CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY

NUMBER: 15/SEOJK.05/2013

CONCERNING

MONTHLY REPORTS OF PT ASABRI (PERSERO)

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

I. GENERAL PROVISIONS

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

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

II. FORM AND STRUCTURE OF MONTHLY REPORTS

The form and structure of the monthly report for PT Asabri (Persero) are as stated in the Appendix which is an inseparable part of this OJK Circular Letter.

III. TIME FOR SUBMISSION OF MONTHLY REPORTS

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

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

IV. PROCEDURES FOR SUBMISSION

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

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

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

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

5. PT Asabri (Persero) is deemed to have submitted the monthly report with the following provisions:
   a. for submission online via email, proven by an acknowledgment email from the OJK, b. for submission offline, proven by:

   1. an acknowledgment letter from the OJK, if the report is handed over directly to the OJK office; or
   2. a shipping receipt from the post office or courier/courier service company, if the report is sent via the post office or courier/courier service company.

6. In the event of changes to the OJK electronic mail address (email) as referred to in item 2 and/or changes to the OJK office address as referred to in item 3, the OJK will convey the address change via letter or announcement.

V. SANCTION PROVISIONS

1. The OJK imposes administrative sanctions in the form of a first written warning as regulated in Article 6 paragraph (3) of OJK Regulation Number 3/POJK.05/2013 concerning Monthly Reports of Non-Bank Financial Service Institutions, with a deadline for fulfilling the obligation to submit the Monthly Report of maximum 30 (thirty) days since the establishment of the administrative sanction in the form of a first written warning.

2. If within the time limit as referred to in item 1 the obligation to submit the Monthly Report is not fulfilled, the OJK imposes administrative sanctions in the form of a second written warning as regulated in Article 6 paragraph (4) of OJK Regulation Number 3/POJK.05/2013 concerning Monthly Reports of Non-Bank Financial Service Institutions, with a deadline for fulfilling the obligation to submit the Monthly Report of maximum 30 (thirty) days since the establishment of the administrative sanction in the form of a second written warning.

3. If within the time limit as referred to in item 2 the obligation to submit the Monthly Report is not fulfilled, the OJK imposes administrative sanctions in the form of a third written warning as regulated in Article 6 paragraph (4) of OJK Regulation Number 3/POJK.05/2013 concerning Monthly Reports of Non-Bank Financial Service Institutions, with a deadline for fulfilling the obligation to submit the Monthly Report of maximum 30 (thirty) days since the establishment of the administrative sanction in the form of a third written warning.

VI. TRANSITIONAL PROVISIONS

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

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

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

VII. CLOSING

This Circular Letter of the Financial Services Authority takes effect on the date of determination. To ensure everyone knows about it, it orders the publication of this Circular Letter of the Financial Services Authority by placing it in the State Gazette of the Republic of Indonesia.

Determined in Jakarta on 25 November 2013 EXECUTIVE HEAD OF SUPERVISOR FOR NON-BANK FINANCIAL INSTITUTIONS FINANCIAL SERVICES AUTHORITY, Signed, FIRDAUS DJAELANI

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

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APPENDIX
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER: 15/SEOJK.05/2013 CONCERNING MONTHLY REPORTS OF PT ASABRI

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

MONTHLY REPORT
PT ASABRI (PERSERO)
Period ... / Month ... Year ...
(Company Address)

(in millions of Rupiah)

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

Month … Year …
PT ASABRI (PERSERO)
FINANCIAL POSITION REPORT
Non-Consolidated
As of …

(in millions of Rupiah)

