OJK Circular No. 6/SEOJK.05/2013 on Monthly Reports of Financing Companies

To:
Financing Companies
At Location

COPY
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 6/SEOJK.05/2013 CONCERNING MONTHLY REPORTS OF FINANCING COMPANIES

In connection with the Financial Services Authority Regulation Number 3/POJK.05/2013 dated September 12, 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 monthly reports for Financing Companies in this Financial Services Authority Circular as follows:

I. GENERAL PROVISIONS

1. The Financial Services Authority, hereinafter abbreviated as OJK, is an independent institution 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 OJK, covering the period from the 1st to the end of the current month, and submitted according to the format and procedures determined by OJK.

II. FORM AND STRUCTURE OF MONTHLY REPORTS

1. Monthly reports consist of:
   a. Balance Sheet; b. Comprehensive Income Statement;
   c. Cash Flow Statement;
   d. Asset-Liability Matching Analysis Report; and e. Other reports.

2. The form, structure, and guidelines for preparing Monthly Reports for Financing Companies are as set forth in Appendix I, which constitutes an integral part of this OJK Circular.

3. For Financing Companies conducting business activities based on Sharia principles, in addition to submitting Monthly Reports in the form and structure as set forth in Appendix I, they are required to submit Monthly Reports in the form and structure as set forth in Appendix II, which constitutes an integral part of this OJK Circular.

4. The Balance Sheet referred to in item 1 letter a is the balance sheet as set forth in Appendix I and Appendix II of this OJK Circular.

III. TIME FOR SUBMISSION OF MONTHLY REPORTS

1. Financing Companies are required to submit Monthly Reports to 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 Monthly Reports 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, Monthly Reports are submitted online:
   a. through the LBPP system, except for the asset-liability matching analysis report, which is submitted in spreadsheet format via official company email to LBPP@ojk.go.id; b. via official company email by attaching a softcopy of the Monthly Report in spreadsheet format to LBPP.Syariah@ojk.go.id for Financing Companies conducting business activities based on Sharia principles.

3. In the event that Monthly Reports are submitted offline, submission is conducted via a letter signed by the Board of Directors and addressed to:
   a. Financial Services Authority u.p. Director of Financing Institution Supervision Sumitro Djojohadikusumo Building, 13th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710; and b. Financial Services Authority u.p. Director of Sharia Non-Bank Financial Institutions Sumitro Djojohadikusumo Building, 13th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710 for Financing Companies conducting business activities based on Sharia principles.

4. Offline submission of Monthly Reports as referred to in item 3 may be done in one of the following ways:
   a. handed over directly to the OJK office; b. sent via registered mail; or
   c. sent via courier/courier service company.

5. Financing Companies are deemed to have submitted Monthly Reports under the following conditions:
   a. for online submission through the LBPP system, evidenced by a receipt from the LBPP system; b. for online submission via email, evidenced by a receipt email from OJK; or
   c. for offline submission, evidenced by:

1. a receipt letter from 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 post office or courier/courier service company.

6. In the event of changes to the OJK email address as referred to in item 2 and/or changes to the OJK office address as referred to in item 3, OJK will communicate the address changes via letter or announcement.

V. SANCTION PROVISIONS

1. OJK imposes administrative sanctions in the form of a first written reprimand 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 compliance period for submission of Monthly Reports of up to 30 (thirty) days from the imposition of the administrative sanction in the form of a first written reprimand.

2. If within the time period referred to in item 1 the obligation to submit Monthly Reports is not fulfilled, OJK imposes administrative sanctions in the form of a second written reprimand 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 compliance period for submission of Monthly Reports of up to 30 (thirty) days from the imposition of the administrative sanction in the form of a second written reprimand.

3. If within the time period referred to in item 2 the obligation to submit Monthly Reports is not fulfilled, OJK imposes administrative sanctions in the form of a third written reprimand 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 compliance period for submission of Monthly Reports of up to 30 (thirty) days from the imposition of the administrative sanction in the form of a third written reprimand.

VI. TRANSITIONAL PROVISIONS

1. Financing Companies are required to submit Monthly Reports to OJK for the reporting period from September 2013 to the reporting period of August 2014 no later than the 15th day of the following month.

