SEOJK on Monthly Reports of Infrastructure Financing Companies

To:
Infrastructure Financing Companies
At Your Location

COPY

CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 7/SEOJK.05/2013 CONCERNING MONTHLY REPORTS OF INFRASTRUCTURE FINANCING COMPANIES

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 monthly reports for Infrastructure Financing Companies in this Financial Services Authority Circular Letter as follows:

I. GENERAL PROVISIONS

The Financial Services Authority, hereinafter abbreviated as OJK, is an independent institution free from the interference of 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.
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, as well as guidelines for preparing Monthly Reports for Infrastructure Financing Companies, are as stated in the Appendix which is an integral part of this OJK Circular Letter.

III. TIME OF SUBMISSION OF MONTHLY REPORTS

Infrastructure Financing Companies are required to submit Monthly Reports to the OJK no later than the 10th day of the following month.
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

Submission of Monthly Reports is conducted online through the OJK data communication network system.
In the event that the OJK data communication network system is not yet available, Monthly Reports are submitted online via the company's official email by attaching a softcopy of the Monthly Report in spreadsheet format to LBPP.Infrastruktur@ojk.go.id
In the event that Monthly Reports are submitted offline, submission is conducted via a letter signed by the Board of Directors and addressed to:
Financial Services Authority u.p. Director of Supervision of Financing Institutions Sumitro Djojohadikusumo Building, 13th Floor Jl. Lapangan Banteng Timur Number 2-4 Jakarta 10710
Submission of Monthly Reports offline as referred to in item 3 can be done in one of the following ways:
a. handed in directly to the OJK office; b. sent via registered post office; or
c. sent via a courier/courier service company.
Infrastructure Financing Companies are deemed to have submitted Monthly Reports with the following provisions:
a. for online submission via email, evidenced by an email receipt from the OJK, b. for offline submission, evidenced by:

a receipt letter from the OJK, if the report is handed in directly to the OJK office; or
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.

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, the OJK will convey the address changes via letter or announcement.

V. SANCTION PROVISIONS

The OJK establishes 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 Monthly Reports of no more than 30 (thirty) days from the establishment of the administrative sanction in the form of a first written warning.
If within the period as referred to in item 1 the obligation to submit Monthly Reports has not been fulfilled, the OJK establishes 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 Monthly Reports of no more than 30 (thirty) days from the establishment of the administrative sanction in the form of a second written warning.
If within the period as referred to in item 2 the obligation to submit Monthly Reports has not been fulfilled, the OJK establishes 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 Monthly Reports of no more than 30 (thirty) days from the establishment of the administrative sanction in the form of a third written warning.

VI. TRANSITIONAL PROVISIONS

Infrastructure Financing Companies are required to submit Monthly Reports to the OJK for the reporting period of September 2013 through August 2014 no later than the 20th day of the following month.
In the event that the 20th day as referred to in item 1 falls on a holiday, the Monthly Report must be submitted on the next working day.

VII. CLOSING

This OJK Circular Letter takes effect on the date of establishment.
To ensure that everyone knows it, it orders the announcement of this OJK Circular Letter by placing it in the State Gazette of the Republic of Indonesia.

Established in Jakarta on 25 November 2013

EXECUTIVE HEAD OF SUPERVISOR OF NON-BANK FINANCIAL INSTITUTIONS FINANCIAL SERVICES AUTHORITY, Signed, FIRDAUS DJAELANI

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

APPENDIX
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 7/SEOJK.05/2013 CONCERNING MONTHLY REPORTS OF INFRASTRUCTURE FINANCING COMPANIES

FORM I.1 : COMPANY PROFILE

Filling Instructions:

Company Name
Filled with the name of the reporting Infrastructure Financing Company (PPI). a. Full name Filled with the full name of the company. b. Previous name Filled with the full previous name of the company if the company has changed its name.
Taxpayer Identification Number (NPWP)
Filled with the taxpayer identification number of the reporting PPI.
Year of Establishment
Filled with the year of establishment as stated in the deed of establishment of the legal entity of the reporting PPI.
Business License
a. Number
Filled with the business license number as a PPI from the Minister of Finance of the Republic of Indonesia. b. Date Filled with the date, month, and year the business license as a PPI was established by the Minister of Finance of the Republic of Indonesia.
Statement of Effectiveness of the Registration Statement for Initial Public Offering (IPO) of Shares from OJK (specifically for reporting PPIs that have gone public)
a. Number
Filled with the number of the statement of effectiveness of the registration statement for IPO of shares from OJK. b. Date Filled with the date, month, and year the statement of effectiveness of the registration statement for IPO of shares from OJK was issued.
Address
a. Full address
Self-explanatory. b. City name
Self-explanatory.
c. Postal code
Self-explanatory. d. Building ownership or control status Filled with the building ownership or control status, i.e., rent, own property, or other types of ownership or control.
Capital
a. PT (Limited Liability Company)

Authorized capital
Paid-up capital
b. Cooperative
Basic savings
Mandatory savings
Self-explanatory.

