly
pension benefits below the minister's regulation limit
ii. Reasons other than
item b (i)
c. Number
of Benefit
Recipients Pensions purchasing annuities during the activity 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
Management Statement
We, the Management of the Pension Fund, state that all data and information provided in this technical report are true data and in accordance with the actual conditions of the Pension Fund. If it is later found that there is data/information that does not correspond to the actual conditions, we are willing to be accountable in accordance with applicable regulations. Place, Date (date/month/year) (signature) Clear Name Position

II. Performance Evaluation Report by the Sharia Supervisory Board
(report substance filled by the board considering the Management's reasonable reasons for explaining the inconsistency of Pension Fund Investment Performance with Investment Guidelines and Annual Investment Plans)

III. Pension Fund Risk Level Assessment Report
Pension Fund Name :
Type: (1) DPPK PPMP (2) DPPK PPIP (3) DPLK Assessment Date :
Report Date :
A. General Information
Founders and Co-Founders :
Name Details Quantity
Participants
Management :
Name Position Term of Office
Sharia Supervisory Board:
Name Position/Representation Term of Office Financial Information As of Assessment Date Details Value (Rupiah) Ratio per Net Assets Net Assets Investments Normal Contribution Receivables Additional Contribution Receivables Other Receivables Other Assets Business Results* Funding Ratio (PPMP) Solvency Ratio (PPMP) Return on Investment (ROI)* Number of Participants *For the last one-year period since the assessment date B. Risk Level Assessment Summary Risk Type Risk Value Risk Weight Net Risk

Management
Governance
Strategy
3.1 Inherent Risk
3.2 Management and Control
Operational
4.1 Inherent Risk

4.2 Management and Control
5. Assets and Liabilities
5.1 Inherent Risk
5.2 Management and Control
Total Net Risk Value

Funding Capability
Additional Funding
Total Fund Support Risk Value
Total Net Risk Value
Total Capitalization Value
Risk Value
Risk Level
C. Risk Description
General Description
Details per Risk Type
Management Risk Risk Value:.... Risk Level: ... Notes:
Governance Risk Risk Value:.... Risk Level: ... Notes:
Strategy Risk Risk Value:.... Risk Level: ... Inherent Risk Value:
Notes:
Management and Control Value:
Notes:
Operational Risk Risk Value:.... Risk Level: ... Inherent Risk Value:
Notes:
Management and Control Value:
Notes:

Assets and Liabilities Risk Risk Value:.... Risk Level: ... Inherent Risk Value:
Notes:
Management and Control Value:
Notes:
Fund Support Risk Risk Value:.... Risk Level: ... Funding Capability Value:
Notes:
Additional Funding Value:
Notes:
Acknowledged,
Name:
Position:
Prepared by:
Name:
Position:

IV. Follow-up Plan for Pension Fund Risk Level Assessment

Name:
Type:
(1) DPPK PPMP
(2) DPPK PPIP
(3) DPLK
Date of Risk Level Assessment:
Report Date:
Risk Level:
Risk Value:
Risk Type 8. Cause
Risk
Follow-up
Plan
Target
Time
PIC
Prepared by
Name
:
Signature
Position
:
Acknowledged by
Name
:
Signature
Position
:
Filling Guidelines:
Fill in the Pension Fund name.
Fill in the Pension Fund type by selecting one from the list.
Fill in the date of the risk level assessment that serves as the basis for the follow-up plan.
Fill in the date the risk level assessment report was signed.
Fill in the Pension Fund's risk level according to the results of the risk level assessment as referred to in item 3.
Fill in the Pension Fund's risk value according to the results of the risk level assessment as referred to in item 3.
Fill in the risk type as referred to in POJK Number 10/POJK.05/2014 concerning the Risk Level Assessment of Non-Bank Financial Service Institutions.
Fill in the cause of the risk.
Fill in the plan for various follow-up steps to be taken to reduce the risk level for each type of risk area.
Fill in the target time for implementing the follow-up steps to be taken for each follow-up step; this can be the completion date of the follow-up or the start and end dates of the follow-up if the target time for starting the follow-up is not immediately after the follow-up plan is drawn up.
Fill in the unit responsible for implementing the follow-up.
Fill in the name of the official who prepared the follow-up plan for the Pension Fund's risk level assessment.
Fill in the signature of the official who prepared the follow-up plan for the Pension Fund's risk level assessment.
Fill in the position name of the official who prepared the follow-up plan for the Pension Fund's risk level assessment.
Fill in the name of the Pension Fund official handling Pension Fund risk management.
Fill in the signature of the Pension Fund official handling Pension Fund risk management.
Fill in the position name of the Pension Fund official handling Pension Fund risk management.

V. Self-Assessment Report on the Implementation of Risk Management for Pension Funds Implementing All or Part of Their Business Based on Sharia Principles
SELF-ASSESSMENT REPORT
ON THE IMPLEMENTATION OF RISK MANAGEMENT PENSION FUND YEAR … PENSION FUND XYZ (Pension Fund Address)

SELF-ASSESSMENT REPORT
ON THE IMPLEMENTATION OF RISK MANAGEMENT FOR PENSION FUNDS Pension Fund Name :
Pension Fund Type : (1) DPPK PPMP (2) DPPK PPIP (3) DPLK Sharia Business : (1) Full fledged (2) Sharia Business Unit (UUS) (3) Sharia Investment Package Assessment Position Date :
A. GENERAL INFORMATION
Founders and Partners
Founder:
No. Name Description Number of Participants 1. 2. etc. Management:
No. Name Position Term of Office 1.
2.
3. etc.
Supervisory Board:
No. Name Position Term of Office 1.
2.
3. etc.
Sharia Supervisory Board:
No. Name Position Date
Appointment
1.
2.
3. etc.

B. FINANCIAL INFORMATION OF SHARIA PENSION FUND Description Value (Rupiah)* Ratio per Net Assets Net Assets Investments Normal Contribution Receivables Additional Contribution Receivables Other Receivables Other Assets Business Results Funding Ratio (PPMP) Solvency Ratio (PPMP) Return on Investment (ROI)* Number of Participants

Except for financial ratios and number of participants
For the last one-year period since the assessment date
C. SUMMARY OF GENERAL RISK MANAGEMENT IMPLEMENTATION

Active Supervision by the Board of Directors and Board of Commissioners
…………… (Filled with a description of the role of the Board of Directors and Board of Commissioners in Risk Management and the Risk Management organizational structure)
Adequacy of Policies, Procedures, and Risk Limit Setting
…………… (Filled with a description of risk appetite, risk tolerance, and risk limit setting)
Adequacy of Risk Identification, Measurement, Monitoring, and Control Processes
…………… (Filled with a description of risk identification, measurement, monitoring, and control processes)
Risk Management Information System
…………… (Filled with a description of how the pension fund's information system supports the implementation of Risk Management)
Comprehensive Internal Control System
…………… (Filled with a description of how internal controls including the compliance function are carried out by the pension fund)

D. IMPLEMENTATION OF RISK MANAGEMENT FOR EACH TYPE OF RISK

Strategic Risk
Scope of Implementation
Risk Management Description
Active Supervision by the Board of Directors and Board of Commissioners …………… (Filled with a description of active supervision by the Board of Directors and Board of Commissioners over Strategic Risk) Adequacy of Policies, Procedures, and Risk Limit Setting …………… (Filled with a description of risk appetite, risk tolerance, and limit setting for Strategic Risk) Adequacy of Process for Identification, Measurement, Monitoring, and Risk Control …………… (Filled with a description of the process for identification, measurement, monitoring, and control of Strategic Risk) Strategic Risk Management Information System …………… (Filled with a description of how the pension fund's information system supports the implementation of Risk Management for Strategic Risk) Comprehensive Internal Control System …………… (Filled with a description of how internal controls including the compliance function are carried out by the pension fund for Strategic Risk)
Operational Risk
Scope of Implementation
Risk Management Description
Active Supervision by the Board of Directors and Board of Commissioners …………… (Filled with a description of active supervision by the Board of Directors and Board of Commissioners over Operational Risk) Adequacy of Policies, Procedures, and Risk Limit Setting …………… (Filled with a description of risk appetite, risk tolerance, and limit setting for Operational Risk) Adequacy of Process for Identification, Measurement, Monitoring, and Risk Control …………… (Filled with a description of the process for identification, measurement, monitoring, and control of Operational Risk) Operational Risk Management Information System …………… (Filled with a description of how the information system supports the implementation of Risk Management for Operational Risk) Comprehensive Internal Control System …………… (Filled with a description of how internal controls including the compliance function are carried out by the pension fund for Operational Risk)
Asset and Liability Risk
Scope of Implementation
Risk Management
Description
Active Supervision by the Board of Directors and Board of Commissioners …………… (Filled with a description of active supervision by the Board of Directors and Board of Commissioners over Asset and Liability Risk) Adequacy of Policies, Procedures, and Risk Limit Setting …………… (Filled with a description of risk appetite, risk tolerance, and limit setting for Asset and Liability Risk) Adequacy of Process for Identification, Measurement, Monitoring, and Risk Control …………… (Filled with a description of the process for identification, measurement, monitoring, and control of Asset and Liability Risk) Risk Management Information System …………… (Filled with a description of how the information system supports the implementation of Risk Management for Asset and Liability Risk) Comprehensive Internal Control System …………… (Filled with a description of how internal controls including the compliance function are carried out by the pension fund for Asset and Liability Risk)
Management Risk
Scope of Implementation
Risk Management
Description
Active Supervision by the Board of Directors and Board of Commissioners …………… (Filled with a description of active supervision by the Board of Directors and Board of Commissioners over Management Risk) Adequacy of Policies, Procedures, and Risk Limit Setting …………… (Filled with a description of risk appetite, risk tolerance, and limit setting for Management Risk) Adequacy of Process for Identification, Measurement, Monitoring, and Risk Control …………… (Filled with a description of the process for identification, measurement, monitoring, and control of Management Risk) Risk Management Information System …………… (Filled with a description of how the information system supports the implementation of Risk Management for Management Risk)

Comprehensive
Internal Control
System
…………… (Filled with a description of how internal controls including the compliance function are carried out by the pension fund for Management Risk)
5. Governance Risk
Scope of Implementation
Risk Management
Description
Active Supervision by the Board of Directors and Board of Commissioners …………… (Filled with a description of active supervision by the Board of Directors and Board of Commissioners over Governance Risk) Adequacy of Policies, Procedures, and Risk Limit Setting …………… (Filled with a description of risk appetite, risk tolerance, and limit setting for Governance Risk) Adequacy of Process for Identification, Measurement, Monitoring, and Risk Control …………… (Filled with a description of the process for identification, measurement, monitoring, and control of Governance Risk) Risk Management Information System …………… (Filled with a description of how the information system supports the implementation of Risk Management for Governance Risk) Comprehensive Internal Control System …………… (Filled with a description of how internal controls including the compliance function are carried out by the pension fund for Governance Risk)
6. Fund Support Risk
Scope of Implementation
Risk Management
Description
Active Supervision by the Board of Directors and Board of Commissioners …………… (Filled with a description of active supervision by the Board of Directors and Board of Commissioners over Fund Support Risk) Adequacy of Policies, Procedures, and Risk Limit Setting …………… (Filled with a description of risk appetite, risk tolerance, and limit setting for Fund Support Risk) Adequacy of Process for Identification, Measurement, Monitoring, and Risk Control …………… (Filled with a description of the process for identification, measurement, monitoring, and control of Fund Support Risk)

Risk Management
Information System
…………… (Filled with a description of how the information system supports the implementation of Risk Management for Fund Support Risk) Comprehensive Internal Control System …………… (Filled with a description of how internal controls including the compliance function are carried out by the pension fund for Fund Support Risk) Prepared by, Acknowledged by, (Signature) (Signature) (Name) (Name) (Position) (Position)

VI. Report on the Implementation of Pension Fund Governance Implementing All or Part of Its Business Based on Sharia Principles

Transparency of Good Governance Implementation for Pension Funds
a. DPPK Management

Number, name, position, criteria, appointment date, term of office,
citizenship, and domicile of DPPK Management members No Name Position Criteria Appointment Date Term of Office Citizenship Domicile Last Formal Education And Professional Degree Competency And Fit and Proper Test 1. 2. Etc.
Concurrent positions of DPPK Management members
No. Name
Position at Pension
Fund
Position at Other
Pension Fund
Position at Companies and/or other institutions 1. 1. 2. Etc. 2. 1. 2. Etc. Etc
Frequency of DPPK Management meetings held within 1 (one) month.
No Name Position
Number of Management Meetings (... meetings) % Attendance Physical Attendance Teleconference/Video/ Conference/Other Electronic Media Facilities 1. 2. Etc
Family relationships between DPPK Management members and DPPK Supervisory Board members
and/or Sharia Supervisory Board members at the Pension Fund where the DPPK Management member in question holds office. No. Name Family Relationship With DPPK Supervisory Board Sharia Supervisory Board Yes No Note* Yes No Note* 1. 2. Etc

Note:
*) Form of family relationship: spouse/child/parent/sibling/ in-law, etc. b. Supervisory Board

Number, name, position, criteria, appointment date, term of office,
citizenship, and domicile of Supervisory Board members No Name Position Criteria Appointment Date Term of Office Citizenship Domicile Last Formal Education and professional degree Competency and Fit and Proper Test 1. 2. Etc.
Concurrent positions of the Supervisory Board
No. Name
Position at Pension
Fund
Position at Other
Pension Fund
Position at Companies and/or other institutions 1. 1. 2. Etc. 2. 1. 2. Etc. Etc.
Frequency of Supervisory Board meetings held within 1 (one) month.
No Name Position
Number of Supervisory Board Meetings (... meetings) Physical Attendance % Attendance Teleconference/Video/Conference/ Other Electronic Media Facilities 1. 2. Etc
Family relationships between Supervisory Board members and other Supervisory Board members,
DPPK Management members, and/or Acting Management members where the Supervisory Board member in question holds office. No. Name Family Relationship With Other Supervisory Board Members DPPK Management Members Acting Management Members Yes No Note* Yes No Note* Yes No Note* 1. 2. Etc

Note:
*) Form of family relationship: spouse/child/parent/sibling/in-law, etc.
c. Sharia Supervisory Board

Number, name, position, criteria, appointment date, term of office,
citizenship, and domicile of Sharia Supervisory Board members No Name Position Criteria Appointment Date Term of Office Citizenship Domicile Last Formal Education and professional degree Competency and Fit and Proper Test 1. 2. Etc.
Concurrent positions of the Sharia Supervisory Board
No. Name
Position at Pension
Fund
Position at Other
Pension Fund
Position at Companies and/or other institutions 1. 1. 2. Etc. 2. 1. 2. Etc. Etc.
Frequency of Sharia Supervisory Board meetings held within 1 (one)
month.
No Name Position
Number of Sharia Supervisory Board Meetings (... meetings) Physical Attendance % Attendance Teleconference/Video/Conference/ Other Electronic Media Facilities 1. 2. Etc
Family relationships between Sharia Supervisory Board members and other Sharia
Supervisory Board members, DPPK Management members, and/or Acting Management members where the Sharia Supervisory Board member in question holds office. No. Name Family Relationship With Other Sharia Supervisory Board Members DPPK Management Members Yes No Note* Yes No Note* 1. 2. Etc

Note:
*) Form of family relationship: spouse/child/parent/ sibling/in-law, etc. d. Supervisory Board Supervision Results Report

Supervisory Board activity report on the implementation of Pension Fund Governance
Summary of Supervision Results Recommendations e. Committees
Functions under DPPK Management
No.
Name
Function
Name
Member
Position*
Work
Experience
Appointment
Decree
Number of Meetings in One Year

Internal auditor function
1.
2.
Etc
2.
Risk
Management
Function
1.
2.
Etc
3. Compliance
Function
1.
2.
Etc
Etc
2) Committees under the Supervisory Board
No.
Name
Committee
Name
Member
Position*
Work
Experience
Appointment
Decree
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 auditor functions. No. Description Year n-2 Year n-1 Year n