2. In the event that the 15th day referred to in item 1 falls on a holiday, the Monthly Report must be submitted on the next working day.

VII. CLOSING

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

VII. CLOSING
This OJK Circular takes effect on the date of determination. To ensure everyone knows it, order the publication of this OJK Circular by placing it in the State Gazette of the Republic of Indonesia. Determined in Jakarta on November 25, 2013 EXECUTIVE HEAD OF SUPERVISOR FOR NON-BANK FINANCIAL INSTITUTIONS FINANCIAL SERVICES AUTHORITY, Signed, FIRDAUS DJAELANI

APPENDIX I
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 6/SEOJK.05/2013 CONCERNING MONTHLY REPORTS OF FINANCING COMPANIES

To:
Financial Services Authority u.p. Financing Supervision Directorate Sumitro Djojohadikusumo Building, 13th Floor Jl. Lapangan Banteng Timur 1 - 4 Jakarta - 10710

MONTHLY REPORT
Financing Company
Month... Year…
PT XYZ

DESCRIPTION INFORMATION

1. Company Code :
2. Company Name
   a. Full Name :
   b. Short Name :
   c. Previous Name :
3. NPWP (Tax ID) :
4. Company Status :
5. Business Entity Form :
6. Year of Establishment :
7. Business License
   a. No :
   b. Date :
8. Public Listing License
   a. No :
   b. Date :
9. Address
   a. Full Address :
   b. City Code and Name i.Code :
   ii.City Name :
   c. Postal Code :
   d. Building ownership status :
10. Business Field :
11. Capital
    a. Authorized Capital :
    b. Placed Capital :
    c. Paid-up Capital :
12. Cooperative
    a. Principal Savings :
    b. Mandatory Savings :
13. Number of Shareholders :
14. Management
    a. Number of Commissioners :
    b. Number of Directors :
15. Number of Branch Offices :
16. Number of Employees
    a. Fax No :
    b. Branch Offices :
17. Report Preparer and Person in Charge
    a. Preparer i.Name :
    ii.Department / Division :
    iii.Phone No :
    iv.Fax No :
    b. Person in Charge i.Name :
    ii.Department / Division :
    iii.Phone No :
    iv.Fax No :

PT XYZ
COMPANY PROFILE
Per...

List of Detailed Business Licenses Data Period :
Company Code :
Company Name :
No License Date Description

List of Detailed Shareholders Data Period :
Company Code :
Company Name :
I II III IV VI
Value
(Thousand Rp)

No. Order Related Party Relationship With PP Note: 1) For PT Legal Entities, must be detailed in Form 4, List of Detailed Shareholders and Second Degree Management Degree % V Name 1) Category Owner Legal Entity Ownership

Data Period :
Company Code :
Company Name :
I II III IV

List of Detailed Shareholders and Second Degree Management No. Order Company Name Shareholder / Manager Position

List of Detailed Management Data Period :
Company Code :
Company Name :
I II III

Name Position Start Date

List of Detailed Branch Offices Data Period :
Company Code :
Company Name :
I IV V VI
No License Date Full Address Regency/City Regency/City Code Phone No Employee Count Branch Head Name II III Location License No

List of Detailed Employee Education Levels Data Period :
Company Code :
Company Name :
L P Total

1. Head Office
   a. Elementary School 9110 b. Junior High School 9120
   c. Senior High School 9130
   d. Bachelor's Degree 9140 e. Above Bachelor's Degree 9150 f. Foreign Workers 9160
2. Branch Offices
   a. Elementary School 9210 b. Junior High School 9220
   c. Senior High School 9230
   d. Bachelor's Degree 9240 e. Above Bachelor's Degree 9250 f. Foreign Workers 9260 Total Education Level Code Amount

ASSETS (In Thousand Rupiah)

1. Cash and Cash Equivalents 1100
   a. Cash 1110 b. Domestic Banks 1120

• Current Accounts 1121
• Other Deposits 1129
  c. Foreign Banks 1130
• Current Accounts 1131
• Other Deposits 1139