Exchange Rate
Filled according to the Bank Indonesia middle exchange rate on the reporting date.
Number of Shareholders
Filled with the number of shareholders and must be detailed in Form I.1.1 Shareholder Detail List. For reporting PPIs that are Public Companies, the mention of shareholders follows the regulations applicable in the capital market. If the legal entity is a cooperative, filled with the number of members.
Management
a. Number of Board of Commissioners/Supervisors members b. Number of Board of Directors/Managers For reporting PPIs with PT legal entity status, filled with the number of Board of Directors members and number of Directors. For those with cooperative legal entity status, filled with the number of Supervisors and number of Managers. This column must be detailed in Form I.1.2 Management Detail List.
Number of Branch Offices
Filled with the number of branch offices of the reporting PPI. The number of branch offices must be detailed in Form I.1.3 Branch Office Detail List.
Number of Employees
a. Head Office b. Branch Offices
Filled with the number of employees at the head office and branch offices respectively and must be detailed in Form I.1.4 Employee Education Level Detail List.
Report Compiler and Supervisor
Filled with complete data of each personnel acting as the report compiler officer and supervising officer. a. Compiler

Full name
Self-explanatory.
Department/Division
Filled with the department/division/unit of work of the personnel responsible for compiling the report.
Telephone number
Self-explanatory.
Fax number
Self-explanatory.
Email
Self-explanatory. b. Supervisor
Full name
Self-explanatory.
Department/Division
Filled with the department/division/unit of work of the supervisor.
Telephone number
Self-explanatory.
Fax number
Self-explanatory.
Email
Self-explanatory.

FORM I.1.1 : SHAREHOLDER DETAIL LIST

Filling Instructions:
I. No
Self-explanatory.

II. Name
Filled with the name of the shareholder (in case the reporting PPI is a PT legal entity). Filled with the name of the member (in case the reporting PPI is a cooperative legal entity). For shareholders in the form of a business entity, the full status of the business entity must be stated, e.g., PT xxx Tbk. and Cooperative xxx.

III. Owner Category
Filled with a code in the form of a number for the category of owners of the reporting PPI, as follows:

Individual;
Republic of Indonesia State;
Multilateral Organization;
Indonesian Legal Entity;
Foreign Business Entity; or
Public (if the owner obtains shares through the capital market).

IV. Ownership

Value
Filled with the nominal value of ownership in millions of Rupiah.
Percentage
Filled with the percentage value of ownership.

FORM I.1.2 : MANAGEMENT DETAIL LIST

Filling Instructions:
This detail list contains management information of the reporting PPI consisting of commissioners and directors for reporting PPIs with PT legal entity status or supervisors and managers for reporting PPIs with cooperative legal entity status.

I. No
Self-explanatory.

II. Name
Filled with the names of the management of the reporting PPI.

III. Position
Filled with a code in the form of a number for the management position of the reporting PPI, as follows:

Lead Commissioner or equivalent;
Commissioner;
Lead Director or equivalent;
Director;
Supervisor;
Manager.

IV. Date of Appointment
Filled with the date of appointment.

FORM I.1.3 : BRANCH OFFICE DETAIL LIST

Filling Instructions:
I. No
Self-explanatory.

II. Branch Office Name
Self-explanatory.

III. Address

Full Address
Filled with the full address of each branch office.
District/City (Dati II)
Filled with the name of the second-level region where each branch office is located.
Province
Filled with the name of the province where each branch office is located.
Postal Code
Filled with the postal code number where each branch office is located.

IV. Telephone
Filled with the area code and telephone number of each branch office.

V. Fax
Filled with the area code and fax number of each branch office.

VI. Number of Employees
Filled with the number of employees including honorary staff.

VII. Leader Name
Filled with the name of the branch office leader.

FORM I.1.4 : EMPLOYEE EDUCATION LEVEL DETAIL LIST

Filling Instructions:

Head Office
a. Education Level

Up to Senior High School (SLTA)
D1 to D3
S1 (Bachelor's)
S2 (Master's)
S3 (Doctorate)
Self-explanatory. b. Foreign Workers
Filled with the number of foreign workers employed by the reporting PPI.