Name of Public Accounting Firm
Name of Public Accountant
Audit Period

Appointment by Sharia Supervisory Board g. Implementation of remuneration and other facility policies for DPPK Management members, Sharia Supervisory Board members, and Employees. Number of DPPK Management members, Sharia Supervisory Board members, and Employees receiving remuneration packages in 1 (one) year classified by income level as follows:
Total Remuneration per person in 1 year *) Number of DPPK Management Number of Sharia Supervisory Board Employees Above Rp2 billion Above Rp1 billion to Rp2 billion Above Rp500 million to Rp1 billion Rp500 million and below Note: *) requested in cash h. Outsourcing of Investment Management No. Type of Investment Name of Outsourcing Company Value of Investment No. Agreement % of total Investment Portfolio 1. 2. Etc
i. Disclosure of other important matters Disclosure of other important matters
No. Description
Checklist *) If Yes,
Yes No Explain
1.
Resignation or dismissal of external auditor
2. Material transactions with related parties
4.
Ongoing and/or potential Conflicts of Interest
5. Other material information regarding the Pension Fund
6. The Pension Fund has a compliance function
7. The Pension Fund has an internal auditor

No. Description
Checklist *) If Yes,
Yes No Explain
8. The Pension Fund has a risk management function
9.
The Company has an investment management function/unit 10. The Company has a special work unit and/or appoints a Financial Service Institution official responsible for the implementation of AML and CFT programs *) choose one answer by marking with a “√” ) Related Party is an individual or company/entity that has a control relationship with the Pension Fund, either directly or indirectly, through ownership, management, and/or financial relationships
2. Self-Assessment of the Implementation of Good Pension Fund Governance
Filling out the questionnaire for the Implementation of Good Pension Fund Governance is done by the Pension Fund in question. Filling out this questionnaire is done by providing answers to the questions/statements in the questionnaire. Filling Method:
Generally, the answers to the Questions/Statements consist of 5 criteria as follows (except for answers requiring different criteria) :
A= The Pension Fund in question DOES NOT HAVE a written policy regarding the Question/Statement in question. B= The Pension Fund in question HAS a written policy regarding the Question/Statement in question, but the policy has NOT been implemented. C= The Pension Fund in question HAS a written policy regarding the Question/Statement in question, but the policy has NOT been implemented CONSISTENTLY. D= The Pension Fund in question HAS a written policy regarding the Question/Statement in question, the policy is IMPLEMENTED CONSISTENTLY but has NOT BEEN UPDATED regularly. E= The Pension Fund in question HAS a written policy regarding the Question/Statement in question and the policy is IMPLEMENTED CONSISTENTLY and UPDATED regularly. Interpretation of Results An assessment is needed to interpret the number obtained in answering the questions in this Questionnaire, most 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 the assessment criteria required in statutory regulations (mandatory), a minus number is given. For groups of Questions/Statements skipped because "None" and which are not "not applicable", in the result interpretation they must still be calculated by giving the same score as the answer "A/No".
I. 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 among others :
2.1. General policy directing to
statutory regulations and applicable codes of ethics A B C D E
2.2. Policy for Pension Fund organs A B C D E
2.3. Policy for employees A B C D E
2.4. Policy for Participants and/or parties entitled
to receive pension benefits
A B C D E
2.5. Policy for business partners A B C D E
2.6. Policy 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. Giving 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, Management, Sharia Supervisory Board, and pension fund
employees :
5.1. Make a "no conflict of interest" statement for every decision taken by the competent authority
No Yes
5.2. Make an annual statement regarding
the implementation of the company's code of conduct No Yes
5.3. Make an annual statement not to
accept or give anything that could influence decision-making No Yes
The Pension Fund correctly records its own assets, liabilities
and equity using generally accepted accounting principles or accounting principles specific to pension funds No Yes
Has a complaint system regarding violations
of the code of conduct, Pension Fund regulations and statutory regulations and matters related to Participants that guarantee protection for Whistleblowers. A B C D E
II. 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. Follow up on audit findings and recommendations
from work units performing the function of internal auditor of the Pension Fund, external auditor of the Pension Fund, and/or results of supervision by the Financial Services Authority A B C D E B. Management
Composition of Appointment and Dismissal of Management
1.1. The number of Management members has been adjusted
to the complexity of the company while still considering the effectiveness of decision-making. No Yes
1.2. Management consists of members who collectively possess
competence*) such as :
1.2.a Investment field No Yes
1.2.b Risk Management field. No Yes
Management Requirements
2.1. Management members meet the provisions of the
articles of association
No Yes
2.2. Management members meet the requirements
of competency and fit and proper according to regulations of the supervisory authority No Yes
2.3. Management members must understand and
implement GCG
A B C D E

2.4. Management members are prohibited from utilizing the Pension
Fund for personal, family, business group, or other parties' interests that harm the interests of the Pension Fund No Yes
2.5. Do not hold concurrent positions as Supervisory Board
members or DPS on the same Pension Fund No Yes
2.6. Do not hold concurrent positions as directors or board of
commissioners or equivalent in companies and/or other institutions No Yes
2.7. Management does not hold concurrent positions as members
of Management, Acting Management, Supervisory Board, or DPS on other Pension Funds. No Yes
3. Management Functions
3.1. Governance
3.1.1. Management is fully responsible for
the management of the Pension Fund A B C D E
3.1.2. Management manages the resources
owned, effectively and efficiently, including ensuring the possession of human resources meeting certain qualifications to perform its functions. A B C D E
3.1.3. Management considers the legitimate interests of stakeholders
A B C D E
3.1.4. Management has and adheres to rules of procedure
and work guidelines (charter) regulated in PDP and statutory regulations in the Pension Fund field A B C D E
3.1.5. Management members overseeing the
compliance function cannot be concurrently held by Management members overseeing the funding, financial, or investment functions, unless the number of Management members is 2 (two) people, the compliance function can be concurrently held by the Management member overseeing the financial function No Yes
3.2. Risk Management
3.3.1. Management prepares and implements
a Risk Management System covering all aspects of Pension Fund activities A B C D E

3.3.2. The Pension Fund has a Risk Monitoring Committee and Risk Management Unit
No Yes
3.3. Internal Control
3.3.3. The Pension Fund has an internal supervision function
No Yes
3.3.4. Responsible for the execution of its duties to the Founder and Co-Founders
No Yes
3.4. Information Technology
3.3.5. The Company has an integrated computerized administration system
3.3.6. The Company has Standard Operating Procedures for the Information Technology division
4. Accountability of the Board of Directors
4.1. The Board of Directors prepares a report on the management of the Pension Fund in the form of an Annual Report
No Yes
4.2. Criteria for the Annual Report include:
4.2.1. Contains at least:
a. Financial Report No Yes b. Pension Fund Activity Report No Yes
c. Good Corporate Governance (GCG) Implementation Report No Yes
4.2.2. Approved by the Founder and Co-Founders
No Yes
4.2.3. Specifically, the financial report must be approved by the Founder and Co-Founders
No Yes
4.3. Board of Directors Meetings
4.3.1. Every strategic policy and decision must be decided through a DPPK Board of Directors meeting, taking into account supervision according to the duties and responsibilities of the Sharia Supervisory Board
No Yes
4.3.2. The Board of Directors holds regular meetings at least 1 (one) time in 1 (one) month
No Yes
4.3.3. The Board of Directors establishes meeting regulations No Yes
4.3.4. Minutes of every Board of Directors meeting are created No Yes

4.3.5. Meeting minutes state differing opinions (dissenting opinion) with the decisions taken in the meeting (if any)
A B C D E
4.3.6. Every member of the Board of Directors, whether attending the meeting or not, has the right to receive the Board of Directors Meeting Minutes
C. Sharia Supervisory Board
No Yes

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 Company 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 the 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 have competence relevant to their positions
No Yes
1.4. Does not hold concurrent positions as DPS and DPPK Board of Directors in the same Pension Fund
No Yes
Competence and Integrity of the Sharia Supervisory Board
2.1. Meets the Fit and Proper Test requirements No Yes
2.2. Monitors the effectiveness of the implementation of Pension Fund GCG governance
A B C D E
2.3. Does not utilize the Pension Fund for personal, family, business group, or other interests that can harm the Pension Fund.
No Yes
Supervisory Functions of the Sharia Supervisory Board
3.1. Fully responsible for the supervision of DPPK A B C D E
3.2. Executes the duties and responsibilities of the Sharia Supervisory Board as regulated in the PDP and relevant regulations regarding Pension Funds independently
A B C D E
3.3. The Sharia Supervisory Board holds regular meetings
No Yes

3.4. Minutes of every Sharia Supervisory Board meeting are created
No Yes
3.5. Meeting minutes state differing opinions (dissenting opinion) with the decisions taken in the meeting
A B C D E
3.6. Every member of the Sharia Supervisory Board, whether attending the meeting or not, has the right to receive the Sharia Supervisory Board Meeting Minutes
No Yes
4. Sharia 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 implemented 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 implemented according to applicable auditing standards
No Yes
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. members of the Supervisory Board No Yes b. parties outside the Pension Fund who do not have financial, managerial, and/or family relationships with the Supervisory Board, DPPK Board of Directors, and/or Founder, or other relationships that can influence their ability to act independently. No Yes
4.1.7. For Pension Funds that do not have an Audit Committee, there are members of the Supervisory Board who specifically have the duty 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 implemented according to applicable auditing 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 implemented according to applicable auditing 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 matters:
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 Directors.
A B C D E
4.2.3. Members of the Risk Monitoring Committee consist of:
a. members of the Supervisory Board representing Participants No Yes b. other parties No Yes
4.2.4. For Companies that do not have a Risk Monitoring Committee, there are members of the Supervisory Board who specifically have the duty for the following matters:
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 Directors. 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 Sharia Supervisory Board for the following matters:
4.3.1. Facilitator for the Sharia Supervisory Board in assisting the Founder in setting criteria and selecting candidates for the Sharia Supervisory Board and Pension Fund Board of Directors
A B C D E

4.3.2. Facilitator for the Sharia Supervisory Board in assisting the Founder to set the remuneration system
A B C D E
4.3.3. Members of the Nomination and Remuneration Committee consist of:
a. members of the Sharia 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 specifically have the duty for the following matters:
a. Assist the Founder in setting criteria and selecting candidates for the Sharia Supervisory Board and Pension Fund Board of Directors A B C D E b. Assist the Founder to set the remuneration system A B C D E
III. HEALTHY BUSINESS PRACTICES
A. External Auditor

The 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
No Yes
Action Plan
No.
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 of Fraud Division/Section Involved b) Position Loss in Follow- an Compa ny c) Weakness/Cau se of Fraud d) Follow- Up/Improv ement e) Chronolo gy of Fraud events f) Fraud g) b. Progress of Anti-Fraud Strategy Implementation

Prevention:
……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………
Detection:
……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………
Investigation, Reporting, and Sanctions:
……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………
Monitoring, Evaluation, and Follow-Up:
……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………

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

GENERAL INFORMATION

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

STATEMENT OF THE DPS
A. IF NO PRACTICES VIOLATING
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..../DPLK Sharia Investment Package ..... 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 this supervision, we carry out assessments of the implementation of the Pension Program Based on Sharia Principles, which include aspects of the Contracts used, aspects of contribution management, aspects of investment placement, aspects of Pension Benefits, aspects of Other Benefits, 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 these matters by the Sharia Pension Fund..../DPPK Sharia Unit..../DPLK Sharia Investment Package ... 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..../DPLK Sharia Investment Package ... 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 this supervision, we carry out assessments of the implementation of the Pension Program Based on Sharia Principles, which include aspects of the Contracts used, aspects of contribution management, aspects of investment placement, aspects of Pension Benefits, aspects of Other Benefits, and other activities. From the supervision results, it is known that the Sharia Pension Fund..../DPPK Sharia Unit..../DPLK Sharia Investment Package... 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 these matters by the Sharia Pension Fund..../DPPK Sharia Unit..../DPLK Sharia Investment Package... has not been in accordance with Sharia Principles. Summary of Practices Not Yet in Accordance with Sharia Principles No. Practice Period of Incident Cause Remarks ....................(City Name),...........................(date-month-year) Sharia Supervisory Board No Name Position Signature

SUMMARY OF SUPERVISION RESULTS AND RECOMMENDATIONS Summary of Supervision Results and Recommendations Based on our supervision and assessment results regarding the implementation of Sharia Principles in the operational implementation of PPBS on the Sharia Pension Fund..../DPPK Sharia Unit..../DPLK Sharia Investment Package... during the period from date................... to ..............., the summary of supervision results and recommendations are as follows:
A. Contracts Used
Main Material 1:
Suitability of Contracts used with PPBS activities Suitability Status:
Status Remarks:
Recommendation:
Main Material 2:
Implementation of systems and procedures for the use of Contracts in PPBS activities Suitability Status:
Status Remarks:
Recommendation:
Main Material 3:
Setting fair and transparent ujrah/nisbah in PPBS activities Suitability Status:
Status Remarks:
Recommendation:

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

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

D. Pension Benefit Payments
Main Material 1:
Implementation of systems and procedures for Pension Benefit payments Suitability Status:
Status Remarks:
Recommendation
Main Material 2 :
Pension Benefit calculations and payments have been carried out in accordance with the promises of the employer, or are in accordance with the ownership rights of Participants, and do not conflict with Sharia Principles. Suitability Status:
Status Remarks:
Recommendation
E. Other Benefits (if any)
Main Material 1:
Implementation of systems and procedures for managing contribution funds for Other Benefits Suitability Status:
Status Remarks:
Recommendation:
Main Material 2:
Implementation of systems and procedures for investing Other Benefits Suitability Status:
Status Remarks:
Recommendation:
Main Material 3:
Implementation of systems and procedures for Other Benefit payments Suitability Status:
Status Remarks:

Recommendation:
Main Material 4:
Other Benefit calculations and payments have been carried out in accordance with the promises of the employer, or are in accordance with the ownership rights of Participants, and do not conflict with Sharia Principles and relevant regulations regarding Pension Funds Suitability Status:
Status Remarks:
Recommendation
F. Other Activities
Main Material 1:
Implementation of systems and procedures for placing PPBS assets other than investments Suitability Status:
Status Remarks:
Recommendation:
Main Material 2:
Administration of proof of ownership of other assets Suitability Status:
Status Remarks:
Recommendation:
Main Material 3:
Recording and administration of PPBS Participant accounts Suitability Status:
Status Remarks:
Recommendation:

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

VIII. Proof of Fulfillment of Requirements for the Continuity of Directors and Employees Handling Investments
FORM :
FORM SELF ASSESSMENT
REPORT ON THE FULFILLMENT OF CONTINUITY REQUIREMENTS FOR DIRECTORS AND EMPLOYEES HANDLING INVESTMENTS Name of Pension Fund :
Report Letter Number :
Report Letter Date :
Contact Person (Name,
Telp/e-mail)
:
NO DESCRIPTION LEGAL BASIS YES NO REMARKS 1.
The report on the fulfillment of continuity requirements is submitted by the Pension Fund Board of Directors to OJK no later than 1 (one) month after the annual period ends. o POJK 3/POJK.05/2015 o POJK 5/POJK.05/2018
2. Proof of fulfillment of continuity requirements
Additional remarks (if necessary):
No Name
Type
Principal Party *)
No. and date
FPT Decision Letter
Type
Fulfillment *)
Title of
Activity
Organizer
Activity
*)
Name of
Organizer
Date of
Implementation
Fulfill- ment
Year
Proof of fulfill- ment *)
..... oDirectors oEmployees
..... o attending seminars, workshops, or other similar activities o attending courses, training, or similar educational programs o writing papers, articles, or other written works that are published o becoming speakers in seminars, workshops, or other similar activities, becoming teachers or becoming instructors in courses, training, or similar educational programs ..... o financial service supervisory institutions inside and outside the country o financial service institution associations inside and outside the country o universities inside and outside the country o training institutions that have licenses from competent authorities ..... ..... ..... o certificate (number and date) o attendance proof o others,
namely.....
Remarks:

Filling method: click twice in the box, then select "Checked"
*) select one
This Self Assessment Form is prepared based on OJK Regulation No. 3/POJK.05/2015 Regarding 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 Regarding Pension Fund Investments

FORMAT I D
A. Consumer Service and Complaint Resolution Report for Financial Service Business Actors The form and structure of consumer complaint reports and follow-up services 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 Consumer Service and Resolution of Complaints for Financial Service Business Actors. B. Report on the Appointment of Public Accountants and/or Public Accounting Firms in the Context of Audits on Annual Historical Financial Information The form and structure of reports on the appointment of public accountants and/or public accounting firms in the context of audits 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 Reports for Employer Pension Funds Operating Defined Benefit Pension Programs General Data Report Number Report Date Company Code Company Name Company Address Reporting Period Reporting Month Fiscal Year Type of Reporting Period Annual Report Name of Directors Director Position

Actuarial Statement
1.1 Company Actuarial Information:

Actuary Name;
Office Address and Telephone Number;
1.2 Confirmation regarding Actuarial Present Value, Solvency Liabilities, Funding Assets, Surplus or Deficit, Solvency Ratio, Funding Ratio, and funding quality.
1.3 Confirmation regarding:

the amount of Normal Contributions that must be paid until the end of the first book 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 the year after the book year as referred to in number 1, up to the submission of the next Actuarial Report;
the portion of Normal Contributions whose fulfillment becomes the responsibility of the Employer that can be paid from Surplus that occurs, along with its usage period; and
1.4 Confirmation regarding the amount of additional monthly contributions along with their payment period.
for Periodic Actuarial Reports as referred to in the Financial Services Authority Regulations regarding Pension Fund Funding

1.5 Pension Cost Sharing
I, the undersigned, state 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 reason, testing has been conducted to assess its reliability.
The Report meets the relevant regulations regarding Pension Funds.
The Report meets the Employer's requirements.
The Report is prepared based on the PDP; and
The Report is prepared based on actuarial practice standards for Pension Funds applicable in Indonesia;
Place, date of creation
Signature.
Name
No. Indonesia Association of Actuaries (PAI) Registration Public Actuary License No.:
Founder/Co-Founder Statement
We, the undersigned, state that:
the submitted data and PDP are complete and correct;
we are able to pay contributions according to the minimum funding stated in the Actuarial statement; and
in the event that there is a surplus, it is used to reduce the Employer's Normal Contributions, including those representing the statement of all employers in the case of cost sharing/non-sharing pension cost
Place, date of creation Position*) Signature. Name
Actuarial Valuation Date
Reported actuarial valuation date Previous period actuarial valuation date
Purpose of Preparation
Summary of PDP and Changes that occurred in the PDP since the previous actuarial valuation date
Summary of the number of Participants and the number of entitled parties along with changes that occurred since the previous actuarial valuation date
Actuarial Valuation Method and Actuarial Assumptions Used
Actuarial valuation method and actuarial assumptions used Data Description Actuarial Calculation Method Actuarial Present Value Calculation Method Liability Calculation Method Economic Assumptions Inflation Rate Interest Rate Basic pension income growth rate Pension benefit growth rate Demographic Assumptions Active mortality rate Retirement mortality rate Disability rate Resignation rate Other Assumptions Taxes (in the event that taxes on pension benefits are borne by the Pension Fund) Age difference between husband and wife Pension program management costs Reasons for selecting the 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
Data Description a. Funding Value of Wealth Wealth

Funding Wealth
Liabilities
Solvency Liabilities
Actuarial Present Value b. Analysis of Surplus or Deficit Changes Funding Position Surplus Surplus Excess Surplus Usage Period Total Deficit Pre-legislative Deficit Deficit Categorized as Solvency Shortage External Deficit Categorized as Solvency Shortage Analysis:
Funding Quality Level
Funding Ratio
Solvency Ratio
CONTRIBUTIONS
Normal Contribution
First Year (Rp)
Subsequent Years 0.00%
Participant Normal Contribution (%) Employer Normal Contribution (%) Total Additional Contributions
Monthly Contribution
Installment Period (months)
c. Overall Actuarial Valuation Results
Reported Actuarial Valuation Date:
Previous Actuarial Valuation Date:

Monthly Actuarial Present Value Projection for at least the first 3 (three) years
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 Pension Funds Implementing Defined Contribution Pension Programs and Making Periodic Pension Benefit Payments General Data Report Number Reporting Date Company Code Company Name Company Address Reporting Period Reporting Month Fiscal Year Type of Reporting Period Annual Report Board of Directors Name Board of Directors Position

Actuarial Statement
1.1 Company Actuary Information:

Actuary Name;
Office Address and Telephone Number;
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 legislation in the field of Pension Funds.
The Report complies with Employer requirements.
The Report is prepared based on the Pension Data Package (PDP); and
The Report is prepared based on actuarial practice standards for Pension Funds applicable in Indonesia;
Place, date of preparation
Signature.

Name
Indonesia Actuarial Association (PAI) Registration No. Public Actuary License No.:

Actuarial Valuation Date
Reported Actuarial Valuation Date Previous Period Actuarial Valuation Date
Purpose of Preparation
Summary of PDP including payment patterns and normal retirement age
Summary of the number of Participants, widows/widowers, and children choosing periodic Pension Benefit payments
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 Implementing Other Defined Benefit Programs
General Data
Report Number
Reporting Date
Company Code
Company Name
Company Address
Reporting Period
Reporting Month
Fiscal Year
Type of Reporting Period Annual Report Board of Directors Name Board of Directors Position

Actuarial Statement
1.1 Company Actuary Information:

Actuary Name;
Office Address and Telephone Number;
1.2 Confirmation regarding the program asset value of ODB, the present value of potential Other Benefit payments, and the adequacy of ODB funds.
1.3 Confirmation regarding the amount of funding required in the implementation of ODB.
1.4 Pension Cost Sharing
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 legislation in the field of Pension Funds.
The Report complies with Employer requirements.
The Report is prepared based on the Pension Data Package (PDP); and
The Report is prepared based on actuarial practice standards for Pension Funds applicable in Indonesia;
Place, date of preparation
Signature.

Name
Indonesia Actuarial Association (PAI) Registration No. Public Actuary License No.:

Founder/Partner 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 outlined in the Actuarial Statement; and
In the event of excess funding, ODB is used to reduce ODB contributions, including those representing the statement of all employers in the event of sharing/non-sharing pension cost.
Place, date of preparation Position*) Signature. Name
Actuarial Valuation Date
Reported Actuarial Valuation Date Previous Period Actuarial Valuation Date
Purpose of Preparation
Summary of PDP and Changes occurring in the PDP since the previous actuarial valuation date
Summary of the Number of Participants and the number of parties entitled to Other Benefits, along with changes occurring since the previous actuarial valuation date
Actuarial Valuation Method and Actuarial Assumptions Used
Actuarial Valuation Method and Actuarial Assumptions Used Data Description Actuarial Calculation Method Actuarial Present Value Calculation Method Solvency Liability Calculation Method Economic Assumptions Inflation Rate Interest Rate Basic pensionable salary increase rate Pension benefit increase rate Demographic Assumptions Active mortality rate Retirement mortality rate 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 the 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
Data Description a. Funding Value of Wealth Wealth

Funding Wealth
Liabilities
Solvency Liabilities
Actuarial Present Value b. Analysis of Surplus or Deficit Changes Funding Position Surplus Surplus Excess Surplus Usage Period Total Deficit Pre-legislative Deficit Deficit Categorized as Solvency Shortage External Deficit Categorized as Solvency Shortage Funding Quality Level Funding Ratio Solvency Ratio CONTRIBUTIONS

Normal Contribution
First Year (Rp)
Subsequent Years
Participant Normal Contribution (%) Employer Normal Contribution (%) Total Additional Contributions

Monthly Contribution
Installment Period (months)
c. Overall Actuarial Valuation Results
Reported Actuarial Valuation Date:
Previous Actuarial Valuation Date:

Program asset value of ODB
Description of the determination of the ODB program asset value
Analysis of changes in ODB fund adequacy
Present value projection of potential Other Benefit payments semi-annually for at least the first 3 (three) years

E. Pension Fund Business Plan
A. Executive Summary

Financial Indicators
No. Description
Projection
Millions of Rupiah % Growth
1 Assets
2 Investments
3 Liabilities
4 Investment Income for the Pension Fund business plan as referred to in the Financial Services Authority regulations regarding good governance for Pension Funds

5 Investment Expenses
6 Investment Business Results
7 Operational Expenses
8 Pre-Tax Business Results
9 Post-Tax Business Results

Financial Ratios
No. Description %
1 Investment Income Ratio (ROI) 2 Investment Income to Assets Ratio (ROA) 3 Operational Expense Ratio (BOPO)
Non-Financial Executive Summary
The non-financial executive summary contains a summary of information regarding Company targets for 1 (one) to 3 (three) years ahead, which the Pension Fund considers very necessary to include in the executive summary.

B. Evaluation of Previous Business Plan Implementation Indicator 20XX-1 20XX-2 20XX-3 Plan Realization % Plan Realization % Plan Realization % Plan Realization % (1) (2) (1/2) (1) (2) (1/2) (1) (2) (1/2) Investment Income Ratio (ROI) Investment Income to Assets Ratio (ROA) Operational Expense Ratio (BOPO) Fund Adequacy Ratio

C. Vision, Mission, Business Strategy, and Management Policy
Completed with targets to be achieved for 1 (one) to 3 (three) years ahead, accompanied by policies and strategies to be implemented.

Vision and Mission
No. Target Policy Strategy

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

D. Implementation of Risk Management and Compliance Scope of Implementation Risk Management Description Active Supervision Managers, Acting Managers, and Sharia Supervisory Board …………… (Filled with a description of the role of Managers, Acting Managers, and the Sharia Supervisory Board in Risk Management and the Risk Management organizational structure) Adequacy of Policies, Procedures, and Risk Limit Determination …………… (Filled with a description of risk appetite, risk tolerance, and risk limit determination) Adequacy of the Identification, Measurement, Monitoring, and Risk Control Process …………… (Filled with a description of the risk identification, measurement, monitoring, and control process) Risk Management Information System …………… (Filled with a description of how the pension fund information system supports the implementation of Risk Management) Comprehensive Internal Control System …………… (Filled with a description of how internal control, including the compliance function, is conducted by the pension fund)

E. Implementation of Pension Fund Governance

Pension Fund Governance Implementation Plan
Action Plan
No.
Corrective Action
Completion Target
Completion Obstacles
Remarks

Etc

Anti-Fraud Strategy Implementation Plan

F. Current and Previous Period Pension Fund Financial Performance

Investment Income
No.
RKAP
Year n-1
RKAP
Year n
Actual as of
September
Year n
%
Achievement
% Increase (Decrease) against RKAP Year n-1 1 2 3 4 5=4/3 6=(5-4)/4
Investment Business Results
No.
Investment Type
Investment Business Results
RKAP
Year n-1
RKAP
Year n
Actual as of 30
September
Year n
%
Achievement
% Increase
(Decrease) against
RKAP Year n-1
1 2 3 4 5 6=5/4 7=(4-3)/3
Business Results
No.
Profit
RKAP
Year n-1
RKAP
Year n
Actual as of 30
September
Year n
%
Achievement
% Increase
(Decrease) against
RKAP Year n-1
1 2 3 4 5 6=5/4 7=(4-3)/3
Pre-Tax Business Results
Post-Tax Business Results

G. Financial Statement Projection and Assumptions Used

Financial Position Projection for Pension Funds
(in millions of Rupiah)
DESCRIPTION
Actual as of 30
Sept
20XX1*
Projection as of 31
Dec
20XX-1*
Projection
Year 1
Projection as of 31
Mar
20XX* as of 30
Jun
20XX* as of 30
Sep
20XX* as of 31
Dec
20XX* as of 31
Dec
20XX
+1* as of 31
Dec
20XX+
ASSETS
INVESTMENTS
Bank Savings
On-call Deposits at Banks
Time Deposits at Banks
Certificates of
Deposit at Banks
Securities
Issued by
Bank Indonesia
Government
Securities
Stocks
Listed on the
Indonesian Stock
Exchange

Corporate Bonds
Listed on the
Indonesian Stock
Exchange

Regional Bonds/Sukuk
Mutual Funds - - - -
MTN - - - -
Asset-Backed
Securities

Real Estate
Investment Funds
Structured as
Collective Investment
Contracts

Infrastructure
Investment Funds
Structured as
Collective Investment
Contracts
Options Contracts and Derivative Contracts on Securities Listed on the Indonesian Stock Exchange

REPO - - - -

Land in
Indonesia

Buildings in
Indonesia

Land and
Buildings in
Indonesia

TOTAL
INVESTMENTS

VALUATION
DIFFERENCE
OF
INVESTMENTS
CURRENT ASSETS
OUTSIDE
INVESTMENTS

Cash and
Bank

Contribution
Receivables

Interest
Receivables
Late
Contribution

Prepaid
Expenses

Investment
Receivables

Investment
Income
Receivables

Other
Receivables

DESCRIPTION
Actual as of 30
Sept
20XX1*
Projection as of 31
Dec
20XX-1*
Projection
Year 1
Projection as of 31
Mar
20XX* as of 30
Jun
20XX* as of 30
Sep
20XX* as of 31
Dec
20XX* as of 31
Dec
20XX
+1* as of 31
Dec
20XX+
TOTAL
CURRENT ASSETS
OUTSIDE
INVESTMENTS

OPERATING
ASSETS

Land and
Buildings

Vehicles -
Computer
Equipment

Office
Equipment

Other
Operating
Assets

Accumulated
Depreciation

TOTAL
OPERATING
ASSETS

OTHER ASSETS

TOTAL
ASSETS

LIABILITIES - - - -
ACTUARIAL
PRESENT
VALUE
VALUATION
DIFFERENCE
OF
ACTUARIAL
PRESENT
VALUE
LIABILITIES
OUTSIDE

DESCRIPTION
Actual as of 30
Sept
20XX1*
Projection as of 31
Dec
20XX-1*
Projection
Year 1
Projection as of 31
Mar
20XX* as of 30
Jun
20XX* as of 30
Sep
20XX* as of 31
Dec
20XX* as of 31
Dec
20XX
+1* as of 31
Dec
20XX+
LIABILITIES
ACTUARIAL
PRESENT
VALUE
Pension Benefit and Other
Benefits Due
Liabilities

Investment
Liabilities

Unearned
Income

Accrued
Expenses

Other
Liabilities
Voluntary
Benefit
Liabilities
TOTAL
LIABILITIES
OUTSIDE
ACTUARIAL
PRESENT
VALUE
LIABILITIES
TOTAL
LIABILITIES
Remarks:
*If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc. If the items below have no figures related to SAP, they are entered manually in the ratio:

Income Statement Projection
(in millions of Rupiah)
DESCRIPTION
Actual
Actual
Projection
Projection
Year 1
Jan-Sept
Jan-Dec
Jan-Mar
20XX*
Jan-Jun
20XX*
Jan-Sep
20XX*
Jan-Dec
20XX*
Jan-Dec
20XX
+1*
Jan-31
Dec
20XX+
20XX1*
20XX1*
INVESTMENT
INCOME
Interest/Profit
Sharing
Dividends
Rent
Profit (Loss)
Investment
Disposal
Other
Investment
Income

Total
Investment
Income
INVESTMENT
EXPENSES
Transaction
Expenses
Maintenance
Expenses
Land and
Buildings

-
Building
Depreciation
Expenses

Investment
Manager
Expenses
Custody
Expenses
Other
Investment
Expenses
Total
Investment
Expenses
INVESTMENT
BUSINESS
RESULTS

-
OPERATIONAL
EXPENSES

Salaries/Honoraria for Employees, Managers, and Supervisory Board Office Expenses - - Maintenance Expenses Depreciation Expenses Third-Party Service Expenses

-
Late
Contribution
Interest
Profit (Loss)
Sale of
Operating
Assets

Profit (Loss)
Sale of
Other Assets

-
Other Income
Outside
Investment
Other Expenses
Outside
Investment and
Operations
Total
Income and
Expenses
Others
PRE-TAX
BUSINESS
RESULTS
INCOME
TAX
POST-TAX
BUSINESS
RESULTS
Remarks:
*If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.