2. Short-term Investments in Securities (LB6) 1200
3. Financing Receivables - Net (LB5) 1300
   a. Leasing 1310 b. Factoring 1320
   c. Credit Cards 1330
   d. Consumer Financing 1340
4. Equity Participation (LB8) 1400
   a. Banks 1410 b. Other Financial Service Companies 1420
5. Long-term Investments in Securities (LB6) 1500
6. Leased Assets – Net 1600
   a. Leased Assets 1610 b. Accumulated Depreciation of Leased Assets -/- 1620
7. Fixed Assets and Inventories – net 1700
   a. Fixed assets and inventories 1710 b. Accumulated depreciation of Fixed Assets and Inventories -/- 1720
8. Deferred Tax Assets 1800
9. Other Assets 1900

Positions

1. Liabilities Payable Immediately 2100
   a. Banks 2110 b. Other Financial Service Companies 2120
2. Tax Payables 2200
3. Loans Received (LB9) 2300
   a. Domestic 2310
   i. Banks 2311
   ii. Others 2319
   b. Foreign 2320
   i. Banks 2321
   ii. Others 2329
4. Securities Issued (LB10) 2400
5. Deferred Tax Liabilities 2500
6. Subordinated Loans 2600
   i. Domestic 2610
   ii. Foreign 2620
7. Other Liabilities 2900
8. Equity 3100
   a. Paid-up Capital 3110 b. Share Premium 3120
   c. Discount -/- 3130
9. Reserves 3200
   a. General Reserve 3210 b. Specific Reserve 3220
   c. Asset Revaluation Reserve 3230
10. Retained Earnings (Loss)
    a. Profit 3310 b. Loss -/- 3320
11. Current Year Profit (Loss)
    a. Profit 3410 b. Loss -/- 3420 Total Liabilities and Equity 3000 No. Code Rp Foreign Currency PT XYZ BALANCE SHEET Per... No. Positions Code Rp Foreign Currency Total Total Assets 1000

LIABILITIES AND EQUITY
Total Assets 1000

A. REVENUE 4000

1. Operational Revenue 4100
   1.1. Leasing Revenue 4110
   4111 b. Operating Lease 4112
   1.2. Factoring Revenue 4120
   a. Discount 4121 b. Fee 4122
   1.3. Credit Card Revenue 4130
   a. Interest 4131 b. Fee 4132
   c. Commission/Discount 4133
   d. Administration 4134
   1.4. Consumer Financing Revenue 4140
   a. Interest 4141 b. Administration 4142
   1.5. Revenue from Co-financing Disbursement 4150
2. Non-operational Revenue 4200
   2.1. Interest/Giro Service Revenue 4210
   2.2. Other Non-operational Revenue 4290
   B. EXPENSES 5000
3. Operational Expenses 5100
   1.1. Interest 5110
   1.2. Swap Premium 5120
   1.3. Insurance Premium 5130
   1.4. Labor Costs 5140
   1.5. Write-off/Depreciation 5150
   a. Financing Receivables : 5151 b. Leased Assets 5156
   c. Fixed Assets and Inventories 5157
   1.6. Rent 5160
   1.7. Maintenance and Repair 5170
   1.8. Goods and Services 5180
   1.9. Others 5190
4. Non-operational Expenses 5200
   C. 1. Profit (A - B) 6110
5. Loss (A - B) -/- 6120
   D. ESTIMATED INCOME TAX
6. Current Year Tax -/- 5315
7. Deferred Tax
   a. Deferred Tax Expense -/- 5321 b. Deferred Tax Revenue 5322 E. 1. Net Profit After Tax (C1 - C2 - D1 - D2a + D2b) 6210
8. Net Loss (C1 - C2 - D1 - D2a + D2b) -/- 6220
   PT XYZ
   INCOME STATEMENT
   Per...
   Thousand Rp
   Positions
   Code
   Rp Foreign Currency Total

Thousand Rp
No. Positions Code Rupiah Foreign Currency Total

1. Undrawn Loan Facilities 8510
   a. Domestic 8511
   i. Banks 8512
   ii. Others 8513
   b. Foreign 8515
   i. Banks 8516
   ii. Others 8517
2. Undrawn Financing Facilities to Customers 8530
3. Issuance of Standby Letters of Credit 8540
   a. Domestic Loans 8541
   B. Foreign Loans 8545
4. Co-financing Disbursement 8550
   a. Channeling 8551 b. Joint Financing 8552 Total 8500 PT XYZ ADMINISTRATIVE ACCOUNT Per...