Branch Offices
a. Education Level

Up to Senior High School (SLTA)
D1 to D3
S1 (Bachelor's)
S2 (Master's)
S3 (Doctorate)
Self-explanatory. b. Foreign Workers
Filled with the number of foreign workers employed by the reporting PPI.

Total
a. Male (L) b. Female (P)
c. Total
Self-explanatory.

FORM I.2 : FINANCIAL POSITION REPORT

Filling Instructions:
The financial position of the reporting PPI is presented in Rupiah currency. Assets, liabilities, and equity in Rupiah are reported in the Rupiah column, while assets, liabilities, and equity in foreign currency (valas) are reported in the foreign currency (valas) column.

For reporting PPIs with cooperative legal entity status, adjustments to the presentation of financial report items can be made according to cooperative characteristics.

A. ASSETS

Cash
Is cash in the form of banknotes and coins issued by Bank Indonesia that are legal tender in Indonesia. This also includes foreign banknotes and coins that are still valid as legal tender. Commemorative coins and commemorative notes issued by Bank Indonesia are reported under Other Assets.
Deposits in Banks
Is the deposit of the reporting PPI in Rupiah and foreign currency in banks, for example, deposits in checking accounts, time deposits, and other savings accounts in banks. This item must be detailed in Form I.2.1 List of Details of Deposits in Banks.
Held Securities
Is the deployment of funds by the reporting PPI in the form of Bank Indonesia Certificates, Government Bonds, and/or other financial instruments that have an investment grade rating. This item must be detailed in Form I.2.2 List of Details of Held Securities.
Accrued Income
Is the income of the reporting PPI that has been recognized in the reporting period but payment has not yet been received, such as income from consulting services, loan interest, and deposit interest where payment has not been received.
Loans Given
This item is detailed as follows:
a. Direct Loans
Is the provision of funds in Rupiah and foreign currency, based on a loan agreement between the reporting PPI and other parties. b. Refinancing Is the provision of funds in Rupiah and foreign currency, based on a loan agreement between the reporting PPI and other parties through a refinancing mechanism for infrastructure financed by other parties.
c. Subordinated Loans
Is loans given by the reporting PPI to other parties related to infrastructure financing with a minimum term of 5 (five) years and in the event of liquidation, its claim rights apply last among all loans. d. Others Is loans given by the reporting PPI to other parties related to infrastructure financing and not included in the loan categories as referred to in letters a, b, and c. This item must be detailed in Form I.2.3 List of Details of Loans Given.
Equity Investments
Is the investment of funds in the form of ownership in other PPIs and/or companies engaged in infrastructure projects. This item must be detailed in Form I.2.4 List of Details of Equity Investments.
Allowance for Impairment Losses on Financial Assets
Is the allowance for impairment losses on financial assets that must be formed by the reporting PPI in accordance with Financial Accounting Standards regarding financial instruments. This item is detailed into allowances for impairment of financial assets in the form of: a. deposits in banks b. held securities c. loans given d. others
Intangible Assets
Is assets that can be identified and do not have physical form and are owned by the reporting PPI for use in operational activities for more than one year. Accumulated Amortization of Intangible Assets Is the accumulation up to the end of the reporting Month of the systematic allocation of the depreciable amount of an asset over its useful life.
Fixed Assets
Is tangible assets owned by the reporting PPI and used in operational activities for use for more than one year. Accumulated Depreciation of Fixed Assets Is the accumulation up to the end of the reporting Month of the systematic allocation of the depreciable amount of an asset over its useful life.
Deferred Tax Assets
Is the amount of recoverable income tax in the future period as a result of deductible temporary differences and remaining loss carryforwards.
Other Assets
Is assets that cannot be classified into any of items 1 to 10 above. Commemorative coins/notes issued by Bank Indonesia are also included in this item.

B. LIABILITIES

Accrued Expenses
Is expenses that have occurred but payment has not yet been fulfilled, such as salary expenses, rental expenses, consulting expenses, and interest expenses.
Tax Payables
Is the amount of taxes payable by the reporting PPI.
Unearned Revenue
Is income where payment has been received by the reporting PPI but has not yet been recognized as revenue on the balance sheet date, such as portions of guarantee fee receipts and advance payments for consulting services to be performed.
Other Current Liabilities
Is current liabilities not included in the classification of current liabilities above.
Issued Securities
Is short-term, medium-term, and long-term debt instruments in Rupiah and foreign currency, both bearer and registered, issued by the reporting PPI that are purchased or held by other parties. This item must be detailed in Form I.2.5 List of Details of Issued Securities.
Guarantee Claim Payables
Is debts arising from agreements on claims submitted by guarantee recipients that have not been paid by the reporting PPI. Guarantee claim payables are recognized and recorded when the claim is approved for payment (claim settled).
Loans Received
Is short-term, medium-term, and/or long-term loans in Rupiah and foreign currency received by the reporting PPI from the Government of the Republic of Indonesia, foreign governments, multilateral institutions, and banks and financial institutions, both domestic and foreign. This item must be detailed in Form I.2.6 List of Details of Loans Received.
Post-Employment Benefits
Is employee benefits other than termination benefits and equity-based benefits that are payable after the worker completes their working period.
Deferred Tax Liabilities
Is the amount of income tax payable for future periods as a result of taxable temporary differences.
Other Liabilities
Is liabilities that cannot be classified into any of items 1 to 9 above.