Projection of Ratios and Certain Other Items for Pension Funds
(in millions of Rupiah)
(ratios in percentage)
DESCRIPTION
Actual
Projection
Year 1
Jan-Sept
Jan-Dec
Jan-Mar
20XX

Jan-Jun
20XX*
Jan-Sep
20XX*
Jan-Dec
20XX
*
Jan-Dec
20XX
+1*
Jan-Dec
20XX
+2*
20XX1*
20XX1*
Investment Income
Ratio (ROI)
Investment Income
Ratio to Assets
(ROA)
Operational Expense
Ratio (BOPO)
Funding Ratio
Solvency Ratio
Fund Adequacy Ratio
ALM
Remarks:
*If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc. If there are accounts that must be filled from accumulated calculations, e.g., from the income statement, they are filled with accumulated values.

Assumptions Used
No. DESCRIPTION
Actual
Projection
Projection
Projection
Year 1
Jan-Sept
Jan-Dec
Jan-Mar
20XX
2
Jan-Jun
20XX
2
Jan-Sep
20XX
2
Jan-Dec
20XX
2
Jan-Dec
20XX
+1 3
Jan-Dec
20XX
+2 3
20XX1 1
20XX-1
1 Interest Rate Assumptions
2 Actuarial Calculation
Method Assumptions
3 Mortality Rate
Assumptions
4 Investment return rate
5 etc. (other relevant assumptions)

H. Pension Fund Plan

Funding Plan
The funding plan generally comes from contributions or development results. Contributions can be made by the employer alone or jointly by the employer and workers (participants). DESCRIPTION Actual Projection Year 1 As of 30 Sept As of 31 Dec As of 31 Mar 20XX As of 30 Jun 20XX As of 30 Sep 20XX* As of 31 Dec 20XX As of 31 Dec 20XX+ As of 31 Dec 20XX+ 20XX-1 20XX-1 FUNDS CONTRIBUTIONS Employer (filled with nominal) Participants Total Contribution Funds Remarks:
*If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.
Investment Plan
a. Investment Composition
No.
Investment
Type
Actual
Projection
Year 1
As of 30
Sept
As of 31
Dec
As of
Mar
20XX
As of
Jun
20XX
As of
Sep
20XX

As of
Dec
20XX
As of 31
Dec
20XX+
As of 31
Dec
20XX+
20XX-1 20XX-1
Etc.

b. Investment Results
No.
Investment
Type
Actual
Projection
Year 1
As of 30
Sept
As of 31
Dec
As of
Mar
20XX
As of
Jun
20XX
As of
Sep
20XX
*
As of
Dec
20XX
As of
Dec
20XX
+1
As of 31
Dec
20XX+
20XX-1 20XX-1
Etc.

Organizational and Human Resources Development Plan
a. Human Resources Quantity Requirements Plan No Level Position HR Quantity as of 30 Sept 20XX-1 Recruitment to be Implemented Quarter IV 20XX-1 Quarter I 20XX Quarter II 20XX Quarter III 20XX Quarter IV 20XX Increase Reduction Increase Reduction Increase Reduction Increase Reduction Increase Reduction Etc Total

b. Human Resources Education and Training Implementation Plan for Managers, Acting Managers, and the Supervisory Board No. Material/Topic Participants Training Time Etc

Office Network Development and/or Change Plan
The office network development and/or change plan must at least include plans for opening and merging offices outside the head office. No. Office Type Implementation Time 1 Location 2 Remarks 3 A. Opening B. Status Change
C. Merger
D. Address Transfer
Etc
E. Office Closure
Etc
Remarks:
1 Filled with the month of the planned implementation time. 2 For locations in the DKI Jakarta region, at least mention the province name of DKI Jakarta. For locations outside the DKI Jakarta region, at least mention the Regency/City name. 3 Detailed remarks can be attached in a separate sheet.

I. Information Technology System Development Plan
Detail the plan for the use of information technology used by the company to support business activities. No. Application Type/Name Ownership (In-house/vendor) Vendor Name Application Function

J. 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:

merger and separation plans;
portfolio transfer plans;

This copy is consistent with the original Legal Director 1 Legal Department signed Yuliana

plans to change business activities not based on Sharia principles to based on Sharia principles.

Determined in Jakarta on 5 March 2019 EXECUTIVE HEAD OF SUPERVISOR OF INSURANCE, PENSION FUNDS, LENDING INSTITUTIONS, AND OTHER FINANCIAL SERVICE INSTITUTIONS FINANCIAL SERVICES AUTHORITY, signed RISWINANDI

APPENDIX II
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 4 /SEOJK.05/2019 REGARDING THE FORM AND STRUCTURE OF PERIODIC REPORTS FOR PENSION FUNDS IMPLEMENTING PENSION PROGRAMS BASED ON SHARIA PRINCIPLES

FORMAT II A
To
The Directorate of Statistics and Information IKNB Financial Services Authority MONTHLY REPORT/ANNUAL FINANCIAL REPORT ELECTRONIC DATA SHARIA-BASED FINANCIAL INSTITUTION PENSION FUNDS/ Per DD-MM-YYYY 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 Manager Name Manager Position SID Number Audit Data Auditor License Number Audit Type Auditor Code Auditor Name Opinion Audit Executor Audit Date Report Compiler Officer Name Division Telephone Fax Email Manager Person in Charge Person in Charge Name Position Telephone Fax E-mail Pension Fund Address

Description Details
Code
Percentage
Pension Program Other Benefits Combined ASSETS SHARIA INVESTMENTS Bank Savings 1101 On-call Deposits at Banks 1102 Time Deposits at Banks 1103 Certificates of Deposit at Banks 1104 Sharia-Based Securities Issued by Bank Indonesia 1105 Sharia Government Securities 1106 Sharia Stocks Listed on the Indonesian Stock Exchange 1107 Corporate Sukuk Listed on the Indonesian Stock Exchange 1109 Regional Sukuk 1110 Sharia Mutual Funds 1111 Sharia MTN 1112 Sharia Asset-Backed Securities 1113 Sharia Real Estate Investment Funds Structured as Collective Investment Contracts 1114 Sharia Infrastructure Investment Funds Structured as Collective Investment Contracts 1115 Sharia Options Contracts and Derivative Contracts on Securities Listed on the Indonesian 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 Bank 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 Payable 1502 Investment Payable 1503 Unearned Income 1504 Accrued Expenses 1505 Other Payable 1506 Total Liabilities Outside Pension Benefit Liabilities TOTAL LIABILITIES NET ASSETS DEFINED CONTRIBUTION PENSION PROGRAM NET ASSET REPORT Per DD-MM-YYYY

Defined Contribution Pension Program Other Benefits Combined INCREASES Investment Income Profit Sharing Dividends Rent Profit (Loss) on Investment Disposal Other Investment Income Total Investment Income Increase (Decrease) in Investment Value 401 Contributions 402 Income Outside Investment 403 Transfer of Funds from Other Pension Funds 404 Total Increases DECREASES Investment Expenses 405 Operational Expenses 406 Expenses Outside Investment and Operations 407 Pension Benefits and Other Benefits Income Tax 408 Transfer of Funds to Other Pension Funds 409 Contribution Withdrawals Total Decreases INCREASE (DECREASE) IN NET ASSETS NET ASSETS AT BEGINNING OF PERIOD NET ASSETS AT END OF PERIOD DEFINED CONTRIBUTION PENSION PROGRAM NET ASSET CHANGE REPORT Per DD-MM-YYYY Description Details Code Accumulation as of DD-MM-YYYY

Program Pensiun Manfaat Lain Gabungan ASET INVESTASI (Historical Value) Bank Savings On-Call Deposits at Banks Term 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 Sharia Infrastructure Investment Funds in the Form of Collective Investment Contracts Sharia Equity Options 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 Prepaid Expenses Investment Receivables Investment Income Receivables Other Receivables TOTAL CURRENT ASSETS EXCLUDING INVESTMENTS TOTAL ASSETS LIABILITIES PENSION BENEFIT LIABILITIES Accumulated Contributions Business Results Transfer of Funds from Other Pension Funds TOTAL PENSION BENEFIT LIABILITIES LIABILITIES EXCLUDING PENSION BENEFIT LIABILITIES Due Pension Benefits and Other Benefits Payable Voluntary Benefit Payables Investment Payables Unearned Income Expenses Incurred but Not Yet Paid Other Payables TOTAL LIABILITIES EXCLUDING PENSION BENEFIT LIABILITIES TOTAL LIABILITIES DEFINITE CONTRIBUTION PENSION PROGRAM BALANCE SHEET As of DD-MM-YYYY Description Accumulated as of DD-MM-YYYY

Program Pensiun Manfaat Lain Gabungan INVESTMENT INCOME Profit Sharing Dividends Rent Gain (Loss) on Investment Disposal Other Investment Income Total Investment Income INVESTMENT EXPENSES Transaction Costs Land and Building Maintenance Costs Building Depreciation Costs Investment Manager Fees Custodian Fees Other Investment Expenses Total Investment Expenses INVESTMENT BUSINESS RESULTS OPERATIONAL EXPENSES Fee to Founder Total Operational Expenses OTHER INCOME AND EXPENSES Other Income Outside of Investments Other Expenses Outside of Investments and Operations Total Other Income and Expenses INCOME BEFORE TAX INCOME TAX INCOME AFTER TAX DEFINITE CONTRIBUTION PENSION PROGRAM INCOME STATEMENT As of DD-MM-YYYY Description Accumulated as of DD-MM-YYYY

Program Pensiun Manfaat Lain Gabungan 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 Flows from Investment Activities CASH FLOWS FROM OPERATIONAL ACTIVITIES Payment of Operational Expenses Other Income Outside of Investments Other Expenses Outside of Investments and Operations Income Tax Net Cash Flows from Operational Activities CASH FLOWS FROM FINANCING ACTIVITIES Contribution Receipts Receipts of Fund Transfers from Other Pension Funds Payment of Fund Transfers 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 BEGINNING OF PERIOD CASH AT END OF PERIOD Description DEFINITE CONTRIBUTION PENSION PROGRAM CASH FLOW STATEMENT As of DD-MM-YYYY Accumulated as of DD-MM-YYYY

(1) Active Participants a. Individuals b. Groups (2) Inactive Participants (Those Entitled to Pension Benefits) a. Individuals b. Groups (3) Total DPLK Participants (1) + (2) PENSION FUND MEMBERSHIP As of DD-MM-YYYY Description Program Pensiun Manfaat lain Total

Bank Savings
On-Call Deposits at Banks
Term 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 Sharia Infrastructure Investment Funds in the Form of Collective Investment Contracts Sharia Equity Options 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 DEFINITE CONTRIBUTION PENSION PROGRAM INVESTMENT RECAPITULATION As of DD-MM-YYYY Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Description

Bank Term Deposit Certificate of Deposit SBI Syariah SBSN abcd efg Life Cycle Fund As of DD-MM-YYYY Investment Assets Total Number of Participants Total Funds

Profit Sharing Dividends Rent Gain/Loss Disposal Others Bank Savings On-Call Deposits at Banks Term 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 Sharia Infrastructure Investment Funds in the Form of Collective Investment Contracts Sharia Equity Options and Forward Contracts Listed on the Indonesia Stock Exchange REPO Direct Participation Land in Indonesia Buildings in Indonesia Land and Buildings in Indonesia Total DEFINITE CONTRIBUTION PENSION PROGRAM INVESTMENT INCOME STATEMENT As of DD-MM-YYYY Investment Type Realized Investment Income Unrealized Investment Income Investment Expenses Net Investment Income Average Investment ROI

Profit Sharing Dividends Rent Gain/Loss Disposal Others Bank Savings On-Call Deposits at Banks Term 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 Sharia Infrastructure Investment Funds in the Form of Collective Investment Contracts Sharia Equity Options and Forward Contracts Listed on the Indonesia Stock Exchange REPO Direct Participation Land in Indonesia Buildings in Indonesia Land and Buildings in Indonesia Total DEFINITE CONTRIBUTION PENSION PROGRAM INVESTMENT INCOME STATEMENT FOR OTHER BENEFIT PROGRAMS As of DD-MM-YYYY Investment Type 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 Term 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 Sharia Infrastructure Investment Funds in the Form of Collective Investment Contracts Sharia Equity Options 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 Prepaid Expenses Investment Receivables Investment Income Receivables Other Receivables Total Current Assets Excluding Investments
C. Total Assets (A+B)
D. Pension Benefit Liabilities
Accumulated Contributions
Business Results
Transfer of Funds from Other Pension Funds E. Liabilities Excluding Pension Benefit Liabilities Due Pension Benefits and Other Benefits Payable Voluntary Benefit Payables Investment Payables Unearned Income Expenses Incurred but Not Yet Paid Other Payables Total Liabilities Excluding Pension Benefit Liabilities F. Total Liabilities (D+E) G. Difference Between Total Assets and Total Liabilities (E-H) H. Percentage (%) Fund Sufficiency Ratio Total DEFINITE CONTRIBUTION PENSION PROGRAM ASSET AND LIABILITY RECAPITULATION As of DD-MM-YYYY (in Rupiah) Due >= 10 Years Description Due < 1 year 1 year <= Due < 5 years 5 years <= Due < 10 years

Type Quantity Percentage of Total Investment ab c d e f g … Details of Investment with One Counterparty No. Counterparty Name Investment Limit in Instructions Investment Limit According to Regulations

Investment Income Ratio (ROI)
A. Investment Income after deducting operational investment expenses B. Average Investment
C. Ratio (a:b)
Investment Income to Assets Ratio (ROA) A. Investment Income + Other Income - Investment and Non-Investment Expenses B. Total Assets
C. Ratio (a:b)
Operational Expense Ratio (BOPO) A. Operational Expenses B. Total Available Assets
C. Ratio (a:b)
FINANCIAL RATIOS
Description Total Other Benefits Pension Program

No. Investment Manager Name Contract Number Contract Date Agreement Term Investment Type Funds Managed (Rp) Investment Return Rate Net (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 Manager Disclosure Format Use of Investment Manager As of DD-MM-YYYY Total etc.