I. Net Cash Flow from Operating Activities
A. Cash Surplus 7101
B. Cash Deficit -/- 7102

1. Cash Receipts from Operating Activities 7110

• Receipts from leasing financing 7111
• Receipts from factoring financing 7112
• Receipts from credit card financing 7113
• Receipts from consumer financing 7114
• Receipts from co-financing disbursement activities 7115
• Receipts from other income 7119

2. Cash Payments for Operating Activities 7120

• Payments for leasing financing activities 7121
• Payments for factoring financing activities 7122
• Payments for credit card financing activities 7123
• Payments for consumer financing activities 7124
• Payments for co-financing activities 7125
• Payments for interest 7126
• Payments for general and administrative expenses 7127
• Payments for income tax 7128
• Payments for other operating activities 7129
  II. Net Cash Flow from Investing Activities
  A. Cash Surplus 7201
  B. Cash Deficit -/- 7202

1. Cash Receipts from Investing Activities 7210

• Receipts from disposal of subsidiaries 7211
• Receipts from sale of land, buildings, and equipment 7212
• Receipts from sale of securities not held for trading 7213
• Dividend receipts 7214
• Interest receipts from investment activities 7215
• Receipts from other investing activities 7219

2. Cash Payments from Investing Activities 7220

• Payments for acquisition of subsidiaries 7221
• Payments for purchase of land, buildings, and equipment 7222
• Payments for acquisition of securities 7223
• Payments for other investing activities 7229
  III. Net Cash Flow from Financing Activities
  A. Cash Surplus 7301
  B. Cash Deficit -/- 7302

1. Cash Receipts from Financing Activities 7310

• Receipts from issuance of share capital 7311
• Receipts from loans & issuance of loan instruments 7312
• Receipts from other financing activities 7319

2. Cash Payments for Financing Activities 7320

• Payments for withdrawal of company capital 7321
• Payments for loan principal 7322
• Dividend payments 7323
• Payments for other financing activities 7329
  IV. Effect of Exchange Rate Changes on Cash and Cash Equivalents
  A. Surplus 7401
  B. Deficit -/- 7402
  V. Net Increase in Cash and Cash Equivalents
  A. Increase 7501
  B. Decrease -/- 7502
  VI. Cash and Cash Equivalents at Beginning of Period 7600
  VII. Cash and Cash Equivalents at End of Period 7700
  CODE
  (In Thousand Rupiah)
  PT XYZ
  CASH FLOW STATEMENT
  Per...
  OTHER FOREIGN CURRENCY TOTAL FOREIGN CURRENCY CURRENT ACCOUNT FOREIGN BANKS DESCRIPTION RUPIAH

(In Thousand Rupiah)
< 1 Year > 1 Year Total < 1 Year > 1 Year Total

1. Net Leasing Investment 10
   i. Leasing Receivables 11
   ii. Guaranteed Residual Value 12
   iii. Unrecognized Revenue 13
   iv. Security Deposits 14
   v. Provision for Leasing Receivables 15
2. Factoring 20
   i. Factoring without Recourse - Net 21
   a. Factoring Without Recourse 22 b. Retention Value 23
   ii. Factoring with Recourse - Net 24
   a. Factoring with Recourse 25 b. Retention Value 26
   c. Deferred Factoring Revenue 27
   iii. Provision for Factoring Receivables 28
3. Credit Cards – Net 30
   i. Credit Card Receivables 31
   ii. Provision for Factoring Receivables 32
4. Consumer Financing 40
   i. Consumer Financing Receivables 41
   ii. Deferred Interest Income 42
   iii. Provision for Consumer Financing Receivables 43
   TOTAL 50
   PT XYZ
   FINANCING RECEIVABLE MATURITY PROFILE
   Per....
   Maturity Up To Maturity Up To Total Positions Code Rupiah Foreign Currency

