Monthly Report on the Management of Employment Social Security Programs for Employment Social Security Implementing Agencies

To:
The Board of Directors of the Employment Social Security Management Agency, At your location.

COPY
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY REPUBLIC OF INDONESIA NUMBER 26 /SEOJK.05/2022

ON
MONTHLY REPORT ON THE MANAGEMENT OF EMPLOYMENT SOCIAL SECURITY PROGRAMS FOR EMPLOYMENT SOCIAL SECURITY IMPLEMENTING AGENCIES

In accordance with the mandate of Article 16 paragraph (10) of the Financial Services Authority Regulation Number 5/POJK.05/2013 concerning Supervision of Employment Social Security Implementing Agencies by the Financial Services Authority (State Gazette of the Republic of Indonesia Year 2013 Number 258, Supplement to the State Gazette of the Republic of Indonesia Number 5487), it is necessary to regulate provisions regarding the form and structure of the monthly report on the management of employment social security programs for employment social security implementing agencies in this Financial Services Authority Circular Letter as follows:

I. GENERAL PROVISIONS

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

1. Employment Social Security Implementing Agency, hereinafter abbreviated as BPJS Ketenagakerjaan, is a public legal entity established to implement programs for work accident insurance, old age benefits, pension insurance, death benefits, and job loss insurance.

2. Monthly Report on the Management of Employment Social Security Programs, hereinafter referred to as the Monthly Report, is a management report prepared by BPJS Ketenagakerjaan for the benefit of the Financial Services Authority, covering the period from January 1 to the end of the current month, presented and submitted according to the form and structure of the Monthly Report and in accordance with the procedures determined by the Financial Services Authority.

3. Work Accident Insurance, hereinafter abbreviated as JKK, is benefits in the form of cash and/or health services provided when a participant experiences a work accident or illness caused by the work environment.

4. Old Age Benefits, hereinafter abbreviated as JHT, is cash benefits paid in a lump sum when a participant reaches retirement age, dies, or experiences permanent total disability.

5. Pension Insurance, hereinafter abbreviated as JP, is social insurance aimed at maintaining a decent standard of living for participants and/or their heirs by providing income after the participant reaches retirement age, experiences permanent total disability, or dies.

6. Death Benefits, hereinafter referred to as JKM, is cash benefits provided to heirs when a participant dies not due to a work accident.

7. Job Loss Insurance, hereinafter abbreviated as JKP, is social insurance provided to workers/laborers who experience termination of employment in the form of cash benefits, access to labor market information, and job training.

II. FORM AND STRUCTURE OF THE MONTHLY REPORT ON THE MANAGEMENT OF EMPLOYMENT SOCIAL SECURITY PROGRAMS

1. BPJS Ketenagakerjaan is required to prepare the Monthly Report for each monthly employment social security program for periods ending on January 31, February 28 or 29, March 31, April 30, May 31, June 30, July 31, August 31, September 30, October 31, November 30, and December 31.

2. Types of employment social security programs include:
   a. JKK program; b. JHT program;
   c. JP program;
   d. JKM program; and e. JKP program.

3. The Monthly Report includes:
   a. profile reports, consisting of:

1. general profile;
2. supervisory board and board of directors profile;
3. organizational structure profile;
4. regional office and branch office profile;
5. workforce education level profile; and
6. certified skilled employee profile; and
   b. recapitulation reports, consisting of:
7. participant recapitulation;
8. complaint recapitulation;
9. participant, wages, contributions, and claims recapitulation for the JKK program;
10. participant, wages, contributions, funds, and claims recapitulation for the JHT program;
11. participant, wages, contributions, funds, and claims recapitulation for the JP program;
12. participant, wages, contributions, and claims recapitulation for the JKM program; and
13. participant, wages, contributions, and claims recapitulation for the JKP program.

4. BPJS Ketenagakerjaan must have an information system capable of processing and maintaining report data and supporting data for the reports as referred to in number 3.

5. The Financial Services Authority may request BPJS Ketenagakerjaan to submit supporting data as referred to in number 4 for the purpose of supervising BPJS Ketenagakerjaan.

6. The form, structure, and guidelines for preparing the profile report as referred to in number 3 letter a are contained in Appendix I, which is an integral part of this Financial Services Authority Circular Letter.

7. The form, structure, and guidelines for preparing the recapitulation report as referred to in number 3 letter b are as follows:
   a. for participant recapitulation for all programs according to format 1; b. for complaint recapitulation for all programs according to format 2;
   c. for the JKK program according to format 3;
   d. for the JHT program according to format 4; e. for the JP program according to format 5; f. for the JKM program according to format 6; and g. for the JKP program according to format 7, as contained in Appendix II, which is an integral part of this Financial Services Authority Circular Letter.

8. The Monthly Report must be accompanied by a director's statement letter regarding responsibility for the Monthly Report as contained in Appendix III, which is an integral part of this Financial Services Authority Circular Letter.

III. SUBMISSION TIME FOR THE MONTHLY REPORT ON THE MANAGEMENT OF EMPLOYMENT SOCIAL SECURITY PROGRAMS

1. BPJS Ketenagakerjaan is required to submit the Monthly Report to the Financial Services Authority no later than the 10th (ten) of the following month.

2. In the event that the 10th (ten) as referred to in number 1 falls on a Saturday, Sunday, and/or holiday, the submission deadline for the Monthly Report becomes the next working day.

3. In the event that the submission date for the Monthly Report as referred to in number 1 or number 2 falls on a national holiday or joint holiday, the Financial Services Authority has the authority to determine the submission deadline for the Monthly Report.

IV. PROCEDURES FOR SUBMITTING THE MONTHLY REPORT ON THE MANAGEMENT OF EMPLOYMENT SOCIAL SECURITY PROGRAMS

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

2. In the event that the Financial Services Authority's data communication network system as referred to in number 1 is not yet available, experiences technical disturbances, or experiences force majeure, BPJS Ketenagakerjaan must submit the Monthly Report online via email to the Financial Services Authority.

3. In the event that the Financial Services Authority's data communication network system experiences technical disturbances or force majeure as referred to in number 2, the Financial Services Authority notifies information regarding the occurrence of technical disturbances or force majeure in writing and submitted:
   a. through the Financial Services Authority's data communication network system; and/or b. via email from the official email address of the Financial Services Authority.

4. In the event that BPJS Ketenagakerjaan must submit the Monthly Report online via email to the Financial Services Authority as referred to in number 2, the Financial Services Authority provides BPJS Ketenagakerjaan with the email address used for the submission of the Monthly Report.

5. In the event of submission online via email as referred to in number 2, BPJS Ketenagakerjaan must submit in writing to the Financial Services Authority the email address of BPJS Ketenagakerjaan used for the submission of the Monthly Report to the Financial Services Authority.

6. In the event that the Financial Services Authority's data communication network and email systems as referred to in number 1 and number 2 experience technical disturbances or force majeure, or BPJS Ketenagakerjaan experiences technical disturbances so that it cannot submit the Monthly Report online, the Monthly Report is submitted offline in the form of an electronic copy (soft file) and sent to the Financial Services Authority via a letter signed by the Board of Directors and addressed to:

Financial Services Authority u.p. Director of Pension Fund and BPJS Ketenagakerjaan Supervision Wisma Mulia 2 Building, 12th Floor Jalan Jenderal Gatot Subroto Kav. 40 Jakarta 12710

7. In the event of changes to the Financial Services Authority's email address as referred to in number 4 and/or changes to the Financial Services Authority's office address as referred to in number 6, the Financial Services Authority will communicate such address changes via letter or announcement.

8. Offline submission of the Monthly Report as referred to in number 6 is conducted by:
   a. being handed directly to the Financial Services Authority office; or b. being sent via a courier service company.

9. Offline submission of the Monthly Report is submitted to the Financial Services Authority on working days and during the Financial Services Authority's working hours.

10. BPJS Ketenagakerjaan is deemed to have submitted the Monthly Report with the following provisions:
    a. for online submission via:

1. the Financial Services Authority's data communication network system, proven by a receipt from the Financial Services Authority's data communication network system; or
2. email to the Financial Services Authority, proven by a receipt from the Financial Services Authority in the event that submission through the data communication network system cannot be performed.
   b. for offline submission, proven by a receipt from the Financial Services Authority.

11. The Financial Services Authority may request original documents in printed form of the Monthly Report that has been submitted by BPJS Ketenagakerjaan through the Financial Services Authority's data communication network system or email.

This copy is consistent with the original
Director of Law 1
Legal Department signed
Mufli Asmawidjaja

V. CLOSING

1. Upon the implementation of this Financial Services Authority Circular Letter, Financial Services Authority Circular Letter Number 20/SEOJK.05/2014 concerning Monthly Reports on the Management of Employment Programs for Employment Social Security Implementing Agencies is revoked and declared invalid.

2. This Financial Services Authority Circular Letter comes into force on the date of establishment.

Established in Jakarta on December 21, 2022

EXECUTIVE HEAD OF INSURANCE, PENSION FUND, FINANCING INSTITUTION, AND OTHER FINANCIAL SERVICE INSTITUTIONS SUPERVISOR FINANCIAL SERVICES AUTHORITY REPUBLIC OF INDONESIA, signed OGI PRASTOMIYONO

APPENDIX I
FINANCIAL SERVICES AUTHORITY CIRCULAR LETTER REPUBLIC OF INDONESIA NUMBER 26 /SEOJK.05/2022 ON MONTHLY REPORT ON THE MANAGEMENT OF EMPLOYMENT SOCIAL SECURITY PROGRAMS FOR EMPLOYMENT SOCIAL SECURITY IMPLEMENTING AGENCIES

BPJS KETENAGAKERJAAN PROFILE REPORT

I. GENERAL PROFILE

1. Institution Name : ……….........................................................
2. Company Address
   a. Full Address : ……….........................................................
   b. Ownership Status
   Building
   : ……….........................................................
   c. Location Code : ……….........................................................
   d. City Name : ……….........................................................
   e. Postal Code : ……….........................................................
3. Telephone : ……….........................................................
4. Website : ……….........................................................
5. NPWP (Tax ID) : ……….........................................................
6. Number of Offices
   a. Number of Regional Offices
   : ……….........................................................
   b. Number of Branch Offices
   : ……….........................................................
7. Number of Workforce
   a. Head Office : ……….........................................................
   b. Regional Office : ……….........................................................
   c. Branch Office : ……….........................................................
   d. Total : ……….........................................................
8. Actuary Name : ……….........................................................
9. Management
   a. Number of Directors : ……….........................................................
   b. Number of Supervisory Board
   : ……….........................................................
10. Report Compiler and Person in Charge
    Person in Charge
    a. Full Name : ……….........................................................
    b. Position : ……….........................................................
    c. Work Unit : …………………………………………………….
    d. Telephone : ……….........................................................
    e. Email : ……….........................................................
    Compiler
    a. Full Name : ……….........................................................
    b. Position : ……….........................................................
    c. Work Unit : …………………………………………………….
    d. Telephone : ……….........................................................
    e. Email : ……….........................................................
    Jakarta, …….
    Report Person in Charge
    Name
    Director

EXPLANATION:
This form contains all information regarding the institutional profile of BPJS Ketenagakerjaan.