C. EQUITY

Capital
a. Paid-in Capital
Is the paid-in capital of the reporting PPI in accordance with applicable regulations. b. Share Premium What is included in this sub-item is the excess of share capital payments received by the reporting PPI as a result of share prices exceeding their nominal value.
c. Share Discount
What is included in this sub-item is the shortfall in share capital payments as a result of share prices being lower than their nominal value.
Reserves
Is reserves formed according to the articles of association and/or decisions of owners/shareholders' meetings. In this definition, it includes:
a. General Reserves
What is included in this sub-item is reserves formed from the allocation of net profit after tax used to cover losses arising from the business activities of the reporting PPI. b. Specific Reserves What is included in this sub-item is a portion of profit after tax allocated for specific purposes.
c. Other Reserves
What is included in this sub-item is reserves not included in general reserves and specific reserves in items a and b, among others, reserves formed from the difference in revaluation of fixed assets.
Grants
Is grants received by the reporting PPI from other parties. Grants are reported in Rupiah. In the event grants are received in foreign currency, the grant must be converted into Rupiah. This item must be detailed in Form I.2.7 List of Details of Grants Received.
Retained Earnings (Losses)
What is included in this item is retained earnings (losses) borne by the reporting PPI at the beginning of the year. This item is detailed as follows:
a. Profit b. Loss
Current Year Profit (Loss)
What is included in this item is the profit (loss) of the reporting PPI during the accounting period up to the reporting date. This item is detailed as follows:
a. Profit b. Loss
Other Comprehensive Income
a. Gains
What is included in this item includes, among others, potential gains arising from increases in the fair value of securities in the available-for-sale category. b. Losses What is included in this item includes, among others, potential losses arising from decreases in the fair value of securities in the available-for-sale category.

FORM I.2.1 : LIST OF DETAILS OF DEPOSITS IN BANKS

Filling Instructions: In this detail list, the position of funds deposited by the reporting PPI in banks where the reporting PPI will receive certain returns is reported. In this reporting system, each deposit account in banks must be reported individually. For simplification of the report, this detail list can combine accounts as long as they have the same characteristics.

I. No
Self-explanatory.

II. Bank Name
Filled with the full name of the bank where the reporting PPI deposits funds.

III. Relationship with PPI
Is the status of connection between the reporting PPI and the bank.

Parties with special relationships are:
a. companies that directly or through one or more intermediaries control, are controlled by, or are under common control with the reporting PPI (including holding companies, subsidiaries, and fellow subsidiaries); b. companies that have, directly or indirectly, a significant voting interest in the reporting PPI;
c. members of the Board of Commissioners, Board of Directors, and officials below the level of Directors of the reporting PPI;
d. parties who have family relationships up to the second degree, both horizontally and vertically, with members of the Board of Commissioners, Board of Directors, and officials below the level of Directors of the reporting PPI. If transactions are conducted with parties having special relationships with the reporting PPI, this column is filled with code 1.
Parties without special relationships are:
Parties that do not have relationships with the reporting PPI as referred to in item 1. If transactions are conducted with parties without special relationships with the reporting PPI, this column is filled with code 2.

IV. Type
Is the form of fund deposits by the reporting PPI in banks in Rupiah and foreign currency. Filled with a code in the form of a number as follows:

Checking Account
Deposit on call
Time Deposit
Certificate of Deposit
Others
Deposits in banks other than types 1 to 4 above.

V. Currency Type
Filled with the type of currency for the deposit of funds by the reporting PPI in banks such as US dollar, yen, Singapore dollar, and so on.

VI. Term
Filled with the maturity term of the deposit of funds by the reporting PPI in banks.

VII. Interest Rate
Filled with the interest rate of the deposit of funds by the reporting PPI in banks.

VIII. Nominal
That is the nominal value stated in the securities or agreed contract.

IX. Amount
Filled in for the initial or subsequent recognition of financial assets in accordance with Financial Accounting Standards regarding financial instruments, namely based on amortized cost or fair value.