I II III V VII VIII IX
Category Issuer/Borrower Related With PP Issue Date Maturity Date Type Type Currency Company Name Quality Total Issuer/Borrower Purpose Ownership Term IV PT XYZ DETAILS OF SECURITIES HELD Per... VI Interest Rate

In Thousands
I II III IV V VI VII VIII IX X XI Category Debtor PT XYZ DETAIL LIST OF FINANCING Per... Economic Sector Project Location Interest Rate Quality Receivable Balance Financing - Gross Debtor Name Contract Amount Related Party With PP Type of Financing Type of Currency

I II III IV V VI VIII IX X XII Cumulative Drawdown Principal Interest Total Type of Loan Interest Rate Type of Currency Plafond/Total Loan Amount Mutation Balance Start Date Maturity Date Payment Source Lender Name Category Lender Related Party With PP Country of Origin Term Thousand Rp VII XI PT XYZ DETAILS OF LOANS RECEIVED Per... Issue Date Maturity Date Determined in Jakarta on November 25, 2013 EXECUTIVE HEAD OF SUPERVISOR FOR NON-BANK FINANCIAL INSTITUTIONS FINANCIAL SERVICES AUTHORITY Signed, FIRDAUS DJAELANI Copy matches the original Head of Legal Assistance Division Legal Directorate Signed, Mufli Asmawidjaja Buyer Category PT XYZ DETAILS OF SECURITIES ISSUED Per... Total Balance Term Type Type of Currency

APPENDIX II
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 6/SEOJK.05/2013 CONCERNING MONTHLY REPORTS OF FINANCING COMPANIES

To:
Financial Services Authority u.p. Sharia Non-Bank Financial Institutions Directorate Sumitro Djojohadikusumo Building, 13th Floor Jl. Lapangan Banteng Timur 1 - 4 Jakarta - 10710

MONTHLY REPORT
Sharia Financing Company
Month... Year…
PT XYZ

(in thousand Rupiah)
DESCRIPTION RUPIAH FOREIGN CURRENCY TOTAL ASSETS u.p. Sharia Non-Bank Financial Institutions Directorate CASH AND CASH EQUIVALENTS a. Cash b. Bank SHARIA SECURITIES HELD RECEIVABLES a. Murabahah Receivables - Net Murabahah Receivables - Gross Deferred Murabahah Margin Revenue -/- Provision for Murabahah Receivables -/- b. Istishna' Receivables - Net Istishna' Receivables - Gross Deferred Istishna' Margin Revenue -/- Provision for Istishna' Receivables -/-
c. Salam Receivables - Net
Salam Receivables - Gross
Provision for Salam Receivables -/- d. Hiwalah Receivables - Net Hiwalah Receivables - Gross Provision for Hiwalah Receivables -/- IJARAH a. Ijarah Assets - Net Ijarah Assets - Gross Accumulated Depreciation of Ijarah Assets -/- b. Ijarah Muntahiyah Bittamlik Assets - Net Ijarah Muntahiyah Bittamlik Assets - Gross Accumulated Depreciation of Ijarah Muntahiyah Bittamlik -/-
c. Ijarah Musyarakah Muntanaqisah Assets

• Net Ijarah Musyarakah Muntanaqisah Assets - Gross Accumulated Depreciation of
  Musyarakah Muntanaqisah
  -/-
  PARTICIPATION
  Istishna' Assets Under Completion - Net Istishna' Assets Under Completion - Gross Isthisna' Termin -/- INVENTORY FIXED ASSETS AND INVENTORIES a. Fixed Assets - Net Fixed Assets - Gross Accumulated Depreciation of Fixed Assets -/- b. Inventories - Net Inventories - Gross Accumulated Depreciation of Fixed Assets -/- OTHER ASSETS TOTAL ASSETS LIABILITIES CURRENT LIABILITIES ADVANCES FOR FINANCING a. Murabahah b. Istishna
  c. Others
  Due Istishna' Assets (To Be Delivered) FINANCING a. Mudharabah Financing b. Mudharabah Muqayyadah Financing
  c. Musyarakah Financing
  d. Murabahah Financing Facilities e. Ijarah Sukuk f. Other Sharia-Based Financing OTHER LIABILITIES CAPITAL a. Paid-up Capital b. Share Premium
  c. Discount -/-
  a. Retained Earnings Balance b. Retained Losses Balance -/- a. Current Period Profit b. Current Period Loss -/- TOTAL LIABILITIES Per … PT XYZ
  I. BALANCE SHEET