1. Institution Name
   Filled with the name of BPJS Ketenagakerjaan.
2. Company Address
   a. Full Address
   Filled with the full address according to the domicile of the BPJS Ketenagakerjaan head office. b. Building Ownership Status Filled with the building ownership status, i.e., rented, owned, or borrowed.
   c. Location Code
   Filled with the location code as stated in the list of location codes for all districts/cities in Indonesia. d. City Name Filled with the city name according to the domicile of the BPJS Ketenagakerjaan head office. e. Postal Code Filled with the postal code number of the domicile of the BPJS Ketenagakerjaan head office.
3. Telephone
   Filled with the telephone number of BPJS Ketenagakerjaan.
4. Website
   Filled with the website address of BPJS Ketenagakerjaan.
5. NPWP
   Filled with the NPWP of BPJS Ketenagakerjaan.
6. Number of Offices
   a. Number of Regional Offices
   Filled with the number of regional offices of BPJS Ketenagakerjaan. b. Number of Branch Offices Filled with the number of branch offices of BPJS Ketenagakerjaan.
7. Number of Workforce
   a. Head Office
   Filled with the number of workforce at the head office of BPJS Ketenagakerjaan. b. Regional Office Filled with the number of workforce at the BPJS Ketenagakerjaan regional office.
   c. Branch Office
   Filled with the number of workforce at the BPJS Ketenagakerjaan branch office.
8. Actuary Name
   Filled with the name of the actuary who performs actuarial calculations at BPJS Ketenagakerjaan in the relevant year.
9. Management
   a. Number of Directors
   Filled with the number of directors of BPJS Ketenagakerjaan. b. Number of Supervisory Board Filled with the number of the supervisory board of BPJS Ketenagakerjaan.
10. Report Compiler and Person in Charge
    Filled with complete data for each personnel acting as the compiler officer and the person in charge of the report. a. Report Person in Charge

1. Full Name
   Filled with the full name of the report person in charge.
2. Position
   Filled with the director position in a specific field who is the person in charge of the report, e.g., Finance Director.
3. Work Unit
   Filled with the work unit of the report person in charge.
4. Telephone
   Filled with the telephone number of the report person in charge.
5. Email
   Filled with the email address of the report person in charge. b. Report Compiler
6. Name
   Filled with the name of the report compiler.
7. Position
   Filled with the position of the report compiler.
8. Work Unit
   Filled with the work unit of the report compiler.
9. Telephone
   Filled with the telephone number of the report compiler.
10. Email
    Filled with the email address of the report compiler.

II. PROFILE OF THE SUPERVISORY BOARD AND BOARD OF DIRECTORS OF BPJS KETENAGAKERJAAN

a. Supervisory Board Profile
Report Period
Name
Supervisory Board
Nomenclature
Position
Date
Started
Serving
Appointment
SK Number
Date
SK
Subject
SK
(1) (2) (3) (4) (5) (6) (7) b. Board of Directors Profile Report Period Name Directors Nomenclature Position Date Started Serving Appointment SK Number Date SK Subject SK (1) (2) (3) (4) (5) (6) (7)

EXPLANATION:
This form contains information on the management of BPJS Ketenagakerjaan consisting of the Supervisory Board and Board of Directors.

1. Report Period
   Filled with the date, month, and year of the end of the submitted report period.
2. Name of Supervisory Board/Directors
   Filled with the names of the Supervisory Board/Directors of BPJS Ketenagakerjaan.
3. Position Nomenclature
   Filled with the position nomenclature of the Supervisory Board/Directors of BPJS Ketenagakerjaan.
4. Date Started Serving
   Filled with the date, month, and year of starting to serve.
5. Appointment SK Number
   Filled with the number of the appointment decision letter of the Supervisory Board/Directors, e.g., KEP-123/MK/2022.
6. Date of SK
   Filled with the date, month, and year the decision letter was issued.
7. Subject of SK
   Filled with the subject of the appointment decision letter.

III. ORGANIZATIONAL STRUCTURE PROFILE OF BPJS KETENAGAKERJAAN

Report Period
Work Unit Name
Name
Official
Structure
Level
Parent Structure Name
(1) (2) (3) (4) (5)

EXPLANATION:
This form contains information on the organizational structure of BPJS Ketenagakerjaan.

1. Report Period
   Filled with the date, month, and year of the end of the submitted report period.
2. Work Unit Name
   Filled with the work unit name according to the organizational structure of BPJS Ketenagakerjaan, e.g., finance section.
3. Official Name
   Filled with the name of the official leading the organizational structure at BPJS Ketenagakerjaan.
4. Structure Level
   Filled with the structure level up to the work unit at BPJS Ketenagakerjaan. No. Structure Level Code
5. Directorate 1
6. Regional Office 2
7. Branch Office 3
8. Parent Structure Name
   Filled with the name of the parent organizational structure at BPJS Ketenagakerjaan, e.g., Finance Department.

IV. REGIONAL OFFICE AND BRANCH OFFICE PROFILE OF BPJS KETENAGAKERJAAN

Table 1 of 2
Report Period
Office Name
Office Type
Full Address
(1) (2) (3) (4)
Table 2 of 2
City Code
Postal Code
Telephone
Total Employees
(5) (6) (7) (8)

EXPLANATION:
This form contains detailed information on the profile list of regional offices and branch offices of BPJS Ketenagakerjaan.

1. Report Period
   Filled with the date, month, and year of the end of the submitted report period.
2. Office Name
   Filled with the name of the BPJS Ketenagakerjaan office.
3. Office Type
   Filled with the type of BPJS Ketenagakerjaan office:
   No. Office Type Code
4. Regional Office 1
5. Branch Office 2
6. Others 3
7. Full Address
   Filled with the full address of the office according to the domicile of the BPJS Ketenagakerjaan branch office.
8. Location Code
   Filled with the location code as stated in the list of location codes for all districts/cities in Indonesia.
9. Postal Code
   Filled with the postal code number of the domicile of the BPJS Ketenagakerjaan branch office.
10. Telephone
    Filled with the telephone number of BPJS Ketenagakerjaan.
11. Total Employees
    Filled with the number of employees of BPJS Ketenagakerjaan, including honorary staff.

V. WORKFORCE EDUCATION LEVEL PROFILE OF BPJS KETENAGAKERJAAN

Report Period
Education Level
Placement
Employment Status
Male
Female
Total
Head Office
Outside Head Office
(1) (2) (3) (4) (5) (6) (7)

EXPLANATION:
This form contains detailed information on the workforce education level list, both at the head office and offices other than the head office of BPJS Ketenagakerjaan.

1. Report Period
   Filled with the date, month, and year of the end of the submitted report period.
2. Education Level
   Filled with the education level of the workforce of BPJS Ketenagakerjaan. No. Education Level Code
3. SD (Elementary School) 9110
4. SMP (Junior High School) 9120
5. SMA (Senior High School) 9130
6. D1 9140
7. D2 9150
   No. Education Level Code
8. D3 9160
9. S1/D4 9170
10. S2 9180
11. S3 9190
12. Foreign Workforce 9200
13. Placement
    Filled with the placement of the workforce, whether at the head office or outside the head office, with the word 'Yes' or 'No'.
14. Employment Status
    Filled with the employment status of the workforce at BPJS Ketenagakerjaan, e.g., permanent employees and non-permanent employees.
15. Male
    Filled with the number of male workforce at BPJS Ketenagakerjaan.
16. Female
    Filled with the number of female workforce at BPJS Ketenagakerjaan.
17. Total
    Filled with the total number of male and female workforce at BPJS Ketenagakerjaan.

VI. CERTIFIED SKILLED EMPLOYEE PROFILE OF BPJS KETENAGAKERJAAN

Report Period
Employee Name
Position
Field of Expertise
Qualification
Position
Description
Date
Started
Serving
(1) (2) (3) (4) (5) (6) (7)

EXPLANATION:
This form contains detailed information on the profile list of certified skilled employees, both at the head office and offices other than the head office of BPJS Ketenagakerjaan.

1. Report Period
   Filled with the date, month, and year of the end of the submitted report period.
2. Employee Name
   Filled with the name of the certified employee of BPJS Ketenagakerjaan.
3. Position
   Filled with the position name of the BPJS Ketenagakerjaan expert staff.
4. Date Started Serving
   Filled with the date, month, and year the expert staff started serving at BPJS Ketenagakerjaan.
5. Field of Expertise
   Filled with the field of expertise of the certified skilled employee of BPJS Ketenagakerjaan. No. Field of Expertise Code
6. Accounting, Audit, and Finance 1
7. Insurance, and Risk Management 2
8. Information Technology 3
9. Actuarial 4
10. Others 5
11. Qualification
    Filled with the qualification of the BPJS Ketenagakerjaan expert staff. No. Field of Expertise Qualification
12. Accounting, Audit, and Finance CFA/WMI/CPA/CISA/Akuntan/CA/QIA/CFE/CIA/Others
13. Insurance, and Risk Management AAIJ/AAAIJ/AAIK/AAAIK/FLMI/ANZIF/ACII/BSMR/AAK/AAAK/CRMP/Others
14. Information Technology Vendor Specific/Non-Vendor Specific/Others
15. Actuarial FSAI/ASAI/Others
16. Others

This copy is consistent with the original
Director of Law 1
Legal Department signed
Mufli Asmawidjaja
7. Description
Filled with additional information required regarding expertise.