Previous Period
Filled in with the amount in the previous reporting period.
Reporting Period
Filled in with the amount in the reporting period.

X. Interest income receivable
Filled in with interest income that has been recognized on the reporting date but payment has not yet been received.

FORMULARY I.2.2: LIST OF DETAILS OF SECURITIES OWNED Filling Instructions:
This detail list reports the position of securities owned by the reporting PPI in rupiah and foreign currency. On principle, each securities account must be reported individually. However, for reporting simplification, reporting of securities in this detail list can be done by combining them as long as the securities are issued by the same issuer and have the same characteristics.

I. Type
Filled in with one of the types of securities owned by the reporting PPI as follows:

Government Bonds
Bank Indonesia Certificates (SBI)
Others

II. Currency Type
Filled in with the type of currency of the securities.

III. Issuer Name
Filled in with the name of the party that is the issuer of the securities.

IV. Issuer Country
Filled in with the name of the country where the issuer is domiciled.

V. Measurement Category
Filled in with the measurement category for financial assets in accordance with Financial Accounting Standards regarding financial instruments, namely:

Measured at fair value through profit or loss
a. trading. b. designated to be measured at fair value through profit or loss.
Loans given and receivables.
Held to maturity.
Available for sale.

VI. Tenor
Filled in with the tenor of the securities owned by the reporting PPI as stated in the agreement.

Issuance Date
Filled in with the date, month, and year of initial issuance stated in the agreement.
Maturity
Filled in with the date, month, and year the agreement ends.

VII. Interest Rate

Interest Rate Level
Filled in with the interest rate of the securities as stated in the agreement.
Interest Rate Type
Filled in with one of the following interest rate types:
a. fixed (Fixed)
That is an interest rate that is fixed until a certain period or until maturity. b. variable That is an interest rate that can change until a certain period or until maturity.

VIII. Nominal
Filled in with the nominal value stated in the securities or agreed contract.

IX. Acquisition Price
Filled in with the amount of funds disbursed by the reporting PPI to purchase the securities.

X. Premium/Discount
Filled in with the remaining premium/discount in rupiah or foreign currency that has not yet been amortized.

XI. Amount (amortized cost or fair value)
Filled in for the initial or subsequent recognition of financial assets in accordance with Financial Accounting Standards regarding financial instruments, namely based on amortized cost or fair value.

Previous Period
Filled in with the amount in the previous reporting period.
Reporting Period
Filled in with the amount in the reporting period.

XII. Impairment Loss Allowance
Is the impairment loss allowance for financial assets that must be formed by the reporting PPI in accordance with Financial Accounting Standards regarding financial instruments.

FORMULARY I.2.3: LIST OF DETAILS OF LOANS GIVEN Filling Instructions:
This detail list reports all realizations of loan disbursements in rupiah and foreign currency. Loans given in the context of joint financing/consortium/syndication, whether the reporting PPI acts as an arranger or participant, are reported at the amount of the reporting PPI's claim to the respective borrower or at the proportion of the reporting PPI. On principle, each loan account given must be reported individually. However, for reporting simplification, reporting of loans given in this detail list can be done by combining them as long as the loans are given to the same debtor and the loans given have the same characteristics.

I. Agreement No.
Filled in with the number stated in the loan agreement (direct loan, refinancing, subordinated loan).

II. Account No.
Filled in with the loan account number.

III. Number of Accounts
Filled in with the number of loan accounts given to the borrower.

IV. Borrower Name
Filled in with the name of the borrower who signed the loan agreement.

V. Relationship with PPI
Is the status of the connection between the reporting PPI and the borrower.

Parties with special relationships are:
a. companies, whether directly or through one or more intermediaries, that control, or are controlled by, or are under common control with the reporting PPI (including holding companies, subsidiaries, and fellow subsidiaries); b. companies that have, whether directly or indirectly, a significant voting interest in the reporting PPI;
c. members of the board of commissioners, board of directors, and officials one level below the board of directors of the reporting PPI;
d. parties who have a family relationship up to the second degree, both horizontally and vertically, with members of the board of commissioners, board of directors, and officials one level below the board of directors of the reporting PPI. If a transaction is conducted with a party that has a special relationship with the reporting PPI, this column is filled with code 1.
Parties without special relationships are:
Parties that do not have a relationship with the reporting PPI as referred to in item 1.
If a transaction is conducted with a party that does not have a special relationship with the reporting PPI, this column is filled with code 2.