Return ab c d e f g
…
Total
SAVINGS DETAILS
No. Bank Name Acquisition Date Nominal Value Notes Pension Program/ Other Benefits

ab c d e f g h
…
Total
ON-CALL DEPOSIT DETAILS
No. Bank Name Acquisition Date Nominal Value Term Return Notes Pension Program/ Other Benefits

ab c d e f g h
…
Total
TERM DEPOSIT DETAILS
No. Bank Name Acquisition Date Nominal Value Term Return Notes Pension Program/ Other Benefits

ab c d e f g h i j
…
Total
CERTIFICATE OF DEPOSIT DETAILS
No. Bank Name Acquisition Date Nominal Value Acquisition Value Maturity Value Term Return Notes Pension Program/ Other Benefits

Value % ab c d e f g h i j k l
…
Total
Notes
SHARIA BANK CERTIFICATE DETAILS No.
Security Code
Acquisition Date Nominal Value Maturity Date Acquisition Date Fair Value Investment Valuation Difference Coupon (%) Pension Program/ Other Benefits

Value % ab c d e f g h i j k l m … Total Notes SHARIA GOVERNMENT SECURITY DETAILS No. Security Code Acquisition Date Nominal Value Maturity Date Acquisition Date Fair Value Investment Valuation Difference Coupon (%) Accounting Method Pension Program/ Other Benefits

Value % ab c d e f g h i j k l
…
Total
Notes
SHARIA STOCK DETAILS
No. Stock Code Issuer/Issuer Name Acquisition Date Number of Shares Acquisition Value Market Value Investment Valuation Difference Economic Sector Pension Program/ Other Benefits

Economic Sector
Beginning End Value % ab c d e f h i j k l m n o p p q r … Total CORPORATE SUKUK DETAILS No. Issuer/Issuer Name Sukuk Code Sukuk Name Acquisition Date Nominal Value Maturity Date Rating Acquisition Value Fair Value Investment Valuation Difference Notes Accounting Method Coupon (%) Pension Program/ Other Benefits

Economic Sector
Beginning End Value % ab c d e f g h i j k l m n o p q r … Total Acquisition Value Fair Value Investment Valuation Difference Notes REGIONAL SUKUK DETAILS No. Issuer/Issuer Name Regional Sukuk Code Regional Sukuk Name Acquisition Date Nominal Value Maturity Date Rating Coupon (%) Accounting Method Pension Program/ Other Benefits

Value % ab c d e f g h i j k l m … 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/Collective Investment Contract Limited Participation Mutual Fund/ and Mutual Funds whose Shares/Participation Units are Traded on the Stock Exchange Investment Valuation Difference Notes SHARIA MUTUAL FUND DETAILS No. Code Product Name Sharia Mutual Fund Type *) Investment Manager Acquisition Date Number of Units Acquisition Value Fair Value Pension Program/ Other Benefits

Economic Sector
Beginning End Value % ab c d e f h i j k l m n o p p q … Total Acquisition Value Fair Value Investment Valuation Difference Notes SHARIA MTN DETAILS No. Code Product Name Issuer Name Acquisition Date Nominal Value Maturity Date Rating Coupon (%) Pension Program/ Other Benefits

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

Value % ab c d e f g h i j k l
…
Total
Notes
SHARIA REAL ESTATE INVESTMENT FUND IN THE FORM OF COLLECTIVE INVESTMENT CONTRACT DETAILS No. Code Product Name Investment Manager Acquisition Date Number of Units Acquisition Value Fair Value Investment Valuation Difference Pension Program/ Other Benefits

Value % ab c d e f g h i j k l
…
Total
Notes
SHARIA INFRASTRUCTURE INVESTMENT FUND IN THE FORM OF COLLECTIVE INVESTMENT CONTRACT DETAILS No. Code Product Name Investment Manager Acquisition Date Number of Units Acquisition Value Fair Value Net Asset Value Investment Valuation Difference Pension Program/ Other Benefits

Value % ab c d e f g h i j k
…
Total
DETAILS OF SHARIA EQUITY OPTIONS AND FORWARD CONTRACTS LISTED ON THE INDONESIA STOCK EXCHANGE No. Issuer Name Buyer Name Acquisition Date Term Acquisition Value Fair Value Investment Valuation Difference Notes Pension Program/ Other Benefits

Beginning End Nominal % Value % ab c d e f g h i j k l m n op q r … Total Pension Program/ Other Benefits Notes REPO DETAILS No. Counterparty Type of Collateral (SBSN/SBIS) Acquisition Date Collateral Value Rating Term Category (KSEI/BIS4) Acquisition Value Margin Amortized Cost Sale Value Investment Valuation Difference

Economic Sector
Name Position Date % Ownership Total % Ownership Total Date % Ownership Total Value % ab c d e f g h i j k l m n o p q r s … Total *) letter e :
Filled with Domestic LJK/Non-Domestic LJK/Foreign LJK/Non-Foreign LJK Pension Fund Representative DETAILS OF DIRECT PARTICIPATION No. Company Name Category Participation *) Acquisition Date Initial Placement Acquisition Value As of Report Date Appraisal/Fair Value Investment Valuation Difference Notes Pension Program/ Other Benefits

Object Type
(Land/Building/Land&Building) Value % a b cde f gh i j k lm n ooq r s … Total Appraisal Year Notes DETAILS OF LAND, BUILDINGS, LAND AND BUILDINGS IN INDONESIA No. Address Location (City,Province) Area Type Proof of Ownership Ownership Document Number Acquisition Date Acquisition Value Accumulated Depreciation Book Value Appraisal/Fair Value Name of Public/Independent Appraiser Pension Program/ Other Benefits Name of KJPP Investment Valuation Difference

No. Cash/Bank Name Account Number Nominal Pension Program/ Other Benefits Notes (Purpose of use) ab c d e f … Total CASH AND BANK DETAILS

No. Expense Type Quantity Pension Program/ Other Benefits Notes ab c d e … Total PREPAID EXPENSES DETAILS

No. Investment Receivable Type Acquisition Date Nominal Pension Program/ Other Benefits Notes ab c d e f … Total INVESTMENT RECEIVABLES DETAILS

No.
Investment Income Receivable Type Nominal Pension Program/ Other Benefits Notes ab c d e … Total INVESTMENT INCOME RECEIVABLES DETAILS

No.
Other Receivable Type
Nominal Pension Program/
Other Benefits
Notes ab c d e
…
Total
OTHER RECEIVABLES DETAILS

<= 1 year >1 year Total ab c d e f … Total DUE PENSION BENEFIT LIABILITIES DETAILS No. Quantity Notes Pension Program/ Other Benefits

<= 1 year >1 year Total ab c d e … Total DUE VOLUNTARY PENSION BENEFIT PAYABLES DETAILS No. Quantity Notes

No. Investment Type Value Pension Program/ Other Benefits Notes ab c d e … Total INVESTMENT PAYABLES DETAILS

No.
Unearned Income Details Counterparty Value Pension Program/ Other Benefits Notes ab c d e f … Total UNEARNED INCOME DETAILS

No.
Expenses Incurred but Not Yet Paid Details Counterparty Value Pension Program/ Other Benefits Notes ab c d e f … Total EXPENSES INCURRED BUT NOT YET PAID DETAILS

No. Other Payable Type Counterparty Value Pension Program/ Other Benefits Notes ab c d e f … Total OTHER PAYABLES DETAILS

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

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

No.
Other Investment Income Type
Quantity Pension Program/ Other Benefits Notes ab c d e ... Total Details of Income Outside of Investments

No.
Name of Pension Fund
Transferring Quantity Pension Program/ Other Benefits Other Benefits Details *) Notes ab 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 Pay Fund/Additional Benefit Fund

No. Expense Type Quantity Pension Program/ Other Benefits Notes ab c d e ... Total Investment Expense Details

No. Expense Type Quantity Pension Program/ Other Benefits Notes ab c d e ... Total Expenses Outside of Investments and Operations Details

No.
Income Tax Type Quantity Pension Program/ Other Benefits Notes ab c d e Total Income Tax Details

No.
Pension Fund Receiving
Transfer Quantity Pension Program/ Other Benefits Other Benefits Details *) Notes ab 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 Pay Fund/Additional Benefit Fund

FORMAT II B
FORM AND STRUCTURE OF ANNUAL REPORTS FOR TECHNICAL REPORTS OF FINANCIAL INSTITUTION PENSION FUNDS ADMINISTERING PENSION PROGRAMS BASED ON SHARIA PRINCIPLES
I. Pension Fund Profile
A. General Profile
Pension Fund Name :
General Register Book Number (NBDU) :
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 :
C. Administration

Management
a. Is there a change in the Acting Board of Directors or extension of the term of office of the Acting Board of Directors during the activity period? If Yes, has this been reported to OJK? b. Does the Acting Board of Directors have a basic knowledge certificate in the field of Pension Funds?
c. Does the Acting Board of Directors
who already has a basic knowledge certificate in the field of Pension Funds meet the minimum points for continuous education? d. Does the Acting Board of Directors have proof of expertise in the field of Sharia finance?? e. Is there a change in the Sharia Supervisory Board or extension of the term of office of the Sharia Supervisory Board during the period of activity If Yes, has this been reported to OJK? f. Does the Sharia Supervisory Board have a recommendation letter from DSN-MUI? g. Does the Sharia Supervisory Board have a Founder's Decision Letter regarding the appointment?
Number of Pension Fund Employees
Based on Education Level
SD (Elementary) :
SMP (Junior High) :
SMU (Senior High) :
Diploma :
S1 (Bachelor) :
S2 (Master) :
S3 (Doctorate) :
Total :
Third-Party Service Users:
a. Does the Pension Fund use third-party services to manage membership administration? If Yes, fill in the name of the Membership Administration Manager:
b. Does the Pension Fund use third-party services to deposit ownership documents If YES, fill in the name of the custodian used
c. Does the Pension Fund
use Investment Manager services?

If YES, fill in the list of names of Investment Managers used (sorted by the proportion of assets managed) d. Does the Pension Fund use Appraiser services? If YES, fill in the list of Appraisers used:
4. Contributions
a. Does the Employer pay contributions in the correct amount? b. Does the Employer pay contributions on time?
5. Investments
a. Are investment activities during the reporting period in accordance with regulatory provisions? b. Has information regarding investments been communicated to participants?
6. Governance
a. Does the Pension Fund have
Pension Fund Governance Guidelines? b. Has the Pension Fund implemented Pension Fund Governance? D. Pension Fund Membership

Number of Active Pension Fund Employee Participants
at the end of the activity period:
Founder (persons) :
Partner Founder (persons) :
Total (persons) :
Total number of participants entitled to
termed pension at the end of the activity period :
Age Structure of Active Participants and
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 termed pension up to 20 :
20 to 30 :
30 to 40 :
40 to 50 :
above 50 :
Estimated number of participants entering normal retirement age in one subsequent activity period :
4. Total number of employers who
include their employees in
DPLK at the end of the activity period :

E. Pensioners and Entitled Parties Description Quantity < Rp. 750,000.00 Rp. 750,000.00 < Rp. 2,000,000.00 Rp. 2,000,000.00

Rp.
5,000,000.00

Rp.
5,000,000.

Number of Beneficiaries

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

i. Pensioners
ii. Widows/Widowers
iii. Children
b. Number of
Pension Benefit Recipients who receive payment as a lump sum during the period of activity with reasons:
i. Monthly pension benefit
below the ministerial regulation limit
ii. Reasons other than item 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 category of size of pension benefit received monthly at the end of the period of activity
i. Pensioners (persons)
ii. Widows/Widowers
iii. Children

Board of Directors Statement
We, the Acting Board of Directors of the Pension Fund, declare that all data and information we provide in this technical report are true data and accurate according to the actual conditions of the Pension Fund. If it is later found that there is data/information that does not match the actual conditions, we are willing to be held accountable in accordance with regulatory provisions. Place, Date (day/month/year) (signature) Full Name Position

II. Pension Fund Risk Assessment Results Report
Pension Fund Name:
Type: (1) DPPK PPMP (2) DPPK PPIP (3) DPLK Assessment Date:
Report Date:
A. General Information
Founders and Co-Founders:
Name Description Number of Participants Management:
Name Position Term of Office
Supervisory Board:
Name Position/Representation Term of Office Financial Information as of Assessment Date Description Value (Rupiah) Ratio per Net Assets Net Assets Investments Normal Contribution Receivables Additional Contribution Receivables Other Receivables Other Assets Business Results* Funding Ratio (PPMP) Solvency Ratio (PPMP) Return on Investment (ROI)* Number of Participants *For the last one-year period since the assessment date B. Risk Assessment Summary Risk Type Risk Value Net Risk Weight

Management
Governance
Strategy
3.1 Inherent Risk
3.2 Management and Control
Operational
4.1 Inherent Risk

4.2 Management and Control
5. Assets and Liabilities
5.1 Inherent Risk
5.2 Management and Control
Total Net Risk Value

Funding Capability
Additional Funding
Total Fund Support Risk Value
Total Net Risk Value
Total Capitalization
Risk Value
Risk Level
C. Risk Description
General Description
Description per Risk Type
Management Risk Risk Value:.... Risk Level: ... Description:
Governance Risk Risk Value:.... Risk Level: ... Description:
Strategy Risk Risk Value:.... Risk Level: ... Inherent Risk Value:
Description:
Management and Control Value:
Description:
Operational Risk Risk Value:.... Risk Level: ... Inherent Risk Value:
Description:
Management and Control Value:
Description:

Assets and Liabilities Risk Risk Value:.... Risk Level: ... Inherent Risk Value:
Description:
Management and Control Value:
Description:
Fund Support Risk Risk Value:.... Risk Level: ... Funding Capability Value:
Description:
Additional Funding Value:
Description:
Acknowledged,
Name:
Position:
Prepared by:
Name:
Position:
III. Follow-up Plan for Pension Fund Risk Assessment

Name:
Type:
(1) DPPK PPMP
(2) DPPK PPIP
(3) DPLK
Risk Assessment Date:
Report Date:
Risk Level: 6. Risk Value:
Risk Type 8. Risk Cause 9. Plan
Follow-up
Target Time 11. PIC
Prepared by
Name
:
Signature
Position
:

Acknowledged
15. Name
:
16. Signature
17. Position
:
Filling Guidelines:

Fill in the Pension Fund name.
Fill in the Pension Fund type by selecting one from the list.
Fill in the risk assessment date that serves as the basis for the follow-up plan.
Fill in the date the risk assessment report is signed.
Fill in the Pension Fund's risk level according to the risk assessment results
as referred to in item 3.
Fill in the Pension Fund's risk value according to the risk assessment results as referred
to in item 3.
Fill in the risk type as referred to in POJK number 10/POJK.05/2014
regarding Risk Assessment of Non-Bank Financial Service Institutions.
Fill in the risk cause.
Fill in the plan for various follow-up steps to be taken to
lower the risk level for each risk area type.
Fill in the target time for implementing follow-up actions for each
follow-up step, which can be the completion date of the follow-up or the start and end dates of the follow-up if the start time target is not immediately after the follow-up plan is drawn up.
Fill in the unit responsible for implementing the follow-up.
Fill in the name of the official preparing the follow-up plan for the Pension Fund risk assessment.
Fill in the signature of the official preparing the follow-up plan for the Pension Fund risk assessment.
Fill in the job title of the official preparing the follow-up plan for the Pension Fund risk assessment.
Fill in the name of the Pension Fund management official handling Pension Fund risk management.
Fill in the signature of the Pension Fund management official handling Pension Fund risk management.
Fill in the job title of the Pension Fund management official handling Pension Fund risk management.

IV. Self-Assessment Results (Self Assessment) of Risk Management Implementation
SELF-ASSESSMENT REPORT
ON THE IMPLEMENTATION OF RISK MANAGEMENT THAT IMPLEMENTES ALL OR PART OF ITS BUSINESS BASED ON SHARIA PRINCIPLES YEAR … PT XYZ (Company Address)

SELF-ASSESSMENT REPORT
ON THE IMPLEMENTATION OF RISK MANAGEMENT FOR PENSION FUNDS THAT IMPLEMENTES ALL OR PART OF ITS BUSINESS BASED ON SHARIA PRINCIPLES Pension Fund Name:
Pension Fund Type: (1) DPPK PPMP (2) DPPK PPIP (3) DPLK Sharia Business: (1) Full fledged (2) Sharia Business Unit (UUS) (3) Sharia Investment Package Assessment Position Date:
A. GENERAL INFORMATION
Founders and Co-Founders
Founder:
No. Name Description Number of Participants 1. 2. etc. Management:
No. Name Position Term of Office 1.
2.
3. etc.
Supervisory Board:
No. Name Position Term of Office 1.
2.
3. etc.
Sharia Supervisory Board:
No. Name Position Term of Office 1.
2.
3. etc.