(in thousand Rupiah)
Positions u.p. Sharia Non-Bank Financial Institutions DirectorateRupiah Foreign Currency Total REVENUE

1. Operational Revenue
   1.1. Ijarah
   a. Ijarah Rental Revenue b. Ijarah Muntahiyah BiTamlik Rental Revenue
   c. Ijarah Musyarakah Muntanaqisah Rental Revenue d. Administration
   1.2. Hiwalah
   a. Administration
   1.3. Murabahah
   a. Murabahah Margin Revenue b. Administration
   1.4. Istishna'
   a. Istishna' Margin Revenue b. Administration
   1.5. Fee Revenue from Co-financing Disbursement 1.6. Other operational revenue
   a. Revenue from participation b. Revenue from Sharia Securities Investment
   c. Others
2. Non-operational Revenue
   2.1. Gain on Disposal of Ijarah Assets
   2.2. Gain on Sale of Fixed Assets and Inventories 2.3. Exchange Differences
   2.9. Others
   TOTAL REVENUE
   EXPENSES
3. Operational Expenses
   1.1. Ijarah Asset Repair Costs
   1.2. Insurance Premium
   1.3. Labor Costs
   a. Salaries and Wages b. Honorariums
   c. Others
   1.4. Write-off/Depreciation
   a. Murabahah Receivables b. Istishna' Receivables
   c. Salam Receivables
   d. Hiwalah Receivables e. Ijarah Assets f. Ijarah Muntahiah Bittamlik Assets g. Ijarah Musyarakah Muntanaqisah Assets h. Fixed Assets and Inventories
   1.5. Rental Costs
   1.6. Maintenance and Repair of Fixed Assets and Inventories 1.7. Goods and Services
   1.8. Others
4. Non-operational Expenses
   2.1. Exchange Differences
   2.9. Others
   TOTAL EXPENSES
5. Profit Before Tax (A-B)
6. Loss Before Tax (A-B) -/-
7. Estimated Current Tax -/-
   2.a. Estimated Deferred Tax: Revenue 2.b. Estimated Deferred Tax: Expense -/-
8. Net Profit After Tax (C-D1+D.2a-D.2b)
9. Net Loss After Tax (C-D1+D.2a-D.2b) -/-
   PT XYZ
   III. COMPREHENSIVE INCOME STATEMENT
   For the Period Ended
   Month … Year …

(in thousand Rupiah)
Positions Rupiah Foreign Currency Total Undrawn Financing Facilities a. Mudharabah Financing b. Mudharabah Muqayyadah Financing
c. Musyarakah Financing
d. Murabahah Financing Facilities e. Ijarah Sukuk f. Other Sharia-Based Financing Undrawn Financing Facilities to Customers Deferred Ijarah Revenue a. Ijarah Financing b. Ijarah Muntahiyah Bittamlik Financing
c. Ijarah Musyarakah Muntanaqisah Financing
Third-party Receivables from Co-financing Disbursement a. Channeling b. Joint Financing
c. Others
Per …
II. ADMINISTRATIVE ACCOUNT
PT XYZ

(in thousand Rupiah)
Current Doubtful Bad Total
I. Debtor Name
CODE
10
20
30
40
5. Individuals 50
CODE
10
20
30
40
Filled with debtor name, whether individual or company, that obtains financing from the Financing Company.
IV. SHARIA FINANCING ACTIVITIES REPORT (OUTSTANDING)
Type of Goods Financed
Debtor Name Category Debtor Value Financing Debtor Category Type of Financing
4. Hiwalah
PT XYZ
Economic Sector Project Location Per …
2. Non-Bank Financial Service Companies
3. Non-Financial Companies
COLUMN EXPLANATIONS

1. Banking
2. Government
   III. Type of Financing
   Filled with debtor category code, namely:
   II. Debtor Category
   Filled with financing activity type code, namely:
3. Ijarah Financing
4. Ijarah Muntahiyah Bittamlik Financing
5. Ijarah Musyarakah Muntanaqisah Financing