Established in Jakarta on December 21, 2022

EXECUTIVE HEAD OF INSURANCE, PENSION FUND, FINANCING INSTITUTION, AND OTHER FINANCIAL SERVICE INSTITUTIONS SUPERVISOR FINANCIAL SERVICES AUTHORITY REPUBLIC OF INDONESIA, signed OGI PRASTOMIYONO

APPENDIX II
FINANCIAL SERVICES AUTHORITY CIRCULAR LETTER REPUBLIC OF INDONESIA NUMBER 26 /SEOJK.05/2022 ON MONTHLY REPORT ON THE MANAGEMENT OF EMPLOYMENT SOCIAL SECURITY PROGRAMS FOR EMPLOYMENT SOCIAL SECURITY IMPLEMENTING AGENCIES

FORMAT: 1
PARTICIPANT RECAPITULATION REPORT
The participant recapitulation report for all employment social security programs is as follows:

1. JKK program;

2. JHT program;

3. JP program;

4. JKM program; and

5. JKP program.

6. PARTICIPANT RECAPITULATION PER PARTICIPANT SEGMENT

Table 1 of 2
Program Type
Report Period
Regional Office Code
Office Name
Branch Office Code
Branch Office
(1) (2) (3) (4) (5) (6)
Table 2 of 2
Wage Recipients
Non-Wage Recipients
Construction Services
Employer
Participants
Employer
Workshop/Type of Business
Project Participants
(7) (8) (9)

EXPLANATION:
This form contains all information regarding the recapitulation of membership per participant segment of BPJS Ketenagakerjaan:

1. Program Type
   Filled with the type of BPJS Ketenagakerjaan program.
2. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.
3. Regional Office Code
   Filled with the code of the BPJS Ketenagakerjaan regional office.
4. Office Name
   Filled with the name of the BPJS Ketenagakerjaan regional office.
5. Branch Office Code
   Filled with the code of the BPJS Ketenagakerjaan branch office.
6. Branch Office
   Filled with the name of the BPJS Ketenagakerjaan branch office.
7. Wage Recipients
   Filled with the number of employers and active participants in the wage recipient participant segment of BPJS Ketenagakerjaan.
8. Non-Wage Recipients
   Filled with the number of business containers/types and active participants in the non-wage recipient participant segment of BPJS Ketenagakerjaan.
9. Construction Services
   Filled with the number of projects and active participants in the construction service worker participant segment of BPJS Ketenagakerjaan.

No. Participant Segment Code
Wage Recipients 1

1. State Organizers 1.1

2. Private Employees/State-Owned Enterprises 1.2

3. Other Workers 1.3
   Non-Wage Recipients 2

4. Self-Employed Workers 2.1

5. Individual Workers 2.2

6. Other Workers 2.3
   Construction Services Workers 3

7. RECAPITULATION OF MEMBERSHIP BY BUSINESS GROUP, GENDER, AND WORKFORCE
   Table 1 of 2
   Program Type
   Reporting Period
   Regional Office Code
   Regional Office
   Branch Office Code
   Branch Office
   Participant Segment
   (1) (2) (3) (4) (5) (6) (7)
   Table 2 of 2
   Business Group/Counterparty
   Gender
   Participants
   1 2 3 4 5 6 7 8 9
   Male
   Female
   In Out Active Inactive
   (8) (9) (10) (11) (12) (13)

EXPLANATION:
This form contains all information regarding the recapitulation of membership by business group, gender, and workforce of BPJS Ketenagakerjaan:

1. Program Type
   Filled with the type of worker social security program.

2. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

3. Regional Office Code
   Filled with the code of the BPJS Ketenagakerjaan regional office.

4. Regional Office
   Filled with the name of the BPJS Ketenagakerjaan regional office.

5. Branch Office Code
   Filled with the code of the BPJS Ketenagakerjaan branch office.

6. Branch Office
   Filled with the name of the BPJS Ketenagakerjaan branch office.

7. Participant Segment
   Filled with the participant segment of BPJS Ketenagakerjaan.
   No. Participant Segment Code
   Wage Recipients

8. State Organizers 1.1

9. Private Employees/State-Owned Enterprises 1.2

10. Other Workers 1.3
    Non-Wage Recipients

11. Self-Employed Workers 2.1

12. Individual Workers 2.2

13. Other Workers 2.3
    Construction Services Workers 3

14. Business Group/Counterparty
    Filled with the counterparty of BPJS Ketenagakerjaan participants. No. Business Group/Counterparty Code

15. Agriculture, Fisheries, Plantations, and Forestry

16. Mining 2

17. Basic and Chemical Industries 3

18. Various Industries 4

19. Consumer Goods Industries 5

20. Property and Real Estate 6

21. Energy, Telecommunications, and Transportation 7

22. Finance and Investment 8

23. Trade and Services 9

24. Gender
    Filled with the gender of participants in the worker social security program.

25. Incoming Participants
    Filled with the number of participants who enter as BPJS Ketenagakerjaan participants.

26. Outgoing Participants
    Filled with the number of participants who leave as BPJS Ketenagakerjaan participants.

27. Active Participants
    Filled with the number of active participants in BPJS Ketenagakerjaan.

28. Inactive Participants
    Filled with the number of inactive participants in BPJS Ketenagakerjaan.

29. RECAPITULATION OF MEMBERSHIP BY AGE GROUP AND NATIONALITY
    Table 1 of 2
    Program Type
    Reporting Period
    Regional Office Code
    Regional Office
    Branch Office Code
    Branch Office
    Participant Segment
    (1) (2) (3) (4) (5) (6) (7)
    Table 2 of 2
    Age Group Nationality
    1 2 3 4 5 6 7 8 9 10 11 12 13 Indonesian Foreigner (8) (9) (10)

EXPLANATION:
This form contains all information regarding the recapitulation by age group and nationality of BPJS Ketenagakerjaan:

1. Program Type
   Filled with the type of worker social security program.

2. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

3. Regional Office Code
   Filled with the code of the BPJS Ketenagakerjaan regional office.

4. Regional Office
   Filled with the name of the BPJS Ketenagakerjaan regional office.

5. Branch Office Code
   Filled with the code of the BPJS Ketenagakerjaan branch office.

6. Branch Office
   Filled with the name of the BPJS Ketenagakerjaan branch office.

7. Participant Segment
   Filled with the participant segment of BPJS Ketenagakerjaan.
   No. Participant Segment Code
   Wage Recipients

8. State Organizers 1.1

9. Private Employees/State-Owned Enterprises 1.2

10. Other Workers 1.3
    Non-Wage Recipients

11. Self-Employed Workers 2.1

12. Individual Workers 2.2

13. Other Workers 2.3
    Construction Services Workers 3

14. Age Group
    Filled with the age group of BPJS Ketenagakerjaan participants.
    No. Age Group Code

15. Under 20 years 1

16. Above 20 – 25 years 2

17. Above 25 – 30 years 3

18. Above 30 – 35 years 4

19. Above 35 – 40 years 5

20. Above 40 – 45 years 6

21. Above 45 – 50 years 7

22. Above 50 – 55 years 8

23. Above 55 – 60 years 9

24. Above 60 – 65 years 10

25. Above 65 – 70 years 11

26. Above 70 – 75 years 12

27. Above 75 years 13

28. Indonesian Citizens
    Filled with the number of BPJS Ketenagakerjaan participants who are Indonesian citizens.

29. Foreign Citizens
    Filled with the number of BPJS Ketenagakerjaan participants who are foreign citizens.

FORMAT: 2
COMPLAINT RECAPITULATION REPORT
The complaint recapitulation report for all worker social security programs is as follows:

1. JKK Program;

2. JHT Program;

3. JP Program;

4. JKM Program; and

5. JKP Program.

6. BPJS KETENAGAKERJAAN COMPLAINT RECAPITULATION
   Table 1 of 2
   Reporting Period
   Complaint Type
   Program Type
   JKK JHT JP JKM JKP General
   (1) (2) (3)
   Total
   (8)
   Table 2 of 2
   Number Percentage
   Complaint Resolution
   Resolved Unresolved
   (4) (5) (6) (7)
   Total
   (8)
   EXPLANATION:
   This form contains all information regarding the recapitulation of complaints from BPJS Ketenagakerjaan participants.

7. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

8. Complaint Type
   Filled with the type of participant complaints to BPJS Ketenagakerjaan via call center, email and/or walk-in customer.

9. Program Type
   Filled with the number of complaints from BPJS Ketenagakerjaan participants for each program.

10. Number
    Filled with the total number of complaints from BPJS Ketenagakerjaan participants.

11. Percentage
    Filled with the percentage of all complaints from BPJS Ketenagakerjaan participants.

12. Resolved Complaints
    Filled with the number of complaints that have been resolved by BPJS Ketenagakerjaan.

13. Unresolved
    Filled with the number of complaints that have not been resolved by BPJS Ketenagakerjaan.

14. Total
    Sum of each column

15. BPJS KETENAGAKERJAAN CALL CENTRE INCOMING CALL RECAPITULATION
    NO.
    Category
    Weekly
    Monthly Percentage
    Week 1 Week 2 Week 3 Week 4 Week 5 (%)
    (1) (2) (3) (4)
    Complaints
    2 Serious Complaints
    Information Requests
    5 Criticism and Suggestions
    Total
    EXPLANATION:
    This form contains all information regarding the recapitulation of complaints from BPJS Ketenagakerjaan participants:

16. Category
    Filled with the category of services received by the BPJS Ketenagakerjaan call centre.

17. Weekly
    Filled with the number of services provided by the BPJS Ketenagakerjaan call centre each week.

18. Monthly
    Filled with the total services provided by the BPJS Ketenagakerjaan call centre each month.

19. Percentage
    Filled with the percentage of BPJS Ketenagakerjaan call centre services each month.

20. BPJS KETENAGAKERJAAN PARTICIPANT SATISFACTION SURVEY RECAPITULATION
    Table 1 of 2
    Table 2 of 2
    EXPLANATION:
    This form contains all information regarding the recapitulation of BPJS Ketenagakerjaan participant satisfaction surveys.