Except for financial ratios and number of participants
For the last one-year period since the assessment date
C. SUMMARY OF GENERAL RISK MANAGEMENT IMPLEMENTATION

Active Supervision by the Board of Directors and Board of Commissioners
…………… (Filled with a description of the role of the Board of Directors and Board of Commissioners in Risk Management and Risk Management organizational structure)
Adequacy of Policies, Procedures, and Risk Limit Setting
…………… (Filled with a description of risk appetite, risk tolerance, and risk limit setting)
Adequacy of Risk Identification, Measurement, Monitoring, and
Control Processes
…………… (Filled with a description of the identification process, measurement, monitoring, and risk control)
Risk Management Information System
…………… (Filled with a description of how the pension fund's information system supports the implementation of Risk Management)
Comprehensive Internal Control System
…………… (Filled with a description of how internal control including the compliance function is carried out by the company)

D. RISK MANAGEMENT IMPLEMENTATION FOR EACH TYPE OF RISK

Strategy Risk
Scope of Implementation
Risk Management Description
Active Supervision by the Board of Directors and Board of Commissioners …………… (Filled with a description of active supervision by the Board of Directors and Board of Commissioners over Strategy Risk) Adequacy of Policies, Procedures, and Risk Limit Setting …………… (Filled with a description of risk appetite, risk tolerance, and limit setting for Strategy Risk) Adequacy of Processes for Identification, Measurement, Monitoring, and Risk Control …………… (Filled with a description of the process for identification, measurement, monitoring, and control of Strategy Risk) Risk Management Information System for Strategy …………… (Filled with a description of how the pension fund's information system supports the implementation of Risk Management for Strategy Risk) Comprehensive Internal Control System …………… (Filled with a description of how internal control including the compliance function is carried out by the pension fund for Strategy Risk)
Operational Risk
Scope of Implementation
Risk Management Description
Active Supervision by the Board of Directors and Board of Commissioners …………… (Filled with a description of active supervision by the Board of Directors and Board of Commissioners over Operational Risk) Adequacy of Policies, Procedures, and Risk Limit Setting …………… (Filled with a description of risk appetite, risk tolerance, and limit setting for Operational Risk) Adequacy of Processes for Identification, Measurement, Monitoring, and Risk Control …………… (Filled with a description of the process for identification, measurement, monitoring, and control of Operational Risk) Risk Management Information System for Operational …………… (Filled with a description of how the pension fund's information system supports the implementation of Risk Management for Operational Risk) Comprehensive Internal Control System …………… (Filled with a description of how internal control including the compliance function is carried out by the pension fund for Operational Risk)
Assets and Liabilities Risk
Scope of Implementation
Risk Management Description
Active Supervision by the Board of Directors and Board of Commissioners …………… (Filled with a description of active supervision by the Board of Directors and Board of Commissioners over Assets and Liabilities Risk) Adequacy of Policies, Procedures, and Risk Limit Setting …………… (Filled with a description of risk appetite, risk tolerance, and limit setting for Assets and Liabilities Risk) Adequacy of Processes for Identification, Measurement, Monitoring, and Risk Control …………… (Filled with a description of the process for identification, measurement, monitoring, and control of Assets and Liabilities Risk) Risk Management Information System …………… (Filled with a description of how the pension fund's information system supports the implementation of Risk Management for Assets and Liabilities Risk) Comprehensive Internal Control System …………… (Filled with a description of how internal control including the compliance function is carried out by the pension fund for Assets and Liabilities Risk)
Management Risk
Scope of Implementation
Risk Management Description
Active Supervision by the Board of Directors and Board of Commissioners …………… (Filled with a description of active supervision by the Board of Directors and Board of Commissioners over Management Risk) Adequacy of Policies, Procedures, and Risk Limit Setting …………… (Filled with a description of risk appetite, risk tolerance, and limit setting for Management Risk) Adequacy of Processes for Identification, Measurement, Monitoring, and Risk Control …………… (Filled with a description of the process for identification, measurement, monitoring, and control of Management Risk) Risk Management Information System …………… (Filled with a description of how the pension fund's information system supports the implementation of Risk Management for Management Risk)

Comprehensive Internal
Control System
…………… (Filled with a description of how internal control including the compliance function is carried out by the pension fund for Management Risk)
5. Governance Risk
Scope of Implementation
Risk Management Description
Active Supervision by the Board of Directors and Board of Commissioners …………… (Filled with a description of active supervision by the Board of Directors and Board of Commissioners over Governance Risk) Adequacy of Policies, Procedures, and Risk Limit Setting …………… (Filled with a description of risk appetite, risk tolerance, and limit setting for Governance Risk) Adequacy of Processes for Identification, Measurement, Monitoring, and Risk Control …………… (Filled with a description of the process for identification, measurement, monitoring, and control of Governance Risk) Risk Management Information System …………… (Filled with a description of how the pension fund's information system supports the implementation of Risk Management for Governance Risk) Comprehensive Internal Control System …………… (Filled with a description of how internal control including the compliance function is carried out by the pension fund for Governance Risk)
6. Fund Support Risk
Scope of Implementation
Risk Management Description
Active Supervision by the Board of Directors and Board of Commissioners …………… (Filled with a description of active supervision by the Board of Directors and Board of Commissioners over Fund Support Risk) Adequacy of Policies, Procedures, and Risk Limit Setting …………… (Filled with a description of risk appetite, risk tolerance, and limit setting for Fund Support Risk) Adequacy of Processes for Identification, Measurement, Monitoring, and Risk Control …………… (Filled with a description of the process for identification, measurement, monitoring, and control of Fund Support Risk)

Risk Management
Information System
…………… (Filled with a description of how the pension fund's information system supports the implementation of Risk Management for Fund Support Risk) Comprehensive Internal Control System …………… (Filled with a description of how internal control including the compliance function is carried out by the pension fund for Fund Support Risk) Prepared by, Acknowledged, (Signature) (Signature) (Name) (Name) (Position) (Position)

V. Pension Fund Governance Implementation Report

Transparency of Good Governance Implementation for Pension Funds
a. Acting Management Members

Number, job title, criteria, appointment date, term of office,
citizenship, and domicile of Acting Management Members No Name Job Title Criteria Appointment Date Term of Office Citizenship Domicile Last Formal Education And Professional Degree Competency And Fit and Proper Test 1. 2. Etc.
Concurrent positions of Acting Management Members
No. Name
Position at Pension
Fund
Position at Other Pension
Fund
Position at Company and/or other institutions 1. 1. 2. Etc. 2. 1. 2. Etc. Etc
Frequency of Acting Management meetings held in 1
(one) year.
No Name Job Title
Number of Acting Management Meetings (... times meeting) % Attendance Physical Attendance Teleconference/Video/ Conference/Other Electronic Media Facilities 1. 2. Etc
Family relationships between Acting Management Members and other Acting Management Members, and/or the Sharia Supervisory Board of DPLK at the Pension Fund where the Acting Management Member in question serves.
No. Name
Family Relationship With
Other Acting Management
Members
Sharia Supervisory Board of DPLK Yes No Note* Yes No Note*

Etc
Description:
*) Form of family relationship: spouse/child/parent/sibling/in-law, etc. b. Supervisory Board

Number, job title, criteria, appointment date, term of office,
citizenship, and domicile of Supervisory Board members No Name Job Title Criteria Appointment Date Term of Office Citizenship Domicile Last Formal Education and Professional Degree Competency and Fit and Proper Test 1. 2. Etc.
Concurrent positions of Supervisory Board members
No. Name
Position at Pension
Fund
Position at Other
Pension Fund
Position at Company and/or other institutions 1. 1. 2. Etc.

Etc.
Etc.
3) Frequency of Supervisory Board meetings held in 1 (one) month.
No Name Job Title
Number of Supervisory Board Meetings (... times meeting) Attendance % Attendance Physical Teleconference/Video/Conference/ Other Electronic Media Facilities 1. 2. Etc
4) Family relationships between Supervisory Board members and other Supervisory Board members, DPPK Management members, and/or Acting Management members where the Supervisory Board member in question serves.
No. Name
Family Relationship With
Other Supervisory Board
Members
DPPK Management members
Acting Management
Members
Yes No Note* Yes No Note* Yes No Note* 1.

Etc
Description:
*) Form of family relationship: spouse/child/parent/sibling/in-law, etc.
c. Sharia Supervisory Board

Number, job title, criteria, appointment date, term of office,
citizenship, and domicile of Sharia Supervisory Board members No Name Job Title Criteria Appointment Date Term of Office Citizenship Domicile Last Formal Education and professional degree Competency and Fit and Proper Test 1. 2. Etc.
Concurrent positions of Sharia Supervisory Board members
No. Name
Position at Pension
Fund
Position at Other
Pension Fund
Position at Company and/or other institutions 1. 1. 2. Etc.

Etc.
Etc.
3) Frequency of Sharia Supervisory Board meetings held in 3
(three) months.
No Name Job Title
Number of Sharia Supervisory Board Meetings (... times meeting) Attendance % Attendance Physical Teleconference/Video/Conference/S Other Electronic Media Facilities 1. 2. Etc

Family relationships between Sharia Supervisory Board members and other Sharia Supervisory Board members, Supervisory Board members, DPLK Management members, and/or Acting Management members where the Sharia Supervisory Board member in question serves.
No. Name
Family Relationship With
Other Sharia Supervisory Board
Members
Acting Management
Members
Yes No Note* Yes No Note*

Etc
Description:
*) Form of family relationship: spouse/child/parent/sibling/in-law, etc. d. Supervisory Board Supervision Results Report

Supervisory Board activity report on the implementation of Pension Fund
Governance
Supervision Results Summary Recommendations e. Committees
Functions under Acting Management
No.
Name
Function
Name
Member
Job Title
Term of Office
Appointment
Letter
Number of
Meetings in
One Year

Internal
Auditor
Function
1.
2.
Etc
2.
Risk
Management
Function
1.
2.
Etc
3. Compliance
Function
1.
2.
Etc
Etc

Committees under the Sharia Supervisory Board
No.
Name
Committee
Name
Member
Job Title
Term of Office
Appointment
Letter
Number of
Meetings in
One Year

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

Name of Public Accounting Firm
Name of Public Accountant
Audit Period

Appointment by Sharia Supervisory Board g. Implementation of remuneration and other facility policies for Acting Management members, Sharia Supervisory Board members, and Employees Number of DPLK Management, Acting Management, Supervisory Board, and Employee members receiving remuneration packages in 1 (one) year grouped by income level as follows:
Remuneration Amount per person in 1 year *) Number of Acting Management Members Number of Sharia Supervisory Board Members Employees Above Rp2 billion Above Rp1 billion to Rp2 billion Above Rp500 million to Rp1 billion Rp500 million and below Description: *) requested in cash

h. Investment Management Outsourcing No. Type of Investment Name of Outsourcing Company Value of Investment No. Agreement % of total Investment Portfolio 1. 2. Etc
i. Disclosure of other material matters Disclosure of other material matters
No. Description
Checklist *) If Yes,
Yes No Explain
1.
Resignation or dismissal of external auditor
2. Material transactions with related parties
4.
Ongoing and/or potential
Conflicts of Interest
5. Other material information regarding the Pension Fund
6. The Pension Fund has a compliance function
7. The Pension Fund has an internal auditor
8. The Pension Fund has a risk management function
9.
The company has an investment management function/unit 10. The company has a special work unit and/or appoints a Financial Service Institution official responsible for the implementation of the AML and CFT program *) select one answer by placing a “√” ) Related Parties are individuals or companies/entities that have a controlling relationship with the Company, either directly or indirectly, through ownership, management, and/or financial relationships

Self-Assessment of Good Pension Fund Governance Implementation
The Good Pension Fund Governance Implementation questionnaire is filled out by the Pension Fund itself. This questionnaire is filled out by providing answers to the questions/statements in the questionnaire. Filling Method:
Generally, answers to the Questions/Statements consist of 5 criteria as follows (except for answers requiring different criteria):
A= The Pension Fund in question DOES NOT HAVE a written policy regarding the Question/Statement in question. B= The Pension Fund in question HAS a written policy regarding the Question/Statement in question, but the policy has NOT been implemented. C= The Pension Fund in question HAS a written policy regarding the Question/Statement in question, but the policy has NOT been implemented CONSISTENTLY. D= The Pension Fund in question HAS a written policy regarding the Question/Statement in question, the policy is IMPLEMENTED CONSISTENTLY but has NOT BEEN UPDATED periodically. E= The Pension Fund in question 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, most of whose answers consist of a 5 (five) scale 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".

I. 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 among others:
2.1. General policies directing towards
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 receive 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, Acting Management, Sharia Supervisory Board,
and pension fund employees:
5.1. Make a statement of "no conflict of interest"
regarding every decision taken by the authorized decision-making party No Yes
5.2. Make an annual statement regarding the implementation
of the company's code of conduct No Yes
5.3. Make an annual statement not to
accept or give anything that could influence decision-making No Yes
The Pension Fund correctly records assets, liabilities, and
own capital (equity) using generally accepted accounting principles as well as 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 and matters related to Participants that ensure protection for Whistleblowers. A B C D E

II. COMPANY ORGAN
A. Founders and Co-Founders

The 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 (Good Corporate Governance). A B C D E
1.4. Following up on audit findings and recommendations from the working units performing the functions of the Pension Fund's internal auditor, the Pension Fund's external auditor, and/or the results of supervision by the Financial Services Authority (OJK).
A B C D E

B. Acting Board of Trustees

Composition of Appointment and Dismissal of Acting Board of Trustees
1.1. The Acting Board of Trustees consists of members who collectively possess competence*) as follows:
1.1.a Investment Field No Yes
1.1.b Risk Management Field. No Yes
Requirements for Acting Board of Trustees
2.1. Members of the Acting Board of Trustees meet the articles of association requirements.
No Yes
2.2. Members of the Acting Board of Trustees meet the competency and propriety requirements in accordance with the regulations of the supervisory and regulatory authority.
No Yes
2.3. Members of the Acting Board of Trustees must understand and implement GCG.
A B C D E
2.4. Members of the Acting Board of Trustees are prohibited from utilizing the Pension Fund for the benefit of themselves, their families, business groups, or other parties that harm the interests of the Pension Fund.
No Yes
2.5. Do not hold concurrent positions as members of the Board of Supervisors or DPS (Sharia Supervisory Board) at the same Pension Fund.
No Yes
2.6. Do not hold concurrent positions as directors or board of commissioners or equivalent positions in companies and/or other institutions.
No Yes
2.7. Trustees and Acting Board of Trustees members do not hold concurrent positions as members of the Board of Trustees, Acting Board of Trustees, Sharia Supervisory Board, or DPS at other Pension Funds.
No Yes
Functions of the Acting Board of Trustees
3.1. Trusteeship
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 the resources owned, effectively and efficiently, including ensuring the availability of human resources that meet 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 rules of procedure and work guidelines (charters) regulated in the PDP (Pension Fund Management Agreement) and relevant legislation in the field of Pension Funds.
A B C D E
3.1.5. The Trustee overseeing the compliance function cannot be held concurrently by the Trustee overseeing the funding, financial, or investment functions, unless the number of Trustees is 2 (two), in which case the compliance function may be held concurrently by the Trustee overseeing the financial function.
No Yes
3.2. Risk Management
3.2.1. The Acting Board of Trustees formulates and implements a Risk Management System that covers 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 Working 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 the execution of its duties to the Founders and Co-Founders.
No Yes
3.4. Information Technology
3.4.1. The Company has an integrated computerized administration system.
A B C D E
3.4.2. The Company has Standard Operating Procedures for the Information Technology department.
A B C D E
Accountability of the Acting Board of Trustees
4.1. The Acting Board of Trustees prepares a report on the accountability of Pension Fund management in the form of an Annual Report.
No Yes
4.2. Criteria for the Annual Report include:
4.2.1. Contains at least:
a. Financial Report No Yes b. Pension Fund Activity Report No Yes
c. GCG Implementation Report No Yes
4.2.2. Receives approval from the Founders and Co-Founders. No Yes
4.2.3. Specifically, the financial report must receive ratification from the Founders and Co-Founders.
No Yes
4.3. Meetings of the Acting Board of Trustees
4.3.1. Every strategic policy and decision must be decided through a DPLK (Sharia Pension Fund) Trustees meeting, taking into account supervision according to the duties and responsibilities of the Sharia 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 Executive Board of the Acting Board of Trustees establishes meeting rules of procedure.
No Yes
4.3.4. Minutes of every Trustees and Acting Board of Trustees meeting are made.
No Yes
4.3.5. Meeting minutes include dissenting opinions with the decisions taken in the meeting (if any).
A B C D E
4.3.6. Every member of the Acting Board of Trustees, whether attending the meeting or not, is entitled to receive the Minutes of the Acting Board of Trustees Meeting.
No Yes