50
60
70
SANDI
11
12
13
14
15
16
17
18
19
21
22
3. Household Items 23
24
5. Non-Electronic Household Appliances 25
c. Others 31
SANDI
10
20
30
40
5. Construction 50
60
70
80
90
99
5. Murabahah Financing
6. Salam Financing
7. Istishna' Financing
9. Computers
IV. Types of Financed Goods
Filled with the code for the type of goods financed, namely:
a. Capital Goods

1. Heavy Equipment
2. Office Equipment
3. Photo Equipment
   b. Consumer Goods
4. Two-Wheeled Motor Vehicles
5. Four-Wheeled Motor Vehicles
6. Electronic Goods
   V. Economic Sector
7. Medical Equipment
8. Printing Equipment
9. Machineries
10. Transportation (Vehicle)
11. Buildings
    Filled with the code for the economic sector of the debtor receiving financing, namely:
12. Agriculture, Hunting and Agricultural Facilities
13. Mining
14. Processing Industry
15. Electricity, Gas and Water
16. Trade, Restaurants and Hotels
17. Transportation, Warehousing and Communication
18. Business Services
19. Social/Community Services
20. Others

VI. Project Location
SANDI

1. West Java 01
2. Banten 02
3. DKI Jakarta 03
4. DI Yogyakarta 04
5. Central Java 05
6. East Java 06
7. Sumatra 07
8. Kalimantan 08
9. Sulawesi 09
   10
   11
   12
   Filled with the code for the project location of the debtor receiving financing, namely:
10. Bali & Nusa Tenggara
    IX. Financing Value - Non-Performing
    Filled with the Rupiah value of receivables/financing assets in the Non-Performing category.
    X. Financing Value - Balance
    Filled with the total Rupiah value of receivables/financing assets balance.
11. Maluku & Papua
12. Outside Indonesia
    VII. Financing Value - Performing
    Filled with the Rupiah value of receivables/financing assets in the Performing category. Filled with the Rupiah value of receivables/financing assets in the Doubtful category.
    VIII. Financing Value - Doubtful

Cash Flows from Operating Activities

1. Cash Receipts from Operating Activities
   Ijarah Receipts:
   Ijarah xxx u.p. Directorate of Sharia IKNB Ijarah Muntahiya bit Tamlik xxx Ijarah Musyarakah Muntanaqishoh xxx Murabahah Receivables Receipts xxx Istishna Receivables Receipts xxx Receipts from Hawalah xxx Receipts of Fees from Joint Financing Distribution xxx Other Receipts xxx Administrative Receipts:
   Ijarah xxx
   Ijarah Muntahiya bit Tamlik xxx Ijarah Musyarakah Muntanaqishoh xxx Murabahah xxx Advance Payment Receipts:
   Murabahah xxx
   Istishna xxx
   Total Receipts xxx
2. Cash Payments for Operating Activities
   Payment of Current Liabilities (xxx) Payment of Other Liabilities (xxx) Payment of Ijarah Asset Repair Costs (xxx) Payment of Insurance Premiums (xxx) Payment of Labor Costs (xxx) Payment of Rental Costs (xxx) Payment of Maintenance and Repair Costs for Fixed Assets and Inventories (xxx) Payment of Goods and Services Costs (Office Supplies) (xxx) Payment of Other Costs (xxx) Payment of Non-Operating Costs (xxx) Payment of Tax Expenses (xxx) Total Payments (xxx) Net Cash Provided by/(Used for) Operating Activities xxx Cash Flows from Investing Activities xxx
3. Cash Receipts from Investing Activities
   Dividend Receipts xxx
   Receipts from Ijarah Sukuk xxx Receipts from Sale of Fixed Assets xxx Receipts from Sale of Istishna Assets xxx Receipts from Sale of Investments xxx Total Receipts xxx
4. Cash Payments for Investing Activities
   Payments for Acquisition of Ijarah Assets (xxx) Payments for Acquisition of Ijarah Muntahiya bit Tamlik Assets (xxx) Payments for Acquisition of Ijarah Musyarakah Muntanaqishoh Assets (xxx) Payments for Acquisition of Istishna Assets in Progress (xxx) Payments for Acquisition of Fixed Assets (xxx) Payments for Acquisition of Investments in Securities (xxx) Payments for Acquisition/Increase in Investments (xxx) Total Payments (xxx) Net Cash Provided by/(Used for) Investing Activities xxx Cash Flows from Financing Activities
5. Cash Receipts from Financing Activities
   Mudharabah Financing Receipts xxx Musyarakah Financing Receipts xxx Murabahah Facility Financing Receipts xxx Ijarah Sukuk Financing Receipts xxx Other Sharia Financing Receipts xxx Increase in Paid-up Capital xxx Total Receipts xxx
6. Cash Payments for Financing Activities
   Dividend Payments (xxx)
   Profit Sharing Payments for Mudharabah Financing (xxx) Profit Sharing Payments for Musyarakah Financing (xxx) Ujrah Payments for Murabahah Financing (xxx) Ijarah Sukuk Financing Payments (xxx) Other Sharia Financing Payments (xxx) Total Payments (xxx) Net Cash Provided by/(Used for) Financing Activities xxx Net Increase in Cash and Cash Equivalents xxx Cash and Cash Equivalents at Beginning of Period xxx Total Cash and Cash Equivalents at End of Period xxx Month Period... Year ... Financing Company XX
   VI. Cash Flow Statement