21. Reporting Period
    Filled with the date, month, and year of the end of the reporting period submitted.

22. Regional Office
    Filled with the name of the Labor regional office.

23. Branch Office
    Filled with the name of the BPJS Ketenagakerjaan branch office.

24. Satisfaction Level
    Filled with the level of satisfaction of BPJS Ketenagakerjaan participants.

25. Total
    Filled with the total participant assessment based on the results of the BPJS Ketenagakerjaan survey on participant satisfaction. Reporting Period Regional Office Branch Office Satisfaction Level Dissatisfied Fairly Dissatisfied Number % Number % (1) (2) (3) (4) Satisfaction Level Total Fairly Satisfied Satisfied Very Satisfied Number % Number % Number % (4) (5)

FORMAT: 3
MONTHLY REPORT ON THE MANAGEMENT OF THE WORK ACCIDENT INSURANCE PROGRAM (JKK)

1. MEMBERSHIP RECAPITULATION
   This form contains all information regarding the recapitulation of membership in the JKK program.
   Table 1 of 3
   Table 2 of 3
   Business Field/Counterparty Gender Participants Participants 1 2 3 4 5 6 7 8 9 Total Male Female Total In Out Active Inactive Total (11) (12) (13) (14) (15) (16) (17) (18) (19)
   Table 3 of 3
   Age Group Nationality
   Target Participants
   1 2 3 4 5 6 7 8 9 10 11 12 13 Total Indonesian Foreigner Total (20) (21) (22) (23) (24) (25) Reporting Period Regional Office Code Regional Office Branch Office Code Branch Office Wage Recipients Non-Wage Recipients Construction Services Workers Participant Segment Target Employers Employers Participants Containers/Types of Business Participants Projects Participants (1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

EXPLANATION:
This form contains all information regarding the recapitulation of membership per participant segment of the JKK program:

1. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office Code
   Filled with the code of the JKK program regional office.

3. Regional Office
   Filled with the name of the JKK program regional office.

4. Branch Office Code
   Filled with the code of the JKK program branch office.

5. Branch Office
   Filled with the name of the JKK program branch office.

6. Wage Recipients
   Filled with the number of employers and active participants in the wage recipient participant segment of the JKK program.

7. Non-Wage Recipients
   Filled with the number of business containers/types and active participants in the non-wage recipient participant segment of the JKK program.

8. Construction Services Workers
   Filled with the number of projects and active participants in the construction service worker participant segment of the JKK program. No. Participant Segment Code Wage Recipients 1

9. State Organizers 1.1

10. Private Employees/State-Owned Enterprises 1.2

11. Other Workers 1.3
    Non-Wage Recipients 2

12. Self-Employed Workers 2.1

13. Individual Workers 2.2

14. Other Workers 2.3
    Construction Services Workers 3

15. Participant Segment
    Filled with the participant segment of the JKK program.
    No. Participant Segment Code
    Wage Recipients

16. State Organizers 1.1

17. Private Employees/State-Owned Enterprises 1.2

18. Other Workers 1.3
    Non-Wage Recipients

19. Self-Employed Workers 2.1

20. Individual Workers 2.2

21. Other Workers 2.2
    Construction Services Workers 3

22. Target Employers
    Filled with the target number of employer participants in the JKK program.

23. Business Field/Counterparty
    Filled with the counterparty of BPJS Ketenagakerjaan participants adjusted to the Indonesian Standard Industrial Classification (KBLI). No. Counterparty Code

24. Agriculture, Fisheries, Plantations, and Forestry

25. Mining 2

26. Basic and Chemical Industries 3

27. Various Industries 4

28. Consumer Goods Industries 5

29. Property and Real Estate 6

30. Energy, Telecommunications, and Transportation 7

31. Finance and Investment 8

32. Trade and Services 9

33. Total
    Filled with the total counterparty of BPJS Ketenagakerjaan participants.

34. Gender
    Filled with the gender of participants in the JKK program.

35. Total
    Filled with the total participants in the JKK program based on gender.

36. In
    Filled with the number of participants who enter as participants in the JKK program.

37. Out
    Filled with the number of participants who leave as participants in the JKK program.

38. Active
    Filled with the number of active participants in the JKK program.

39. Inactive
    Filled with the number of inactive participants in the JKK program.

40. Total
    Filled with the total participants in the JKK program who are active and inactive.

41. Age Group
    Filled with the age group of participants in the JKK program.
    No. Age Group Code

42. Under 20 years 1

43. Above 20 - 25 years 2

44. Above 25 - 30 years 3

45. Above 30 - 35 years 4

46. Above 35 - 40 years 5

47. Above 40 - 45 years 6

48. Above 45 - 50 years 7

49. Above 50 - 55 years 8

50. Above 55 - 60 years 9

51. Above 60 - 65 years 10

52. Above 65 - 70 years 11

53. Above 70 - 75 years 12

54. Above 75 years 13

55. Total
    Filled with the total participants in the JKK program based on age group.

56. Indonesian Citizens
    Filled with participants in the JKK program who are Indonesian citizens.

57. Foreign Citizens
    Filled with participants in the JKK program who are foreign citizens.

58. Total
    Filled with the total participants in the JKK program based on nationality.

59. Target Participants
    Filled with the target number of participants in the JKK program.

60. RECAPITULATION OF WAGES AND CONTRIBUTIONS FOR THE JKK PROGRAM
    This form contains all information regarding the recapitulation of wages and contributions for the JKK program.
    Table 1 of 2
    Table 2 of 2
    Contribution Burden Contributions Received
    Target Participants
    Employer Burden
    Total
    Due
    Already
    Reconciled
    Due
    Not Yet
    Reconciled
    Paid
    In Advance
    Unspecified Contributions (IBR)
    Last Year
    Total
    (9) (10) (11) (12) (13) (14) (15) (16) (17) Reporting Period Regional Office Code Regional Office Branch Office Code Branch Office Participant Segment Wage Group (TK) 1 2 3 4 5 Total (1) (2) (3) (4) (5) (6) (7) (8)

EXPLANATION:
This form contains all information regarding the detailed list of wages and contributions for the JKK program.

1. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office Code
   Filled with the code of the BPJS Ketenagakerjaan regional office.

3. Regional Office
   Filled with the name of the BPJS Ketenagakerjaan regional office.

4. Branch Office Code
   Filled with the code of the BPJS Ketenagakerjaan branch office.

5. Branch Office
   Filled with the name of the BPJS Ketenagakerjaan branch office.

6. Participant Segment
   Filled with the participant segment of the JKK program.
   No. Participant Segment Code
   Wage Recipients

7. State Organizers 1.1

8. Private Employees/State-Owned Enterprises 1.2

9. Other Workers 1.3
   Non-Wage Recipients

10. Self-Employed Workers 2.1

11. Individual Workers 2.2

12. Other Workers 2.3
    Construction Services Workers 3

13. Wage Group
    Filled with the wage group of participants in the JKK program.
    No. Wage Group Code

14. 0-2 million/month 1

15. 2- 5 million/month 2

16. 5-10 million/month 3

17. 10-50 million/month 4

18. 50 million/month 5

19. Total
    JKK.

20. Participants
    Filled with the due contributions that are the burden of participants in the JKK program.

21. Employer Burden
    Filled with the due contributions that are the burden of employers in the JKK program.

22. Total
    Filled with the total due contributions that are the burden of participants and employers in the JKK program.

23. Due Already Reconciled
    Filled with due contributions that have been received and reconciled.

24. Due Not Yet Reconciled
    Filled with due contributions that have been received and not yet reconciled.

25. Paid In Advance
    Filled with contributions received and paid in advance.

26. Unspecified Contributions (IBR) Last Year
    Filled with contributions that are the accumulation of the current year.

27. Total
    Filled with the total contributions received.

28. Target Contributions
    Filled with the target contributions.

29. RECAPITULATION OF BENEFITS FOR THE JKK PROGRAM
    This form contains all information regarding the recapitulation of benefits for the JKK program.
    Table 1 of 2
    Reporting Period Regional Office Code Regional Office Branch Office Code Branch Office Participant Segment (1) (2) (3) (4) (5) (6)
    Table 2 of 2
    Benefit Type Claim Status
    1 2 3 4 5 6 7 Total 1 2 3 4
    Number Value Number Value Number Value Number Value (7) (8) (9)

EXPLANATION:
This form contains all information regarding the recapitulation of benefits for the JKK program of BPJS Ketenagakerjaan:

1. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office Code
   Filled with the code of the BPJS Ketenagakerjaan regional office.

3. Regional Office
   Filled with the name of the BPJS Ketenagakerjaan regional office.

4. Branch Office Code
   Filled with the code of the BPJS Ketenagakerjaan branch office.

5. Branch Office
   Filled with the name of the BPJS Ketenagakerjaan branch office.

6. Participant Segment
   Filled with the participant segment of the JKK program.
   No. Participant Segment Code
   Wage Recipients

7. State Organizers 1.1

8. Private Employees/State-Owned Enterprises 1.2

9. Other Workers 1.3
   Non-Wage Recipients

10. Self-Employed Workers 2.1

11. Individual Workers 2.2

12. Other Workers 2.3
    Construction Services Workers 3

13. Benefit Type
    Filled with the type of JKK program benefits.
    No. Benefit Type Code

14. Partial Anatomical Disability 1

15. Partial Functional Disability 2

16. Permanent Total Disability 3

17. Still Under Treatment 4

18. Death 5

19. Recovery Cases 6

20. Scholarship 7

21. Total
    Filled with the number per benefit type of participants in the JKK program.

22. Claim Status
    Filled with the number and value of claims from participants in the JKK program according to claim status. No. Claim Status Code

23. Submitted 1

24. Determined 2

25. Rejected 3

26. Paid 4

FORMAT: 4
MONTHLY REPORT ON THE MANAGEMENT OF THE OLD AGE INSURANCE PROGRAM (JHT)

1. JHT PROGRAM MEMBERSHIP RECAPITULATION
   This form contains information regarding the recapitulation of membership per participant segment of the JHT program.
   Table 1 of 3
   Reporting Period
   Regional Office Code
   Office Name
   Branch Office Code
   Branch Office
   Wage Recipients
   Employers Participants
   (1) (2) (3) (4) (5) (6)
   Table 2 of 3
   Non-Wage Recipients
   Participant Segment
   Business Field/Counterparty Gender
   Containers/Types of Business
   Participants 1 2 3 4 5 6 7 8 9 Total Male Female Total (7) (8) (9) (10) (11) (12)
   Table 3 of 3
   Participants Participants Age Group Nationality Target In Out Active Inactive Total Participants 1 2 3 4 5 6 7 8 9 10 11 12 13 Total Indonesian Foreigner Total (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23)

EXPLANATION:
This form contains all information regarding the recapitulation of membership per participant segment of the JHT program:

1. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office Code
   Filled with the code of the BPJS Ketenagakerjaan regional office.