VI. Type of Loan
Filled in with a code consisting of the number of the type of loan given by the PPI, namely:

Direct Loan
Refinancing
Subordinated Loan
Others

VII. Type of Use
Filled in with one of the following purposes for the use of the loan:

Working Capital
That is short-term financing to finance the borrower's working capital needs.
Investment
That is medium or long-term financing for the construction of infrastructure projects.
Others
That is financing given by the reporting PPI to other parties for financing purposes other than items 1 and 2.

VIII. Currency Type
Filled in with the type of currency used in the provision of loan facilities as stated in the agreement.

IX. Type of Infrastructure
Filled in with a code consisting of the number of the type of infrastructure, as follows:

Transport Infrastructure
Road Infrastructure
Irrigation Infrastructure
Drinking Water Infrastructure
Wastewater Infrastructure
Telecommunications Infrastructure
Electricity Infrastructure
Oil and Gas Infrastructure
Multi-sector (more than 1 type)
Other infrastructure not included in items 1 to 9 with the approval of the Minister.

X. Measurement Category
Filled in with the measurement category for financial assets in accordance with Financial Accounting Standards regarding financial instruments, namely:

Measured at fair value through profit or loss
a. trading b. designated to be measured at fair value through profit or loss
Loans given and receivables
Held to maturity
Available for sale

XI. Tenor
Filled in with the tenor of the loan given by the reporting PPI as stated in the agreement.

Issuance Date
Filled in with the date, month, and year the loan was given as stated in the agreement.
Maturity
Filled in with the date, month, and year the agreement ends.

XII. Interest Rate

Interest Rate Level Filled in with the interest rate level used in the provision of loan facilities as stated in the agreement/deed.
Interest Rate Type Filled in with one of the following interest rate types:
a. fixed (fixed)
That is an interest rate that is fixed until a certain period or until maturity. b. variable That is an interest rate that can change until a certain period or until maturity.

XIII. Plafond
Filled in with the maximum amount of loan received by the borrower as stated in the agreement letter.

XIV. Nominal
Filled in with the debit balance on the reporting date.

XV. Amount (amortized cost or fair value)
Filled in for the initial or subsequent recognition of financial assets in accordance with Financial Accounting Standards regarding financial instruments, namely based on amortized cost or fair value.

Previous Period
Filled in with the amount in the previous reporting period.
Reporting Period
Filled in with the amount in the reporting period.

XVI. Impairment Loss Allowance
Filled in with the amount of impairment loss allowance for financial assets that must be formed by the reporting PPI in accordance with Financial Accounting Standards regarding financial instruments. For loans that experience failure/delay in principal or interest installment payments but have not yet undergone impairment, they must be disclosed according to the following format:

Borrower account number;
Borrower name; and
Overdue loan value, detailed as follows:
a. loan value overdue up to 30 days; b. loan value overdue between 31 days to 60 days;
c. loan value overdue between 61 days to 90 days; and
d. loan value overdue more than 90 days.

FORMULARY I.2.4: LIST OF DETAILS OF EQUITY PARTICIPATION Filling Instructions:
This detail list reports the position of equity participation by the reporting PPI in other parties, including participation in the context of restructuring of loans given. In accordance with the provisions of PMK Number 100/PMK.010/2009 concerning Infrastructure Financing Companies, participation can only be conducted in other PPIs and/or companies engaged in infrastructure projects.

I. Investee Name
Filled in with the name of the investee company where the reporting PPI makes the participation.

II. Participation Method
Filled in with one of the following participation methods:

Cost Method
An accounting method that records investments at acquisition cost. Income is newly recognized by the investor when the investee distributes net profit (except stock dividends) originating from profit after the acquisition date.
Equity Method
An accounting method that records investments initially at acquisition cost and subsequently adjusted for changes in the investor's share of the net assets of the investee that occur after acquisition. The investor's income statement reflects the investor's share of the profit or loss of the investee's business results.

III. Currency Type
Filled in with the type of currency used in conducting transactions between the reporting PPI and the investee.

IV. Purpose of Participation
Filled in with one of the following purposes for participation:

Equity Participation
That is equity participation in other PPIs and/or companies engaged in infrastructure projects.
Temporary Equity Participation
That is equity participation by the reporting PPI in a borrowing company to overcome loan payment failures (debt to equity swap), in accordance with applicable regulations.

V. Time of Participation
Filled in with the date, month, and year the participation in the investee company effectively began.