(in thousands of Rupiah)
Month Day
I. Company Name
SANDI

1. Banking 10
   20
   30
   40
2. Individual 50
   III. Type of Financing
   SANDI
   10
   20
   30
   40
   50
   60
   SANDI
3. Domestic 10
4. Foreign 20
   V. Country of Origin
   a. Month b. Day
   PT XYZ
   V. SHARIA FUNDING SOURCE REPORT (OUTSTANDING)
   As of …
   Company Name Group
   Company
   Type
   Financing
   Funding Source
   Funding Balance
   Filled with the name of the company including individuals who provide funding to the Financing Company.
   II. Company Group
   Filled with the code for the company group, namely:
   Explanation of Columns
   Country of Origin Funding Tenor
5. Restricted Mudharabah Financing (restricted investment)
6. Musyarakah Financing
7. Murabahah Financing Facilities
8. Ijarah Sukuk
9. Other Sharia-Based Financing
10. Non-Bank Financial Service Companies
11. Non-Financial Service Companies
12. Government
    Filled with the code for the type of Sharia financing received by the Financing Company, namely:
13. Mudharabah Financing
    Filled with the number of days for the funding tenor. (Example: if the funding tenor is 1 year and 10 days, then 12 is filled in the month column and 10 is filled in the day column.)
    VII. Funding Balance
    Filled with the Rupiah value of the outstanding Sharia funding balance received by the Financing Company.
    IV. Funding Source
    Filled with the code for the type of funding source, namely:
    Filled if the funding source is from abroad with the code for the country of origin of the company. (See country of origin codes in the appendix)
    VI. Funding Tenor
    Filled with the number of months for the funding tenor.

Description up to 1 Year Above 1 yr - 5 yr Above 5 yr - 10 yr Above 10 yr Total ASSETS:
Cash and Cash Equivalents
Securities Held
Murabahah Receivables (Net) Istishna Receivables (Net) Salam Receivables (Net) Hawalah Receivables (Net) Ijarah Assets, with contract period Ijarah IMBT Assets, with contract period Ijarah Muntanaqishoh Assets, with contract period Investments Istishna Assets to be Completed within the period Total LIABILITIES Current Liabilities Other Liabilities Istishna Assets to be Delivered Mudharabah Financing Restricted Mudharabah Financing Musyarakah Financing Murabahah Financing Facilities Ijarah Sukuk Other Sharia-Based Financing Total Determined in Jakarta on November 25, 2013 EXECUTIVE HEAD OF IKNB SUPERVISOR Copy matches the original FINANCIAL SERVICES AUTHORITY Head of Legal Assistance Division Legal Directorate Ttd. Ttd. FIRDAUS DJAELANI Mufli Asmawidjaja Due Date (Rp) PT.XYZ
VII. ASSET AND LIABILITY MATCHING ANALYSIS REPORT
As of…