C. Sharia Supervisory Board (Dewan Pengawas Syariah - DPS)

Composition, Appointment, and Dismissal of the Sharia Supervisory Board
1.1. The number of members of the Sharia Supervisory Board has been adjusted to the complexity of the Company 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 Council of the Indonesian Ulema Council (DSN MUI), and their appointment must be
No Yes stated clearly in the Founder's decision letter.
1.3. The entire Sharia Supervisory Board consists of members who collectively possess competence relevant to their positions.
No Yes
1.4. Do not hold concurrent positions as Acting Board of Trustees or DPS at the same Pension Fund.
No Yes
Competency and Integrity of the Sharia Supervisory Board
2.1. Meet the Fit and Proper Test requirements. No Yes
2.2. Monitor the effectiveness of the implementation of Pension Fund GCG (Good Corporate Governance).
A B C D E
2.3. Do not utilize the Pension Fund for personal, family, business group, or other parties' interests, which can harm the company.
No Yes
Supervisory Functions of the Sharia Supervisory Board
3.1. Fully responsible for the supervision of DPLK (Sharia Pension Fund).
A B C D E
3.2. Execute the duties and responsibilities of the Sharia Supervisory Board as regulated in the PDP and relevant legislation in the field of Pension Funds independently.
A B C D E
3.3. The Sharia Supervisory Board holds meetings periodically.
No Yes
3.4. Minutes of every Sharia Supervisory Board meeting are made.
No Yes
3.5. Meeting minutes include dissenting opinions with the decisions taken in the meeting.
A B C D E
3.6. Every member of the Sharia Supervisory Board, whether attending the meeting or not, is entitled to receive the minutes of the Board of Commissioners meeting.
No Yes
Committees of the Sharia Supervisory Board (answered if applicable)
4.1. Audit Committee
No
Yes continue to
4.1.7.
The Audit Committee serves as a facilitator for the Sharia 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 implemented in accordance with 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 implemented in accordance with applicable auditing standards.
No Yes
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. Members of the Board of Supervisors No Yes b. Parties other than those within the Pension Fund who do not have financial, managerial, and/or family relationships with the Board of Supervisors, DPLK Trustees, Acting Board of Trustees, and/or Founder, or other relationships that could influence their ability to act independently. No Yes
4.1.7. For Pension Funds that do not have an Audit Committee, there are members of the Board of Supervisors who are specifically tasked to ensure the following:
a. The Company's internal control structure has been implemented well. A B C D E b. Internal audit implementation is carried out in accordance with applicable auditing 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 implementation has been carried out in accordance with applicable auditing 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 Board of Supervisors for the following matters:
4.2.1. Assess the quality of risk management policies.
A B C D E
4.2.2. Assess the effectiveness of the risk management applied by the Company, including assessing the risk tolerance taken by the Board of Directors.
A B C D E
4.2.3. Members of the Risk Monitoring Committee consist of:
a. Members of the Sharia Supervisory Board representing Participants. No Yes

b. Other parties. No Yes
4.2.4. For Companies that do not have a Risk Monitoring Committee, there are members of the Sharia Supervisory Board who are specifically tasked with the following:
a. Assess the quality of risk management policies. A B C D E b. Assess the effectiveness of the risk management applied by the company, including assessing the risk tolerance taken by the 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 Board of Supervisors for the following matters:
4.3.1. Facilitator for the Sharia Supervisory Board in helping the Founder set criteria and select candidates for the Sharia Supervisory Board and Pension Fund Trustees or Acting Board of Trustees.
A B C D E
4.3.2. Facilitator for the Sharia Supervisory Board in helping the Founder establish a remuneration system.
A B C D E
4.3.3. Members of the Nomination and Remuneration Committee consist of:
a. Members of the Sharia 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 Sharia Supervisory Board who are specifically tasked with the following:
a. Help the Founder set criteria and select candidates for the Sharia Supervisory Board and Pension Fund Trustees or Acting Board of Trustees. A B C D E b. Help the Founder establish a remuneration system. A B C D E

III. HEALTHY BUSINESS PRACTICES
External Auditor

The External Auditor (public accounting firm) conducts independent examinations of the truthfulness of the Pension Fund's financial reports.
No Yes
The designated public accounting firm (KAP) is registered with the Financial Services Authority (OJK).
No Yes
Action Plan
No.
Corrective Action
Target Completion
Completion Obstacles
Notes

...
4. Implementation of Anti-Fraud Strategy
(Company 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/Department of Fraud Occurrence Parties Involved b) Position Financial Loss in Rupiah c) Company Actions d) Weaknesses/Causes of Fraud Occurrence 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:
…………………………………………………………………………………………………… …………………………………………………………………………………………………… …………………………………………………………………………………………………… ……………………………………………………………………

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

GENERAL INFORMATION

Pension Fund Name :
Type of Pension Fund : (1) DPPK PPMP
(2) DPPK PPIP
(3) DPLK
Implementation Scheme
PPBS
: (1) Full Fledged Sharia
(2) Sharia Unit of DPPK
(3) DPLK Sharia Investment Package
Pension Fund Address :
Composition of DPS :
No Full Name Position Appointment Letter of DPS Appointment Number Date 1. 2. ...
Summary of correspondence and/or meeting minutes related to the results of DPS implementation supervision.
No Correspondence and/or
Meeting Minutes
Summary of Substance
Number Date Matter

...
7. Information regarding the report preparer (contact person):
a. Name :
b. Position :
c. Telephone Number :
d. E-mail Address :

STATEMENT OF DPS
A. IF NO PRACTICES VIOLATING
SHARIA SUPERVISORY BOARD STATEMENT Bismillahirrahmanirrahim We have conducted supervision on the implementation of the basic principles of PPBS implementation carried out by the Sharia Pension Fund..../DPPK Sharia Unit..../DPLK Sharia Investment Package ..... 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 carrying out this supervision, we have carried out an assessment of the implementation of the aforementioned Pension Program Based on Sharia Principles, which includes aspects of the Contracts used, aspects of contribution management, aspects of investment placement, aspects of Pension Benefits, aspects of Other Benefits, and other activities. From the results of supervision, 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 these matters by the Sharia Pension Fund..../DPPK Sharia Unit..../DPLK Sharia Investment Package ... 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 conducted supervision on the implementation of the basic principles of PPBS implementation carried out by the Sharia Pension Fund..../DPPK Sharia Unit..../DPLK Sharia Investment Package ... 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 carrying out this supervision, we have carried out an assessment of the implementation of the aforementioned Pension Program Based on Sharia Principles, which includes aspects of the Contracts used, aspects of contribution management, aspects of investment placement, aspects of Pension Benefits, aspects of Other Benefits, and other activities. From the results of supervision, it is known that the Sharia Pension Fund..../DPPK Sharia Unit..../DPLK Sharia Investment Package... 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 these matters by the Sharia Pension Fund..../DPPK Sharia Unit..../DPLK Sharia Investment Package... 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

SUMMARY OF SUPERVISION RESULTS AND RECOMMENDATIONS Summary of Supervision Results and Recommendations Based on the results of supervision and our assessment of the implementation of Sharia Principles in the operational implementation of PPBS at the Sharia Pension Fund..../DPPK Sharia Unit..../DPLK Sharia Investment Package... during the period from date................... to ..............., the summary of supervision results and recommendations are as follows:
A. Contracts Used
Main Material 1:
Suitability of Contracts used with PPBS activities Suitability Status:
Status Notes:
Recommendation:
Main Material 2:
Implementation of systems and procedures for the use of Contracts in PPBS activities Suitability Status:
Status Notes:
Recommendation:
Main Material 3:
Determination of fair and transparent ujrah/nisbah in PPBS activities Suitability Status:
Status Notes:
Recommendation:

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

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

D. Pension Benefit Payments
Main Material 1:
Implementation of systems and procedures for the payment of Pension Benefits Suitability Status:
Status Notes:
Recommendation
Main Material 2 :
The calculation and payment of Pension Benefits have been carried out in accordance with the promise from the employer, or have been in accordance with the Participant's ownership rights, and do not contradict Sharia Principles. Suitability Status:
Status Notes:
Recommendation
E. Other Benefits (if any)
Main Material 1:
Implementation of systems and procedures for the management of contribution funds for Other Benefits Suitability Status:
Status Notes:
Recommendation:
Main Material 2:
Implementation of systems and procedures for the investment placement of Other Benefits Suitability Status:
Status Notes:
Recommendation:

Main Material 3:
Implementation of systems and procedures for the payment of Other Benefits Suitability Status:
Status Notes:
Recommendation:
Main Material 4:
The calculation and payment of Other Benefits have been carried out in accordance with the promise from the employer, or have been in accordance with the Participant's ownership rights, and do not contradict Sharia Principles and relevant legislation in the field of Pension Funds. Suitability Status:
Status Notes:
Recommendation
F. Other Activities
Main Material 1:
Implementation of systems and procedures for the placement of PPBS assets other than investments Suitability Status:
Status Notes:
Recommendation:
Main Material 2:
Administration of proof of ownership of other assets Suitability Status:
Status Notes:
Recommendation:

Main Material 3:
Recording and administration of PPBS Participant accounts Suitability Status:
Status Notes:
Recommendation:
Main Material 4:
Implementation of other activities not yet regulated in relevant legislation in the field of Pension Funds, including fatwas from DSN MUI. Suitability Status:
Status Notes:
Recommendation:

VII. Evidence of Fulfillment of Continuing Requirements for Acting Board of Trustees and Employees in Charge of Investment
FORM :
FORM SELF ASSESSMENT
REPORT ON THE FULFILLMENT OF CONTINUING REQUIREMENTS FOR ACTING BOARD OF TRUSTEES AND EMPLOYEES IN CHARGE OF INVESTMENT Pension Fund Name :
Report Letter Number :
Report Letter Date :
Contact Person (Name,
Telp/e-mail)
:
NO DESCRIPTION LEGAL BASIS YES NO NOTES 1.
The report on the fulfillment of continuing requirements is submitted by the Pension Fund Trustees to OJK no later than 1 (one) month after the annual period ends. o POJK 3/POJK.05/2015 o POJK 5/POJK.05/2018
2. Evidence of fulfillment of continuing requirements
Additional notes (if necessary):
No Name
Type
Principal Party *)
No. and date
FPT Decision
Type of Fulfillment *)
Title
Activity
Organizer
Activity *)
Name
Organizer
Date
Implementation
Fulfillment
Year
Evidence of fulfillment *)
..... o Acting
Board of
Trustees o Employee
..... o attending seminars, workshops, or other similar activities o attending courses, training, or similar educational programs o writing papers, articles, or other published writings o being a speaker in seminars, workshops, or other similar activities, being a teacher or instructor in courses, training, or similar educational programs ..... o supervisory institutions financial services in and outside the country o associations of financial service institutions in and outside the country o universities in and outside the country o training institutions that obtain permission from the competent authority ..... ..... ..... o certificate (number and date ) o attendance proof o others , namely
.....
Notes:

Filling method: click twice in the box, then select "Checked"
*) choose one
This Self Assessment Form is prepared based on the provisions of OJK Regulation No. 3/POJK.05/2015 Concerning Investment
Types of fulfillment of continuing requirements related to knowledge in the field of investment and/or risk management as regulated in OJK Regulation No. 3/POJK.05/2015 Concerning Pension Fund Investment

FORMAT II C
A. Report on Consumer Complaint Services and Resolution by Financial Service Business Actors The form and structure of consumer complaint reports and follow-up on consumer services and resolution 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 Consumer Complaint Services and Resolution by Financial Service Business Actors. B. Report on the Appointment of Public Accountants and/or Public Accounting Firms in the Context of Audits 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 audits 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 the Procedures for the Use of Public Accountants and Public Accounting Firms in Financial Services Activities.
C. Report on the Audit Committee's Evaluation Results Regarding the Implementation of Audit Services on Annual Historical Financial Information by Public Accountants and/or Public Accounting Firms
The form and structure of the report on the Audit Committee's evaluation results regarding 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 the Procedures for the Use of Public Accountants and Public Accounting Firms in Financial Services Activities.

D. Periodic Actuarial Report
A. Actuarial Report for Pension Funds Administering Defined Benefit Pension Programs and Making Periodic Pension Benefit Payments

General Data
Report Number
Reporting Date
Company Code
Company Name
Company Address
Reporting Period
Reporting Month
Fiscal Year
Type of Reporting Period: Annual Report Board of Directors Name Board of Directors Position

Actuarial Statement
1.1 Company Actuarial Information:

Actuarial Name;
Office Address and Telephone Number;

I, the undersigned, hereby declare that:

All data received is complete and can be accounted for for the purpose of preparing the Actuarial Report to the best of the actuary's knowledge, and for this 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 requirements.
The Report is prepared based on the PDP (Pension Fund Program); and
The Report is prepared based on actuarial practice standards for Pension Funds applicable in Indonesia;

Place, Date of Creation
Signature,
Name
No. Indonesia Actuarial Association (PAI) Register Public Actuary License No.:
for the Periodic Actuarial Report as referred to in the Financial Services Authority Regulation regarding Pension Fund Funding

Actuarial Valuation Date
Actuarial valuation date reported Actuarial valuation date of the previous period
Purpose of Preparation
Summary of PDP including payment patterns and normal retirement age
Summary of the number of Participants, widows/widowers, and children choosing periodic Pension Benefit payments
Interest rate used
Cash Flow Projection
Actuarial Gain or Loss Analysis
Investment Results and Cost Analysis
Conversion Table
Conclusions and Recommendations

E. Pension Fund Business Plan
A. Executive Summary

Financial Indicators
No. Description
Projection
Millions of Rupiah % Growth
1 Assets
2 Investments
3 Liabilities
4 Investment Income
5 Investment Costs
6 Investment Business Results
7 Operating Costs
8 Pre-Tax Business Results
9 Post-Tax Business Results
Financial Ratios
No. Description %
1 Investment Income Ratio (ROI) 2 Investment Income to Assets Ratio (ROA) 3 Operating Cost Ratio (BOPO)
Non-Financial Executive Summary
The non-financial executive summary contains a summary of information regarding targets for 1 (one) to 3 (three) years ahead, which the Pension Fund considers very necessary to include in the executive summary.

B. Evaluation of Previous Business Plan Implementation Indicator 20XX-1 20XX-2 20XX-3 Plan Realization % Plan Realization % Plan Realization % (1) (2) (1/2) (1) (2) (1/2) (1) (2) (1/2) Investment Income Ratio for Pension Fund Business Plan as referred to in the Financial Services Authority regulation regarding good governance for Pension Funds

Indicator
20XX-1
20XX-2
20XX-3
Plan
Realization
%
Plan
Realization
%
Plan
Realization
%
(1) (2) (1/2) (1) (2) (1/2) (1) (2) (1/2) Investment Income Ratio (ROI) Investment Income to Assets Ratio (ROA) Operating Cost Ratio (BOPO) Fund Sufficiency Ratio

C. Vision, Mission, Business Strategy, and Management Policy
Completed with targets to be achieved in 1 (one) to 3 (three) years ahead, accompanied by policies and strategies to be implemented.