VI. Participation Share
Filled in with the percentage of participation in the investee company.

VII. Acquisition Value
Filled in with the acquisition value at the time of making the participation.

VIII. Amount
Filled in with the participation value on the reporting date.

IX. Impairment Loss Allowance
Filled in with the amount of impairment loss allowance for financial assets that must be formed by the reporting PPI in accordance with Financial Accounting Standards regarding financial instruments.

FORMULARY I.2.5: LIST OF DETAILS OF SECURITIES ISSUED Filling Instructions:
This detail list reports all positions of short-term, medium-term, and long-term debt instruments in rupiah or foreign currency, both named and bearer, issued by the reporting PPI that are purchased or owned by other parties.

I. Type
Filled in with the type of securities issued, for example medium term notes (MTN) or bonds.

II. Currency Type
Filled in with the type of currency of the securities.

III. Buyer
Filled in with the name of the buyer of the securities.

IV. Buyer Country
Filled in with the country of domicile of the parties purchasing the securities issued by the reporting PPI.

V. Measurement Category
Filled in with the measurement category for financial liabilities in accordance with Financial Accounting Standards regarding financial instruments, namely:

Measured at fair value through profit or loss
a. trading b. designated to be measured at fair value through profit or loss
Measured at amortized cost

VI. Tenor
Filled in with the tenor of the securities issued by the reporting PPI as stated in the agreement.

Issuance Date
Filled in with the date, month, and year of initial issuance stated in the agreement.
Maturity
Filled in with the date, month, and year the agreement ends.

VII. Interest Rate

Interest Rate Level
Filled in with the interest rate of the securities issued by the reporting PPI as stated in the agreement.
Interest Rate Type
a. fixed (fixed)
That is an interest rate that is fixed until a certain period or until maturity. b. variable That is an interest rate that can change until a certain period or until maturity.

VIII. Nominal
Filled in with the nominal value stated in the securities or agreed contract.

IX. Unamortized Premium/Discount
Filled in with the remaining premium/discount in rupiah or foreign currency that has not yet been amortized.

X. Amount
Filled in for the initial or subsequent recognition of financial liabilities in accordance with Financial Accounting Standards regarding financial instruments, namely based on amortized cost or fair value.

Previous Period
Filled in with the amount in the previous reporting period.
Reporting Period
Filled in with the amount in the reporting period.

FORMULARY I.2.6: LIST OF DETAILS OF LOANS RECEIVED Filling Instructions:
I. Source
Filled in with a code consisting of the number for the source of the loan as follows:

Government of the Republic of Indonesia;
Foreign Government;
Multilateral Institutions;
Banks and financial institutions, both domestic and foreign.

II. Type
Filled in with a code consisting of the number for the type of loan as follows:

Senior Debt Loans that have priority over other loans in terms of payment
Subordinated Loans that meet subordination criteria.
Others Loans other than items 1 and 2 above.

III. Currency Type
Filled in with the type of currency of the loan received by the reporting PPI.

IV. Creditor
Filled in with the name of the creditor giving the loan to the reporting PPI.

V. Creditor Country
Filled in with the name of the country of domicile of the parties giving the loan to the reporting PPI.

VI. Measurement Category
Filled in with the measurement category for financial liabilities in accordance with Financial Accounting Standards regarding financial instruments, namely:

Measured at fair value through profit or loss
a. trading b. designated to be measured at fair value through profit or loss
Measured at amortized cost.

VII. Tenor
Filled in with the tenor of the loan received by the reporting PPI as stated in the agreement.

Issuance Date
That is the date, month, and year the loan was received as stated in the agreement.
Maturity
That is the date, month, and year the agreement ends.

VIII. Interest Rate

Interest Rate Level
Filled in with the interest rate level of the loan received as stated in the agreement.
Interest Rate Type
Filled in with one of the following interest rate types:
a. fixed (fixed)
That is an interest rate that is fixed until a certain period or until maturity. b. variable That is an interest rate that can change until a certain period or until maturity.

IX. Plafond
Filled in with the maximum amount of loan received by the reporting PPI as stated in the agreement.

X. Nominal
Filled in with the value of the loan that has been drawn.

XI. Amount
Filled in for the initial or subsequent recognition of financial liabilities in accordance with Financial Accounting Standards regarding financial instruments, namely based on amortized cost or fair value.

Previous Period
Filled in with the amount in the previous reporting period.
Reporting Period
Filled in with the amount in the reporting period.

FORMULARY I.2.7: LIST OF DETAILS OF GRANTS RECEIVED Filling Instructions:
This detail list reports the position of grants received by the reporting PPI from other parties. Grants are reported in rupiah. In the event that grants are received in foreign currency, they are reported into rupiah according to the middle exchange rate of the Bank of Indonesia at the time the grant was received.