Description	Month …	Year …
REVENUE
Premium Revenue
Reinsurance Premiums	-
Decrease (Increase) in CAPYBMP	-
Net Premium Revenue	-
Investment Results	-
Fees from DPLK/Other Management Services	-
Other Revenue	-
TOTAL REVENUE	-
EXPENSES
Insurance Expenses
a. Claims and Benefits
(1) Claims and Benefits Paid	-
(2) Reinsurance Claims	-
(3) Increase (Decrease) in Premium Reserves	-
(4) Increase (Decrease) in Claim Reserves	-
Total Claims and Benefits Expenses	-
b. Acquisition Costs
(1) Commission Expense - First Year	-
(2) Commission Expense - Subsequent Years	-
(3) Commission Expense - Overriding	-
(4) Other Expenses	-
Total Acquisition Costs	-
Total Insurance Expenses	-
Business Expenses:
a. Marketing Expenses	-
b. Other General and Administrative Expenses:
- Employee and Executive Expenses	-
- Education and Training Expenses	-
- Others	-
Other (Income) Expenses	-
Total Business Expenses	-
TOTAL EXPENSES	-
PROFIT (LOSS) BEFORE TAX	-
Income Tax	-
PROFIT AFTER TAX	-
Other Comprehensive Income	-
TOTAL COMPREHENSIVE PROFIT (LOSS)	-

PT ASABRI (PERSERO)
COMPREHENSIVE INCOME STATEMENT
As of …

(in millions of Rupiah)

Description	Month …	Year …
BEGINNING BALANCE OF CASH AND BANKS
CASH FLOWS FROM OPERATING ACTIVITIES
Cash Inflows
a. Premiums
b. Coinsurance Claims
c. Reinsurance Claims
d. Commissions
e. Receivables
f. Others
Total Cash Inflows	-
Cash Outflows
a. Reinsurance Premiums
b. Claims
c. Commissions
d. Expenses
e. Others
Total Cash Outflows	-
NET CASH FLOWS FROM OPERATING ACTIVITIES	-
CASH FLOWS FROM INVESTING ACTIVITIES
Cash Inflows
a. Receipt of Investment Returns
b. Liquidation of Investments
c. Sale of Fixed Assets
d. Others
Total Cash Inflows	-
Cash Outflows
a. Investment Placements
b. Purchase of Fixed Assets
c. Others
Total Cash Outflows	-
NET CASH FLOWS FROM INVESTING ACTIVITIES	-
CASH FLOWS FROM FINANCING ACTIVITIES
Cash Inflows
a. Subordinated Loans
b. Capital Contributions
c. Others
Total Cash Inflows	-
Cash Outflows
a. Dividend Payments
b. Subordinated Loan Repayments
c. Others
Total Cash Outflows	-
NET CASH FLOWS FROM FINANCING ACTIVITIES	-
ENDING BALANCE OF CASH AND BANKS	-

PT ASABRI (PERSERO)
CASH FLOW STATEMENT
As of …

(in millions of Rupiah)

Description	Month …	Year …
Solvency Ratio
Permitted Assets	-
Liabilities (excluding Subordinated Loans)	-
Total Solvency Ratio	-
Minimum Risk-Based Capital (MRBC)
Schedule A	-
Schedule B	-
Schedule C	-
Schedule D	-
Schedule E	-
Schedule F	-
Schedule G	-
Schedule H	-
Total MRBC	-
Surplus (Deficit) of Solvency Ratio Limit	-
Solvency Achievement Ratio (%) 1)	#DIV/0!
1) Total Solvency Ratio divided by Total MRBC
In the event the Company experiences a solvency deficit, the amount of funds needed to reach a 100% RBC ratio
120%

PT ASABRI (PERSERO)
SOLVENCY LEVEL REPORT
Solvency Achievement Ratio
As of …

Currency	Rupiah	Forex 3)	Total	Rupiah	Forex 3)	Total	Rupiah	Forex 3)	Total
≤ 1 year
1 year < age ≤ 5 years
5 years < age ≤ 10 years
> 10 years
Total

Currency	Rupiah 2)	Forex 2)	Total 2)

Notes:
1) In millions of Rupiah
2) In percentage
3) Already converted into Rupiah currency

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

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

Determined in Jakarta on 25 November 2013 EXECUTIVE HEAD OF SUPERVISOR FOR NON-BANK FINANCIAL INSTITUTIONS FINANCIAL SERVICES AUTHORITY FIRDAUS DJAELANI Signed,

Description
Current Assets to Non-Current Assets Ratio
Current Liabilities to Non-Current Liabilities Ratio

PT ASABRI (PERSERO)
ASSET AND LIABILITY MATCHING ANALYSIS REPORT As of … / Month … Year …

Age of Assets 1)	Liabilities 1)	Asset to Liability Ratio 2)
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