Vision and mission
Business Strategy and Management Policy
No. Target Policy Strategy

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

No. Target Policy Strategy
Etc
Etc

D. Implementation of Risk Management and Compliance Scope of Implementation Risk Management Description Active Supervision Board of Directors, Executive Officers, Duties of Board of Directors, and Sharia Supervisory Board …………… (Filled with a description of the role of the Board of Directors, Executive Officers, and Sharia Supervisory Board in Risk Management and Risk Management organizational structure) Adequacy of Policies, Procedures, and Risk Limit Determination …………… (Filled with a description of risk appetite, risk tolerance, and risk limit determination) Adequacy of Risk Identification, Measurement, Monitoring, and Control Processes …………… (Filled with a description of risk identification, measurement, monitoring, and control processes) Risk Management Information System …………… (Filled with a description of how the pension fund information system supports the implementation of Risk Management) Comprehensive Internal Control System …………… (Filled with a description of how internal control, including the compliance function, is conducted by the pension fund)

E. Implementation of Pension Fund Governance

Pension Fund Governance Implementation Plan
Action Plan
No.
Corrective Action
Completion Target
Completion Obstacles
Remarks

Etc

Anti-Fraud Strategy Implementation Plan

F. Current and Previous Period Financial Performance of Pension Funds

Investment Income
No.
RKAP
Year n-1
RKAP
Year n
Actual as of
September
Year n
%
Achievement
% Increase (Decrease) against RKAP Year n-1 1 2 3 4 5=4/3 6=(5-4)/4
Investment Business Results
No.
Type of
Investment
Investment Business Results
RKAP
Year n-1
RKAP
Year n
Actual as of 30
September
Year n
%
Achievement
% Increase
(Decrease) against
RKAP Year n-1
1 2 3 4 5 6=5/4 7=(4-3)/3
Business Results
No. Profit
RKAP
Year n-1
RKAP
Year n
Actual as of 30
September
Year n
%
Achievement
% Increase
(Decrease) against
RKAP Year n-1
1 2 3 4 5 6=5/4 7=(4-3)/3
Pre-Tax Business Results
Post-Tax Business Results

G. Financial Statement Projections and Assumptions Used

Financial Position Projection for Pension Funds
(in millions of rupiah)
DESCRIPTION
Actual as of 30
Sept
20XX1*
Projection as of 31
Dec
20XX-1*
Projection
Year 1
Projection as of 31
Mar
20XX* as of 30
Jun
20XX* as of 30
Sep
20XX* as of 31
Dec
20XX* as of 31
Dec
20XX
+1* as of 31
Dec
20XX+
ASSETS
INVESTMENTS
Bank Savings
On-call Deposits at Banks
Time Deposits at Banks
Certificates of
Deposit at Banks
Securities
Based on
Sharia Principles issued

DESCRIPTION
Actual as of 30
Sept
20XX1*
Projection as of 31
Dec
20XX-1*
Projection
Year 1
Projection as of 31
Mar
20XX* as of 30
Jun
20XX* as of 30
Sep
20XX* as of 31
Dec
20XX* as of 31
Dec
20XX
+1* as of 31
Dec
20XX+ by Bank Indonesia
Sharia State
Securities
Sharia Stocks listed on the
Indonesian Stock Exchange

Corporate Bonds 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

Real Estate
Investment Funds

DESCRIPTION
Actual as of 30
Sept
20XX1*
Projection as of 31
Dec
20XX-1*
Projection
Year 1
Projection as of 31
Mar
20XX* as of 30
Jun
20XX* as of 30
Sep
20XX* as of 31
Dec
20XX* as of 31
Dec
20XX
+1* as of 31
Dec
20XX+
Sharia
Investment
Collective Contract
Infrastructure
Investment Funds in the form of collective investment contracts Option contracts and futures contracts for securities listed on the Indonesian Stock Exchange

REPO - - - -
Direct Participation

Land in
Indonesia

Buildings in Indonesia

Land and
Buildings in Indonesia

TOTAL
INVESTMENTS

DIFFERENCE
IN INVESTMENT
VALUATION
CURRENT ASSETS
OUTSIDE
INVESTMENTS
Cash and
Bank

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

Pension Benefit
Payables and Other
Benefits

Voluntary
Benefit Payables

Investment
Payables
Income
Received in
Advance

Expenses
Still to be
Paid

Other payables - - - -
TOTAL
LIABILITIES
OUTSIDE
PENSION
BENEFIT
LIABILITIES

TOTAL
LIABILITIES

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

Income Statement Calculation Projection
(in millions of rupiah)
DESCRIPTION
Actual
Actual
Projection
Projection
Year 1
Jan-Sept
Jan-Dec
Jan-Mar
20XX*
Jan-Jun
20XX*
Jan-Sep
20XX*
Jan-Dec
20XX*
Jan-Dec
20XX
+1*
Jan-31
Dec
20XX+
20XX1*
20XX1*
INVESTMENT
INCOME
Profit Sharing
Dividends
Rent
Profit (Loss)
Investment
Disposal
Other
Investment
Income

Total
Investment
Income
INVESTMENT
COSTS
Transaction
Costs
Maintenance
Costs
Land and
Buildings

Depreciation
Costs
Buildings

Investment
Manager
Costs
Custody Costs
Other
Investment
Costs
Total Investment
Costs
INVESTMENT
BUSINESS
RESULTS

OPERATING
COSTS

Fee to
Founders
Total Operating
Costs
OTHER INCOME
AND EXPENSES

Other Income
Outside
Investment
Other Expenses
Outside
Investment and
Operations

DESCRIPTION
Actual
Actual
Projection
Projection
Year 1
Jan-Sept
Jan-Dec
Jan-Mar
20XX*
Jan-Jun
20XX*
Jan-Sep
20XX*
Jan-Dec
20XX*
Jan-Dec
20XX
+1*
Jan-31
Dec
20XX+
20XX1*
20XX1*
Total
Other Income and Expenses
BUSINESS
RESULTS
BEFORE
TAX
INCOME
TAX
BUSINESS
RESULTS
AFTER
TAX
Remarks:
*If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc.

Projection of Ratios and Other Specific Items for Pension Funds
(in millions of rupiah)
(ratios in percentage)
DESCRIPTION
Actual
Projection
Year 1
Jan-Sept
Jan-Dec
Jan-Mar
20XX

Jan-Jun
20XX*
Jan-Sep
20XX*
Jan-Dec
20XX
*
Jan-Dec
20XX
+1*
Jan-Dec
20XX
+2*
20XX1*
20XX1*
Investment Income
Ratio (ROI)
Investment Income to Assets Ratio (ROA) Operating Cost Ratio (BOPO) Funding Ratio Solvency Ratio Fund Sufficiency Ratio ALM Remarks:
*If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc. If there are accounts that must be filled from cumulative calculations, e.g., from the income statement, they are filled with the cumulative value.

Assumptions Used

H. Pension Fund Plan

Funding Plan
The funding plan generally comes from contributions or development results. Contributions can be made by the employer alone or jointly between the employer and employees (participants). DESCRIPTION Actual Projection Year 1 As of 30 Sept As of 31 Dec As of 31 Mar 20XX As of 30 Jun 20XX As of 30 Sep 20XX* As of 31 Dec 20XX As of 31 Dec 20XX+ As of 31 Dec 20XX+ 20XX-1 20XX-1 FUNDS CONTRIBUTIONS Employer (filled with nominal) Participants Total Contribution Funds Remarks:
*If the business plan submission is for the years 2015 - 2017, then 20XX-1 is the year 2014 (current year), 20XX is the year 2015, etc. No. DESCRIPTION Actual Projection Projection Projection Year 1 Jan-Sept Jan-Dec Jan-Mar 20XX 1 Jan-Jun 20XX 2 Jan-Sep 20XX 2 Jan-Dec 20XX 2 Jan-Dec 20XX +1 3 Jan-Dec 20XX +2 3 20XX1 1 20XX -1 Interest Rate Assumption 2 Actuarial Calculation Method Assumption 3 Mortality Rate Assumption 4 Investment Return Rate 5 etc. (other relevant assumptions)
Investment Plan
a. Investment Composition
No.
Type of
Investment
Actual
Projection
Year 1
As of 30
Sept
As of 31
Dec
As of
Mar
20XX
As of
Jun
20XX
As of
Sep
20XX

As of
Dec
20XX
As of 31
Dec
20XX+
As of 31
Dec
20XX+
20XX-1 20XX-1
Etc. b. Investment Results
No.
Type of
Investment
Actual
Projection
Year 1
As of 30
Sept
As of 31
Dec
As of
Mar
20XX
As of
Jun
20XX
As of
Sep
20XX
*
As of
Dec
20XX
As of
Dec
20XX
+1
As of 31
Dec
20XX+
20XX-1 20XX-1
Etc.

Organizational and Human Resources Development Plan
a. Human Resources Quantity Requirements Plan No Level Position Number of HR As of 30 Sept 20XX-1 Recruitment to be Implemented Quarter IV 20XX-1 Quarter I 20XX Quarter II 20XX Quarter III 20XX Quarter IV 20XX Addition Reduction Addition Reduction Addition Reduction Addition Reduction Addition Reduction Etc Total

b. Human Resources Education and Training Implementation Plan for Board of Directors, Executive Officers, and Sharia Supervisory Board No. Material/Topic Participants Training Time Etc

Office Network Development and/or Change Plan
The office network development and/or change plan must at least include plans for opening and merging offices outside the head office. No. Type of Office Implementation Time 1 Location 2 Remarks 3 A. Opening B. Status Change
C. Merging
D. Address Relocation
Etc
E. Office Closure
Etc
Remarks:
1 Filled with the month of the planned implementation time. 2 For locations in the DKI Jakarta region, at least mention the name of the DKI Jakarta province. For locations outside the DKI Jakarta region, at least mention the name of the Regency/City. 3 Detailed remarks can be attached in a separate sheet

I. Marketing Policy and Plan (For DPLK Only)
No.
New Investment
Package Name
Marketing Channels
Plan for issuance/implementation Etc.

J. Report on Plans and Realization of Activities to Increase Financial Literacy for Consumers and/or the Public The format for the Report on Plans and Realization of Activities to Increase 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 regarding the Implementation of Activities to Increase Financial Literacy in the Financial Services Sector.

K. Report on Plans and Realization of Activities to Increase Financial Inclusion for Consumers and/or the Public The format for the Report on Plans and Realization of Activities to Increase Financial Inclusion 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 regarding the Implementation of Activities to Increase Financial Inclusion in the Financial Services Sector.

L. Information Technology System Development Plan
Detail the plan for the use of information technology used by the company to support business activities. No. Type/Name of Application Ownership (In-house/vendor) Vendor Name Application Function

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

This copy is consistent with the original Legal Director 1 Legal Department signed Yuliana

Plan for merger and separation;
Plan for transfer of insurance portfolio;
Plan to change business activities from non-Sharia principles to Sharia principles.

F. Report on Data Update Activity Plans and Realization of Data Updates for Customers as Referred to in the Financial Services Authority Regulation regarding the Implementation of Anti-Money Laundering and Counter-Terrorism Financing Programs in the Financial Services Sector

G. Proof of announcement of annual financial reports audited by public accountants on the DPLK website and/or daily newspapers in Indonesian distributed nationally

Determined in Jakarta on March 5, 2019 EXECUTIVE HEAD OF INSURANCE, PENSION FUNDS, FINANCING INSTITUTIONS, AND OTHER FINANCIAL SERVICES INSTITUTIONS FINANCIAL SERVICES AUTHORITY, signed RISWINANDI

APPENDIX III
FINANCIAL SERVICES AUTHORITY CIRCULAR LETTER NUMBER 4 /SEOJK.05/2019 REGARDING THE FORMAT 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. Time Deposits at Banks
d. Certificates of Deposit at Banks e. Sharia Securities issued by Bank Indonesia f. Sharia State Securities g. Sharia Stocks listed on the Indonesian Stock Exchange h. Corporate Sukuk Listed on the Indonesian 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. Infrastructure Investment Funds in the form of collective investment contracts o. Option contracts and futures contracts for Sharia securities listed on the Indonesian 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 Bank b. Prepaid Expenses
c. Investment Receivables
d. Investment Income Receivables e. Other Receivables Liabilities Outside Pension Benefit Obligations a. Pension Benefit and Other Benefits Payables Due b. Voluntary Benefit Payables
c. Investment Payables
d. Income Received in Advance e. Expenses Still to be Paid f. Other Payables Investment Business Results Increase (Decrease) in Investment Value Number of participants RISWINANDI Investment Package Report Per DD-MM-YYYY Account Name Sharia Package SUPERVISOR Determined in Jakarta on March 5, 2019 EXECUTIVE HEAD OF INSURANCE, PENSION FUNDS, FINANCING INSTITUTIONS, AND OTHER FINANCIAL SERVICES INSTITUTIONS FINANCIAL SERVICES AUTHORITY, signed This copy is consistent with the original Legal Director 1 Legal Department signed Yuliana

Form and Structure of Periodic Reports for Pension Funds Implementing Sharia-Based Pension Programs

TOTAL
INVESTMENTS

DESCRIPTION
Actual as of 30
Sept
20XX1*
Projection as of 31
Dec
20XX-1*
Projection
Year 1
Projection as of 31
Mar
20XX* as of 30
Jun
20XX* as of 30
Sep
20XX* as of 31
Dec
20XX* as of 31
Dec
20XX
+1* as of 31
Dec
20XX+
TOTAL
CURRENT ASSETS
OUTSIDE
INVESTMENTS

Vehicles -
Computer
Equipment

Office
Equipment

TOTAL
INVESTMENTS

TOTAL
CURRENT ASSETS
OUTSIDE
INVESTMENTS

Total
Investment
Income
INVESTMENT
COSTS
Transaction
Costs
Maintenance
Costs
Land and
Buildings

Depreciation
Costs
Buildings

Investment
Manager
Costs
Custody Costs
Other
Investment
Costs
Total Investment
Costs
INVESTMENT
BUSINESS
RESULTS

OPERATING
COSTS

Fee to
Founders
Total Operating
Costs
OTHER INCOME
AND EXPENSES

Lineage: Superseded

Timeline

Form and Structure of Periodic Reports for Pension Funds Implementing Sharia-Based Pension Programs

TOTAL INVESTMENTS

DESCRIPTION Actual as of 30 Sept 20XX1* Projection as of 31 Dec 20XX-1* Projection Year 1 Projection as of 31 Mar 20XX* as of 30 Jun 20XX* as of 30 Sep 20XX* as of 31 Dec 20XX* as of 31 Dec 20XX +1* as of 31 Dec 20XX+ TOTAL CURRENT ASSETS OUTSIDE INVESTMENTS

Vehicles - Computer Equipment

Office Equipment

TOTAL INVESTMENTS

TOTAL CURRENT ASSETS OUTSIDE INVESTMENTS

Total Investment Income INVESTMENT COSTS Transaction Costs Maintenance Costs Land and Buildings

Depreciation Costs Buildings

Investment Manager Costs Custody Costs Other Investment Costs Total Investment Costs INVESTMENT BUSINESS RESULTS

OPERATING COSTS

Fee to Founders Total Operating Costs OTHER INCOME AND EXPENSES

Lineage: Superseded

Timeline

TOTAL
INVESTMENTS

DESCRIPTION
Actual as of 30
Sept
20XX1*
Projection as of 31
Dec
20XX-1*
Projection
Year 1
Projection as of 31
Mar
20XX* as of 30
Jun
20XX* as of 30
Sep
20XX* as of 31
Dec
20XX* as of 31
Dec
20XX
+1* as of 31
Dec
20XX+
TOTAL
CURRENT ASSETS
OUTSIDE
INVESTMENTS

Vehicles -
Computer
Equipment

Office
Equipment

TOTAL
INVESTMENTS

TOTAL
CURRENT ASSETS
OUTSIDE
INVESTMENTS

Total
Investment
Income
INVESTMENT
COSTS
Transaction
Costs
Maintenance
Costs
Land and
Buildings

Depreciation
Costs
Buildings

Investment
Manager
Costs
Custody Costs
Other
Investment
Costs
Total Investment
Costs
INVESTMENT
BUSINESS
RESULTS

OPERATING
COSTS

Fee to
Founders
Total Operating
Costs
OTHER INCOME
AND EXPENSES