3. Regional Office
   Filled with the name of the BPJS Ketenagakerjaan regional office.

4. Branch Office Code
   Filled with the code of the BPJS Ketenagakerjaan branch office.

5. Branch Office
   Filled with the name of the branch office of the JHT program.

6. Wage Recipients
   Filled with the number of employers and participants in the wage recipient participant segment of the JHT program.

7. Non-Wage Recipients
   Filled with the number of business containers/types and participants in the non-wage recipient participant segment of the JHT program.

8. Participant Segment
   Filled with the participant segment of the JHT program.
   No. Participant Segment Code
   Wage Recipients

9. State Organizers 1.1

10. Private Employees/State-Owned Enterprises 1.2

11. Other Workers 1.3
    Non-Wage Recipients

12. Self-Employed Workers 2.1

13. Individual Workers 2.2

14. Other Workers 2.3
    Construction Services Workers 3

15. Business Field/Counterparty
    Filled with the counterparty of BPJS Ketenagakerjaan participants. No. Counterparty Code 1. Agriculture, Fisheries, Plantations, and Forestry

16. Mining 2

17. Basic and Chemical Industries 3

18. Various Industries 4

19. Consumer Goods Industries 5

20. Property and Real Estate 6

21. Energy, Telecommunications, and Transportation 7

22. Finance and Investment 8

23. Trade and Services 9

24. Total
    Filled with the total number of counterparty participants of BPJS Ketenagakerjaan.

25. Gender
    Filled with the gender of participants in the JHT program according to gender.

26. Total
    Filled with the total number of male and female participants in the JHT program.

27. In
    Filled with the number of participants who enter as participants in the JHT program.

28. Out
    Filled with the number of participants who leave as participants in the JHT program.

29. Active
    Filled with the number of active participants in the JHT program.

30. Inactive
    Filled with the number of inactive participants in the JHT program.

31. Total
    Filled with the number of active and inactive participants in the JHT program.

32. Age Group
    Filled with the age group of participants in the JHT program.
    No. Age Group Code

33. Under 20 years 1

34. Above 20 - 25 years 2

35. Above 25 - 30 years 3

36. Above 30 - 35 years 4

37. Above 35 - 40 years 5

38. Above 40 - 45 years 6

39. Above 45 - 50 years 7

40. Above 50 - 55 years 8

41. Above 55 - 60 years 9

42. Above 60 - 65 years 10

43. Above 65 - 70 years 11

44. Above 70 - 75 years 12

45. Above 75 years 13

46. Total
    Filled with the number of participants based on the age group of participants in the JHT program.

47. Indonesian Citizens
    Filled with participants in the JHT program who are Indonesian citizens.

48. Foreign Citizens
    Filled with participants in the JHT program who are foreign citizens.

49. Total
    Filled with the number of participants in the JHT program who are Indonesian and foreign citizens.

50. Target Participants
    Filled with the target participants for JHT.

51. RECAPITULATION OF WAGES AND CONTRIBUTIONS FOR THE JHT PROGRAM.
    This form contains all information regarding the recapitulation of wages and contributions for the JHT program.
    Table 1 of 2
    Table 2 of 2
    Contribution Burden Contributions Received
    Target Participants
    Employer Burden
    Total
    Due
    Already
    Reconciled
    Due
    Not Yet
    Reconciled
    Paid In
    Advance
    Unspecified Contributions (IBR)
    Last Year
    Total
    (9) (10) (11) (12) (13) (14) (15) (16) (17) Reporting Period Regional Office Code Regional Office Branch Office Code Branch Office Participant Segment Wage Group (TK) 1 2 3 4 5 Total (1) (2) (3) (4) (5) (6) (7) (8)

EXPLANATION:
This form contains all information regarding the recapitulation of wages and contributions for the JHT program:

1. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office Code
   Filled with the code of the BPJS Ketenagakerjaan regional office.

3. Regional Office
   Filled with the name of the BPJS Ketenagakerjaan regional office.

4. Branch Office Code
   Filled with the code of the BPJS Ketenagakerjaan branch office.

5. Branch Office
   Filled with the name of the branch office of the BPJS Ketenagakerjaan.

6. Participant Segment
   Filled with the participant segment of the JHT program.
   No. Participant Segment Code
   Wage Recipients 1

7. State Organizers 1.1

8. Private Employees/State-Owned Enterprises
   1.2

9. Other Workers 1.3
   Non-Wage Recipients 2

10. Self-Employed Workers 2.1

11. Individual Workers 2.2

12. Other Workers 2.3
    Construction Services Workers 3

13. Wage Group
    Filled with the wage group of participants in the JHT program.
    No. Wage Group Code

14. 0-2 million/month 1

15. 2- 5 million/month 2

16. 5-10 million/month 3

17. 10-50 million/month 4

18. 50 million/month 5

19. Total
    JHT.

20. Participants
    Filled with the contributions that are the burden of participants in the JHT program.

21. Employer Burden
    Filled with the contributions that are the burden of employers in the JHT program.

22. Total
    Filled with the total contributions that are the burden of participants and employers in the JHT program.

23. Due Already Reconciled
    Filled with due contributions for the JHT program that have been reconciled.

24. Due Not Yet Reconciled
    Filled with due contributions for the JHT program that have not been reconciled..

25. Paid In Advance
    Filled with contributions paid in advance for the JHT program.

26. Unspecified Contributions (IBR) Last Year
    Filled with contributions that are the accumulation of the current year.

27. Total
    Filled with the total due contributions and contributions paid in advance for the JHT program.

28. Target Contributions
    Filled with the target contributions for the JHT program.

29. RECAPITULATION OF FUNDS FOR THE JHT PROGRAM
    This form contains the recapitulation of funds for the JHT program of BPJS Ketenagakerjaan.
    Table 1 of 2
    Table 2 of 2
    Reporting Period Regional Office Code Regional Office Branch Office Code Branch Office Participant Segment (1) (2) (3) (4) (5) (6) Opening Balance Contributions Current Year Development Results Amalgamation/ Adjustment Claims Closing Balance (7) (8) (9) (10) (11) (12)

EXPLANATION:
This form contains all information regarding the recapitulation of funds for the JHT (Old Age Savings) program of BPJS Ketenagakerjaan.

1. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office Code
   Filled with the code of the BPJS Ketenagakerjaan regional office.

3. Regional Office
   Filled with the name of the BPJS Ketenagakerjaan regional office.

4. Branch Office Code
   Filled with the code of the BPJS Ketenagakerjaan branch office.

5. Branch Office
   Filled with the name of the BPJS Ketenagakerjaan branch office.

6. Participant Segment
   Filled with the participant segment of the JHT program.

No.	Participant Segment	Code
Wage Earners		1
1. State Organizers		1.1
2. Private Employees/State-Owned Enterprises		1.2
3. Other Workers		1.3
Non-Wage Earners		2
4. Self-Employed Workers		2.1
5. Individual Workers		2.2
6. Other Workers		2.3
Construction Service Workers		3

7. Opening Balance
   Filled with the opening balance of the JHT program.

8. Current Year Contributions
   Filled with the current year contributions of the JHT program.

9. Development Results
   Filled with the development results of the JHT program.

10. Amalgamation/Adjustment
    Filled with the value of amalgamation (merging of old-age security accounts of participants who move jobs)/adjustment of the JHT program.

11. Claims
    Filled with JHT program claims.

12. Closing Balance
    Filled with the closing balance of the JHT program.

13. RECAPITULATION OF JHT PROGRAM BENEFITS
    This form contains information regarding the recapitulation of benefits for the JHT program of BPJS Ketenagakerjaan.

Table 1 of 2

Reporting Period	Regional Office Code	Regional Office	Branch Office Code	Branch Office	Participant Segment
(1)	(2)	(3)	(4)	(5)	(6)

Table 2 of 2

Benefit Type	Claim Status
1	2	3	4	5	6	7	8	Total
1	2	3	4	7	8	9
Amount	Value	Amount	Value	Amount	Value	Amount	Value

EXPLANATION:
This form contains all information regarding the recapitulation of benefits for the JHT program of BPJS Ketenagakerjaan:

1. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office Code
   Filled with the code of the BPJS Ketenagakerjaan regional office.

3. Regional Office
   Filled with the name of the BPJS Ketenagakerjaan regional office.

4. Branch Office Code
   Filled with the code of the BPJS Ketenagakerjaan branch office.

5. Branch Office
   Filled with the name of the BPJS Ketenagakerjaan branch office.

6. Participant Segment
   Filled with the participant segment of the JHT program.

No.	Participant Segment	Code
Wage Earners
1. State Organizers		1.1
2. Private Employees/State-Owned Enterprises		1.2
3. Other Workers		1.3
Non-Wage Earners
4. Self-Employed Workers		2.1
5. Individual Workers		2.2
6. Other Workers		2.3
Construction Service Workers		3

7. Benefit Type
   Benefit types are adjusted according to the provisions of Government Regulation No. 45 of 2015.

No.	Benefit Type
1. Retirement Age (56 Years)
2. Death
3. Permanent Total Disability
4. Termination of Employment Relationship
5. Resignation
6. Leaving the Territory of Indonesia
7. Partial Claim 10%
8. Partial Claim 30%

8. Total
   Filled with the total number of participants receiving each type of JHT program benefit.

9. Claim Status
   Filled with the status of JHT claims; claims are an accumulation of the current year.

FORMAT: 5
MONTHLY REPORT ON THE MANAGEMENT OF PENSION INSURANCE (JP) PROGRAM

1. PARTICIPATION RECAPITULATION
   This form concerns the recapitulation of participation in the JP program.

Table 1 of 3

Reporting Period	Regional Office Code	Regional Office Name	Branch Office Code	Branch Office Name	Wage Earners Employer	Participants
(1)	(2)	(3)	(4)	(5)	(6)

Table 2 of 3

Participant Segment	Business Field/Counterparty	Gender
1	2	3	4	5	6	7	8	9	Total	Male	Female	Total
(7)	(8)	(9)	(10)	(11)

Table 3 of 3

Participants In	Participants Out	Active Participants	Inactive Participants	Total	Age Group	Citizenship
1	2	3	4	5	6	7	8	9	10	11	12	13	Total	WNI	WNA	Total
(12)	(13)	(14)	(15)	(16)	(17)	(18)	(19)	(20)	(21)

EXPLANATION:
This form concerns the recapitulation of participation per participant segment of the JP program:

1. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office Code
   Filled with the code of the BPJS Ketenagakerjaan regional office.

3. Regional Office
   Filled with the name of the BPJS Ketenagakerjaan regional office.

4. Branch Office Code
   Filled with the code of the BPJS Ketenagakerjaan branch office.

5. Branch Office
   Filled with the name of the branch office of the JP program.

6. Wage Earners
   Filled with the number of employers and participants in the wage earner participant segment of the JP program.

7. Participant Segment
   Filled with the participant segment of the JP program.

No.	Participant Segment	Code
Wage Earners
1. State Organizers		1.1
2. Private Employees/State-Owned Enterprises		1.2
3. Other Workers		1.3
Non-Wage Earners
4. Self-Employed Workers		2.1
5. Individual Workers		2.2
6. Other Workers		2.3
Construction Service Workers		3

8. Business Field/Counterparty
   Filled with the business field/counterparty of BPJS Ketenagakerjaan participants.

No.	Counterparty	Code
1. Agriculture, Fisheries, Plantations, and Forestry		1
2. Mining		2
3. Basic and Chemical Industry		3
4. Various Industries		4
5. Consumer Goods Industry		5
6. Property and Real Estate		6
7. Energy, Telecommunications, and Transportation		7
8. Finance and Investment		8
9. Trade and Services		9

9. Total
   Filled with the total number of BPJS Ketenagakerjaan participant counterparties.

10. Gender
    Filled with the gender of JP program participants according to their gender.

11. Total
    Filled with the total number of male and female JP program participants.

12. In
    Filled with the number of participants who entered as JP program participants.

13. Out
    Filled with the number of participants who left as JP program participants.

14. Active
    Filled with the number of active participants in the JP program.

15. Inactive
    Filled with the number of inactive participants in the JP program.

16. Total
    Filled with the number of active and inactive participants in the JP program.

17. Age Group
    Filled with the age group of JP program participants.

No.	Age Group	Code
1. Under 20 years		1
2. Over 20 - 25 years		2
3. Over 25 - 30 years		3
4. Over 30 - 35 years		4
5. Over 35 - 40 years		5
6. Over 40 - 45 years		6
7. Over 45 - 50 years		7
8. Over 50 - 55 years		8
9. Over 55 - 60 years		9
10. Over 60 - 65 years		10
11. Over 65 - 70 years		11
12. Over 70 - 75 years		12
13. Over 75 years		13

18. Total
    Filled with the number of participants based on the age group of JP program participants.

19. Indonesian Citizens
    Filled with JP program participants who are Indonesian citizens.

20. Foreign Citizens
    Filled with JP program participants who are foreign citizens.

21. Total
    Filled with the number of JP program participants who are Indonesian and foreign citizens.

22. WAGE AND CONTRIBUTION RECAPITULATION OF JP PROGRAM
    This form concerns the recapitulation of wages and contributions of the JP program.

Table 1 of 3

Reporting Period	Regional Office Code	Regional Office	Branch Office Code	Branch Office	Participant Segment
(1)	(2)	(3)	(4)	(5)	(6)

Table 2 of 3

Wage Group (TK)	Contribution Burden
1	2	3	4	5	Total	Participants
Participant Burden	Employer Burden	Total
(7)	(8)	(9)	(10)	(11)

Table 3 of 3

Received Contributions
Due Date Already Reconciled	Due Date Not Yet Reconciled	Paid in Advance	IBR Last Year	Total
(12)	(13)	(14)	(15)	(16)	(17)
Contribution Target

EXPLANATION:
This form contains all information regarding the recapitulation of wages and contributions of the JP program.

1. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office Code
   Filled with the code of the BPJS Ketenagakerjaan regional office.

3. Regional Office
   Filled with the name of the BPJS Ketenagakerjaan regional office.

4. Branch Office Code
   Filled with the code of the BPJS Ketenagakerjaan branch office.

5. Branch Office
   Filled with the name of the branch office of BPJS Social Security.

6. Participant Segment
   Filled with the participant segment of the JP program.

No.	Participant Segment	Code
Wage Earners
1. State Organizers		1.1
2. Private Employees/State-Owned Enterprises		1.2
3. Other Workers		1.3
Non-Wage Earners
4. Self-Employed Workers		2.1
5. Individual Workers		2.2
6. Other Workers		2.3
Construction Service Workers		3

7. Wage Group
   Filled with the wage group of JP program participants.

No.	Wage Group	Code
1. 0-2 million/month		1
2. >2-5 million/month		2
3. >5-10 million/month		3
4. >10-50 million/month		4
5. >50 million/month		5

8. Total
   Filled with the total number of JP program participants.

9. Participants
   Filled with the contributions that are the burden of JP program participants.

10. Employers
    Filled with the contributions that are the burden of JP program employers.

11. Total
    Filled with the total contributions that are the burden of JP program participants and employers.

12. Due Date Already Reconciled
    Filled with due date JP program contributions that have been reconciled.

13. Due Date Not Yet Reconciled
    Filled with due date JP program contributions that have not been reconciled.

14. Paid in Advance
    Filled with JP program contributions paid in advance.

15. IBR Last Year
    Filled with IBR (Unspecified Contributions) of the previous year of the JP program.

16. Total
    Filled with the total amount of due date and paid-in-advance JP program contributions.

17. Contribution Target
    Filled with the JP program contribution target.

18. FUND RECAPITULATION OF JP PROGRAM
    This form concerns the recapitulation of funds for the JP program of BPJS Ketenagakerjaan.

Table 1 of 2

Reporting Period	Regional Office Code	Regional Office	Branch Office Code	Branch Office	Participant Segment
(1)	(2)	(3)	(4)	(5)	(6)

Table 2 of 2

Opening Balance	Current Year Contributions	Development Results	Amalgamation/Adjustment	Claims	Closing Balance
(7)	(8)	(9)	(10)	(11)	(12)

EXPLANATION:
This form contains all information regarding the recapitulation of funds for the JP program of BPJS Ketenagakerjaan.

1. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office Code
   Filled with the code of the BPJS Ketenagakerjaan regional office.

3. Regional Office
   Filled with the name of the BPJS Ketenagakerjaan regional office.

4. Branch Office Code
   Filled with the code of the BPJS Ketenagakerjaan branch office.

5. Branch Office
   Filled with the name of the branch office of BPJS Ketenagakerjaan.

6. Participant Segment
   Filled with the participant segment of the JP program.

No.	Participant Segment	Code
Wage Earners
1. State Organizers		1.1
2. Private Employees/State-Owned Enterprises		1.2
3. Other Workers		1.3
Non-Wage Earners
4. Self-Employed Workers		2.1
5. Individual Workers		2.2
6. Other Workers		2.3
Construction Service Workers		3

7. Opening Balance
   Filled with the opening balance of the JP program.

8. Current Year Contributions
   Filled with the current year contributions of the JP program.

9. Development Results
   Filled with the development results of the JP program.

10. Amalgamation/Adjustment
    Filled with the value of amalgamation (merging of pension security accounts of participants who move jobs)/adjustment of the JP program.

11. Claims
    Filled with JP program claims.

12. Closing Balance
    Filled with the closing balance of the JP program.

13. CLAIM RECAPITULATION OF JP PROGRAM
    This form concerns the recapitulation of claims for the JP program of BPJS Ketenagakerjaan:

Table 1 of 2

Reporting Period	Regional Office Code	Regional Office	Branch Office Code	Branch Office	Participant Segment
(1)	(2)	(3)	(4)	(5)	(6)

Table 2 of 2

Claim Type	Claim Status
Periodic	Lump Sum	Total
1	2	3	4
1	2	3	4	5	Total
Amount	Value	Amount	Value	Amount	Value	Amount	Value
(7)	(8)	(9)	(10)	(11)

EXPLANATION:
This form contains all information regarding the recapitulation of claims for the JP program of BPJS Ketenagakerjaan.

1. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office Code
   Filled with the code of the BPJS Ketenagakerjaan regional office.

3. Regional Office
   Filled with the name of the BPJS Ketenagakerjaan regional office.

4. Branch Office Code
   Filled with the code of the BPJS Ketenagakerjaan branch office.

5. Branch Office
   Filled with the name of the branch office of BPJS Ketenagakerjaan.

6. Participant Segment
   Filled with the participant segment of the JP program.

No.	Participant Segment	Code
Wage Earners
1. State Organizers		1.1
2. Private Employees/State-Owned Enterprises		1.2
3. Other Workers		1.3
Non-Wage Earners
4. Self-Employed Workers		2.1
5. Individual Workers		2.2
6. Other Workers		2.3
Construction Service Workers		3

7. Claim Type
   Filled with the type of JP program benefits.

No.	Claim Type	Code
A Periodic
1. Old Age Pension		1
2. Disability Pension		2
3. Widow/Orphan Pension		3
4. Child Pension		4
5. Parent Pension		5
B Lump Sum

8. Periodic
   Filled with the number of claims submitted periodically as JP benefit payments.

9. Lump Sum
   Filled with the number of claims submitted at once as JP benefit payments.

10. Total
    Filled with the total claims submitted at once and partially as JP benefit payments.

11. Claim Status
    Filled with the status of pension security claims, which is an accumulation of the current year.

FORMAT: 6
MONTHLY REPORT ON THE MANAGEMENT OF DEATH INSURANCE (JKM) PROGRAM

1. PARTICIPATION RECAPITULATION
   This form concerns the recapitulation of participation in the JKM program.

Table 1 of 3

Reporting Period	Regional Office Code	Regional Office Name	Branch Office Code	Branch Office Name	Wage Earners Employer	Participants
(1)	(2)	(3)	(4)	(5)	(6)

Table 2 of 3

Non-Wage Earners	Construction Service Workers	Participant Segment	Business Field/Counterparty	Gender
Workplace/Business Type	Participants	Projects	Participants	1	2	3	4	5	6	7	8	9	Total	Male	Female	Total
(7)	(8)	(9)	(10)	(11)	(12)	(13)

Table 3 of 3

Participants In	Participants Out	Active Participants	Inactive Participants	Total	Target Participants	Age Group	Citizenship
1	2	3	4	5	6	7	8	9	10	11	12	13	Total	WNI	WNA	Total
(14)	(15)	(16)	(17)	(18)	(19)	(20)	(21)	(22)	(23)	(24)

EXPLANATION:
This form contains all information regarding the recapitulation of participation per participant segment of the JKM program.

1. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office Code
   Filled with the code of the JKM program regional office.

3. Regional Office Name
   Filled with the name of the JKM program regional office.

4. Branch Office Code
   Filled with the code of the JKM program branch office.

5. Branch Office Name
   Filled with the name of the JKM program branch office.

6. Wage Earners
   Filled with the number of employers and active participants in the wage earner participant segment of the JKM program.

7. Non-Wage Earners
   Filled with the number of workplaces/business types and active participants in the non-wage earner participant segment of the JKM program.

8. Construction Service Workers
   Filled with the number of projects and active participants in the construction service worker participant segment of the JKM program.

No.	Participant Segment	Code
Wage Earners		1
1. State Organizers		1.1
2. Private Employees/State-Owned Enterprises		1.2
3. Other Workers		1.3
Non-Wage Earners		2
4. Self-Employed Workers		2.1
5. Individual Workers		2.2
6. Other Workers		2.3
Construction Service Workers		3

9. Participant Segment
   Filled with the participant segment of the JKM program.

No.	Participant Segment	Code
Wage Earners		1
1. State Organizers		1.1
2. Private Employees/State-Owned Enterprises		1.2
3. Other Workers		1.3
Non-Wage Earners		2
4. Self-Employed Workers		2.1
5. Individual Workers		2.2
6. Other Workers		2.2
Construction Service Workers		3

10. Business Field/Counterparty
    Filled with the counterparty of BPJS Ketenagakerjaan participants.

No.	Counterparty	Code
1. Agriculture, Fisheries, Plantations, and Forestry		1
2. Mining		2
3. Basic and Chemical Industry		3
4. Various Industries		4
5. Consumer Goods Industry		5
6. Property and Real Estate		6
7. Energy, Telecommunications, and Transportation		7
8. Finance and Investment		8
9. Trade and Services		9

11. Total
    Filled with the total number of BPJS Ketenagakerjaan participant counterparties.

12. Gender
    Filled with the gender of JKM program participants.

13. Total
    Filled with the total number of JKM program participants based on JKM.

14. In
    Filled with the number of participants who entered as JKM program participants.

15. Out
    Filled with the number of participants who left as JKM program participants.

16. Active
    Filled with the number of active participants in the JKM program.

17. Inactive
    Filled with the number of inactive participants in the JKM program.

18. Total
    Filled with the total number of active and inactive JKM program participants.

19. Age Group
    Filled with the age group of JKM program participants.

No.	Age Group	Code
1. Under 20 years		1
2. Over 20 - 25 years		2
3. Over 25 - 30 years		3
4. Over 30 - 35 years		4
5. Over 35 - 40 years		5
6. Over 40 - 45 years		6
7. Over 45 - 50 years		7
8. Over 50 - 55 years		8
9. Over 55 - 60 years		9
10. Over 60 - 65 years		10
11. Over 65 - 70 years		11
12. Over 70 - 75 years		12
13. Over 75 years		13

20. Total
    Filled with the total number of JKM program participants based on age group.

21. Indonesian Citizens
    Filled with JKM program participants who are Indonesian citizens.

22. Foreign Citizens
    Filled with JKM program participants who are foreign citizens.

23. Total
    Filled with the total number of JKM program participants based on citizenship.

24. Target Participants
    Filled with the target number of JKM program participants.

25. WAGE AND CONTRIBUTION RECAPITULATION OF JKM PROGRAM
    This form contains all information regarding the recapitulation of wages and contributions of the JKM program of BPJS Ketenagakerjaan.

Table 1 of 3

Reporting Period	Regional Office Code	Regional Office	Branch Office Code	Branch Office	Participant Segment
(1)	(2)	(3)	(4)	(5)	(6)

Table 2 of 3

Wage Group	Contribution Burden
1	2	3	4	5	Total	Participants
Participant Burden	Employer Burden	Total
(7)	(8)	(9)	(10)	(11)

Table 3 of 3

Received Contributions
Due Date Already Reconciled	Due Date Not Yet Reconciled	Paid in Advance	Unspecified Contributions (IBR) Last Year	Total
(12)	(13)	(14)	(15)	(16)	(17)
Contribution Target

EXPLANATION:
This form contains all information regarding the recapitulation of wages and contributions of the JKM program of BPJS Ketenagakerjaan.

1. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office Code
   Filled with the code of the BPJS Ketenagakerjaan regional office.

3. Regional Office
   Filled with the name of the BPJS Ketenagakerjaan regional office.

4. Branch Office Code
   Filled with the code of the BPJS Ketenagakerjaan branch office.

5. Branch Office
   Filled with the name of the branch office of BPJS Ketenagakerjaan.

6. Participant Segment
   Filled with the participant segment of the JKM program.

No.	Participant Segment	Code
Wage Earners		1
1. State Organizers		1.1
2. Private Employees/State-Owned Enterprises		1.2
3. Other Workers		1.3
Non-Wage Earners		2
4. Self-Employed Workers		2.1
5. Individual Workers		2.2
6. Other Workers		2.3
Construction Service Workers		3

7. Wage Group
   Filled with the wage group of JKM program participants.

No.	Wage Group	Code
1. 0-2 million/month		1
2. >2-5 million/month		2
3. >5-10 million/month		3
4. >10-50 million/month		4
5. >50 million/month		5

8. Total
   Filled with the total number of JKM program participants.

9. Participants
   Filled with the due date contributions that are the burden of JKM program participants.

10. Employers
    Filled with the due date contributions that are the burden of JKM program employers.

11. Total
    Filled with the total due date contributions that are the burden of JKM program participants and employers.

12. Due Date Already Reconciled.
    Filled with due date contributions that have been received and reconciled.

13. Due Date Not Yet Reconciled.
    Filled with due date contributions that have been received but not yet reconciled.

14. Paid in Advance
    Filled with contributions that have been received and paid in advance.

15. Unspecified Contributions (IBR) Last Year
    Filled with received contributions that are Unspecified Contributions (IBR) from the previous year.

16. Total
    Filled with the total received contributions.

17. Contribution Target
    Filled with the current year contribution target.

18. CLAIM RECAPITULATION OF JKM PROGRAM
    This form contains all information regarding the recapitulation of funds for the JKM program of BPJS Ketenagakerjaan.

Table 1 of 2

Reporting Period	Regional Office Code	Regional Office	Branch Office Code	Branch Office	Participant Segment
(1)	(2)	(3)	(4)	(5)	(6)

Table 2 of 2

Claim Type	Claim Status
1	2	Total
1	2	3	4
Amount	Value	Amount	Value	Amount	Value	Amount	Value
(7)	(8)	(9)

EXPLANATION:
This form contains all information regarding the recapitulation of funds for the JKM program of BPJS Ketenagakerjaan.

1. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office Code
   Filled with the code of the BPJS Ketenagakerjaan regional office.

3. Regional Office
   Filled with the name of the BPJS Ketenagakerjaan regional office.

4. Branch Office Code
   Filled with the code of the BPJS Ketenagakerjaan branch office.

5. Branch Office
   Filled with the name of the branch office of BPJS Ketenagakerjaan.

6. Participant Segment
   Filled with the participant segment of the JKM program.

No.	Participant Segment	Code
Wage Earners		1
1. State Organizers		1.1
2. Private Employees/State-Owned Enterprises		1.2
3. Other Workers		1.3
Non-Wage Earners		2
4. Self-Employed Workers		2.1
5. Individual Workers		2.2
6. Other Workers		2.3
Construction Service Workers		3

7. Claim Type
   Filled with the type of JKM program claims:

No.	Claim Type	Code
1. Death during active period		1
2. Scholarship		2

8. Total
   Filled with the number per claim type of JKM program participants.

9. Claim Status
   Filled with the number and value of JKM worker participant claims according to claim status.

No.	Claim Status	Code
1. Submitted		1
2. Determined		2
3. Rejected		3
4. Paid		4

FORMAT: 7
MONTHLY REPORT ON THE MANAGEMENT OF UNEMPLOYMENT INSURANCE (JKP) PROGRAM

1. PARTICIPATION RECAPITULATION
   This form concerns the recapitulation of participation in the JKP program.

Table 1 of 3

Reporting Period	Regional Office Code	Regional Office Name	Branch Office Code	Branch Office Name	Wage Earners Employer	Participants
(1)	(2)	(3)	(4)	(5)	(6)

Table 2 of 3

Non-Wage Earners	Construction Service Workers	Participant Segment	Business Field/Counterparty	Gender
Workplace/Business Type	Participants	Projects	Participants	1	2	3	4	5	6	7	8	9	Total	Male	Female	Total
(7)	(8)	(9)	(10)	(11)	(12)	(13)

Table 3 of 3

Participants In	Participants Out	Active Participants	Inactive Participants	Total	Target Participants	Age Group	Citizenship
1	2	3	4	5	6	7	8	9	10	11	12	13	Total	WNI	WNA	Total
(14)	(15)	(16)	(17)	(18)	(19)	(20)	(21)	(22)	(23)	(24)

EXPLANATION:
This form contains all information regarding the recapitulation of participation per participant segment of the JKP program.

1. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office Code
   Filled with the code of the JKP program regional office.

3. Regional Office Name
   Filled with the name of the JKP program regional office.

4. Branch Office Code
   Filled with the code of the JKP program branch office.

5. Branch Office Name
   Filled with the name of the JKP branch office.

6. Wage Earners
   Filled with the number of employers and active participants in the wage earner participant segment of the JKP program.

7. Non-Wage Earners
   Filled with the number of workplaces/business types and active participants in the non-wage earner participant segment of the JKP program.

8. Construction Service Workers
   Filled with the number of projects and active participants in the construction service worker participant segment of the JKP program.

No.	Participant Segment	Code
Wage Earners
1. State Organizers		1.1
2. Private Employees/State-Owned Enterprises		1.2
3. Other Workers		1.3
Non-Wage Earners
4. Self-Employed Workers		2.1
5. Individual Workers		2.2
6. Other Workers		2.3
Construction Service Workers		3

9. Participant Segment
   Filled with the participant segment of the JKP program.

No.	Participant Segment	Code
Wage Earners
1. State Organizers		1.1
2. Private Employees/State-Owned Enterprises		1.2
3. Other Workers		1.3
Non-Wage Earners
4. Self-Employed Workers		2.1
5. Individual Workers		2.2
6. Other Workers		2.2
Construction Service Workers		3

10. Business Field/Counterparty
    Filled with the counterparty of BPJS Ketenagakerjaan participants.

No.	Business Field/Counterparty	Code
1. Agriculture, Fisheries, Plantations, and Forestry		1
2. Mining		2
3. Basic and Chemical Industry		3
4. Various Industries		4
5. Consumer Goods Industry		5
6. Property and Real Estate		6
7. Energy, Telecommunications, and Transportation		7
8. Finance and Investment		8
9. Trade and Services		9

11. Total
    Filled with the total number of BPJS Ketenagakerjaan participant counterparties.

12. Gender
    Filled with the gender of JKP program participants.

13. Total
    Filled with the total number of JKP program participants based on gender.

14. In
    Filled with the number of participants who entered as JKP program participants.

15. Out
    Filled with the number of participants who left as JKP program participants.

16. Active
    Filled with the number of active participants in the JKP program.

17. Inactive
    Filled with the number of inactive participants in the JKP program.

18. Total
    Filled with the total number of JKP program participants who are active and inactive.

19. Age Group
    Filled with the age group of JKP program participants.
    No. Age Group Code

20. Under 20 years old 1

21. Above 20 - 25 years old 2

22. Above 25 - 30 years old 3

23. Above 30 - 35 years old 4

24. Above 35 - 40 years old 5

25. Above 40 - 45 years old 6

26. Above 45 - 50 years old 7

27. Above 50 - 55 years old 8

28. Above 55 - 60 years old 9

29. Above 60 - 65 years old 10

30. Above 65 - 70 years old 11

31. Above 70 - 75 years old 12

32. Above 75 years old 13

33. Total
    Filled with the total number of JKP program participants based on age group.

34. Indonesian Citizens
    Filled with JKP program participants who hold Indonesian citizenship.

35. Foreign Citizens
    Filled with JKP program participants who hold foreign citizenship.

36. Total
    Filled with the total number of JKP program participants based on citizenship.

37. Participant Target
    Filled with the target number of JKP program participants.

38. RECAPITULATION OF WAGES AND CONTRIBUTIONS FOR THE JKP PROGRAM
    This form contains all information regarding the recapitulation of wages and contributions for the JKP program.
    Table 1 of 2
    Reporting Period
    Office Code
    Region
    Regional Office
    Branch Office Code
    Branch Office
    Participant Segment
    Wage Group
    1 2 3 4 5 Total
    (1) (2) (3) (4) (5) (6) (7) (8)
    Table 2 of 2
    Contribution Levies
    Contribution Received
    Contribution Recomp
    JKK Contribution
    Recomp
    JKM Contribution
    Government Total
    Recomp
    JKK Contribution
    Recomp
    JKM Contribution
    Government Total
    (9) (10) (11) (12) (13) (14) (15) (16) (17)

EXPLANATION:
This form contains all information regarding the recapitulation of wages and contributions for the JKP program.

1. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.

2. Regional Office Code
   Filled with the code of the BPJS Ketenagakerjaan regional office.

3. Regional Office
   Filled with the name of the BPJS Ketenagakerjaan regional office.

4. Branch Office Code
   Filled with the code of the BPJS Ketenagakerjaan branch office.

5. Branch Office
   Filled with the name of the BPJS Ketenagakerjaan branch office.

6. Participant Segment
   Filled with the segment of the JKP program participants.
   No. Participant Segment Code
   Wage-Earning Workers

7. State Organizers 1.1

8. Private Employees/State-Owned Enterprises 1.2

9. Other Workers 1.3
   Non-Wage-Earning Workers

10. Self-Employed Workers 2.1

11. Individual Workers 2.2

12. Other Workers 2.3
    Construction Service Workers 3

13. Wage Group
    Filled with the wage group of JKP program participants.
    No. Wage Group Code

14. 0-2 million/month 1

15. 2-5 million/month 2

16. 5-10 million/month 3

17. 10-50 million/month 4

18. 50 million/month 5

19. Total
    JKP.

20. JKK Contribution Recomp
    Filled with the contribution levy based on the proportion of JKK contribution recomp.

21. JKM Contribution Recomp
    Filled with the contribution levy based on the proportion of JKM contribution recomp.

22. Government
    Filled with the contribution levy based on the government's proportion.

23. Total
    Filled with the total contribution levy for the JKP program.

24. JKK Contribution Recomp
    Filled with the contribution received based on the proportion of JKK contribution recomp.

25. JKM Contribution Recomp
    Filled with the contribution received based on the proportion of JKM contribution recomp.

26. Government
    Filled with the contribution received based on the Government's proportion.

27. Total
    Filled with the total contribution received.

28. Contribution Target
    Filled with the current year's contribution target.

29. RECAPITULATION OF BENEFITS FOR THE JKP PROGRAM
    This form concerns the recapitulation of benefits for the BPJS Ketenagakerjaan JKP program.
    Table 1 of 2
    Reporting Period Regional Office Code Regional Office Branch Office Code Branch Office Participant Segment (1) (2) (3) (4) (5) (6)
    Table 2 of 2
    Claim Type Claim Status
    1 2 3 Total 1 2 3 4
    Amount Value Amount Value Amount Value Amount Value (7) (8) (9)

EXPLANATION:
This form contains all information regarding the recapitulation of claims for the BPJS Ketenagakerjaan JKP program.

1. Reporting Period
   Filled with the date, month, and year of the end of the reporting period submitted.
2. Regional Office Code
   Filled with the code of the BPJS Ketenagakerjaan regional office.
3. Regional Office
   Filled with the name of the BPJS Ketenagakerjaan regional office.
4. Branch Office Code
   Filled with the code of the BPJS Ketenagakerjaan branch office.
5. Branch Office
   Filled with the name of the BPJS Ketenagakerjaan branch office.
6. Participant Segment
   Filled with the segment of the JKP program participants.
   No. Participant Segment Code
   Wage-Earning Workers 1
7. State Organizers 1.1
8. Private Employees/State-Owned Enterprises 1.2
9. Other Workers 1.3
   Non-Wage-Earning Workers 2
10. Self-Employed Workers 2.1
11. Individual Workers 2.2
12. Other Workers 2.3
    Construction Service Workers 3
13. Claim Type
    Filled with the type of JKP program claim.
    No. Claim Type Code
14. Cash 1
15. Labor Market Information Access 2
16. Job Training 3
17. Total
    Filled with the number of JKP participant claims.

This copy is consistent with the original
Legal Director 1
Legal Department signed
Mufli Asmawidjaja
9. Claim Status
Filled with the number and value of JKP program participant claims according to claim status:
No. Claim Status Code

1. Submitted 1
2. Determined 2
3. Rejected 3
4. Paid 4
   Established in Jakarta on December 21, 2022 CHIEF EXECUTIVE OF THE SUPERVISOR OF INSURANCE, PENSION FUNDS, FINANCING INSTITUTIONS, AND OTHER FINANCIAL SERVICE INSTITUTIONS FINANCIAL SERVICES AUTHORITY REPUBLIC OF INDONESIA, signed OGI PRASTOMIYONO

APPENDIX III
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY REPUBLIC OF INDONESIA NUMBER 26 /SEOJK.05/2022 CONCERNING MONTHLY REPORT ON THE MANAGEMENT OF THE EMPLOYMENT SOCIAL SECURITY PROGRAM FOR THE EMPLOYMENT SOCIAL SECURITY IMPLEMENTING AGENCY

This copy is consistent with the original
Legal Director 1
Legal Department signed
Mufli Asmawidjaja
DIRECTOR'S STATEMENT LETTER EXAMPLE
DIRECTOR'S STATEMENT
Regarding
Responsibility for the Monthly Report on the Management of the Employment Social Security Program For the Employment Social Security Implementing Agency Per... BPJS Ketenagakerjaan We, the undersigned:

1. Name :
2. Position:
3. Address :
   hereby declare that:
4. We are responsible for the preparation and presentation of the Monthly Report on the Management of the Employment Social Security Program for the Employment Social Security Implementing Agency.
5. All information in the Monthly Report on the Management of the Employment Social Security Program has been presented completely and in accordance with the actual conditions and has complied with applicable regulations.
6. The Monthly Report on the Management of the Employment Social Security Program for the Employment Social Security Implementing Agency does not contain incorrect information or facts, and does not omit material information or facts.
   Thus, this statement is made truthfully.
   Jakarta, ……..
   Official's Name
   Position
   Established in Jakarta on December 21, 2022 CHIEF EXECUTIVE OF THE SUPERVISOR OF INSURANCE, PENSION FUNDS, FINANCING INSTITUTIONS, AND OTHER FINANCIAL SERVICE INSTITUTIONS FINANCIAL SERVICES AUTHORITY REPUBLIC OF INDONESIA, signed OGI PRASTOMIYONO