I. Grantor
Filled in with the name of the party giving the grant.

II. Relationship with PPI
Is the status of the connection between the reporting PPI and the grantor.

Parties with special relationships are:
a. companies, whether directly or through one or more intermediaries, that control, or are controlled by, or are under common control with the reporting PPI (including holding companies, subsidiaries, and fellow subsidiaries); b. companies that have, whether directly or indirectly, a significant voting interest in the reporting PPI;
c. members of the board of commissioners, board of directors, and officials one level below the board of directors of the reporting PPI;
d. parties who have a family relationship up to the second degree, both horizontally and vertically, with members of the board of commissioners, board of directors, and officials one level below the board of directors of the reporting PPI. If a transaction is conducted with a party that has a special relationship with the reporting PPI, this column is filled with code 1.
Parties without special relationships are:
Parties that do not have a relationship with the reporting PPI as referred to in item 1. If a transaction is conducted with a party that does not have a special relationship with the reporting PPI, this column is filled with code 2.

III. Country of Origin
Filled in with the name of the country of domicile of the parties giving grants to the reporting PPI.

IV. Type
Filled in with the type of grant received, for example cash.

V. Amount
Filled in with the value of the grant received.

FORMULARY I.3: FINANCIAL PERFORMANCE REPORT
Filling Instructions:
The income statement of the reporting PPI is prepared in such a way as to provide a picture of the business results of the reporting PPI in a certain period. Included in the income statement are cumulative figures of revenues and expenses of the reporting PPI in rupiah and foreign currency from the beginning of the fiscal year to the reporting date. Revenues and expenses in rupiah are entered in the rupiah column, while revenues and expenses in foreign currency are entered in the foreign currency column. The income statement of the reporting PPI is prepared in a multi-step format that describes revenues or expenses originating from the activities of the reporting PPI. The presentation method of the income statement of the reporting PPI is as follows:

Contains detailed elements of revenues and expenses; and
Revenue and expense elements must be distinguished between revenues and expenses originating from operational and non-operational activities.
The Income Statement is detailed as follows:
I. OPERATIONAL REVENUES AND EXPENSES
Operational Revenue
Is all revenue in rupiah and foreign currency obtained by the reporting PPI from operational activities. a. interest, provision, and fee income from loans given Is all interest income as well as provisions and fees that are not capitalized obtained by the reporting PPI from loan disbursement activities.

direct loan
Is all interest income as well as provisions and fees that are not capitalized obtained by the PPI from direct loan disbursement activities.
refinancing
Is all interest income as well as provisions and fees that are not capitalized obtained by the reporting PPI from loan disbursement activities through the refinancing mechanism.
subordinated loan
Is all interest income as well as provisions and fees that are not capitalized obtained by the reporting PPI from subordinated loan disbursement activities.
others
Is all interest income as well as provisions and fees that are not capitalized obtained by the reporting PPI from other types of loan disbursement activities. b. guarantee fee income Is income obtained by the reporting PPI as compensation for providing guarantee services.
c. consulting service income
Is income obtained by the reporting PPI from providing consulting services. d. dividend income Is income obtained by the reporting PPI from profit distribution on investments in the form of equity participation. e. investment interest income Is interest income obtained by the reporting PPI from fund placements, among others in the form of time deposits, Bank Indonesia Certificates, Government Bonds, and other securities. f. increase in fair value of financial assets Is unrealized potential profit from securities and other financial assets measured at fair value through profit or loss, which is the positive difference between the fair value of securities and other financial assets on the reporting date and the fair value of securities and other financial assets in the previous period. g. decrease in fair value of financial liabilities Is unrealized potential profit from financial liabilities measured at fair value through profit or loss, which is the negative difference between the fair value of financial liabilities on the reporting date and the fair value of such financial liabilities in the previous period. h. profit from sale of financial assets Is profit that can be realized from the sale of financial assets.
i. profit from equity participation using the equity method
Is profit obtained by the reporting PPI from equity participation in other companies (investee) using the equity method, which is the proportional recognition of the acquiree's net profit. j. other operational revenue Is income obtained by the reporting PPI other than operational revenue in groups a to i above.

Operational Expenses
Is all expenses in rupiah and foreign currency disbursed by the reporting PPI for operational activities. a. loan interest, provisions, and fees

loan interest
Is all interest expenses disbursed by the reporting PPI related to funding received.
provision and fee expenses
Is provision and fee costs that are not capitalized disbursed by the reporting PPI related to funding received. b. guarantee claim expenses Is claim expenses arising in connection with guarantee activities.
c. decrease in fair value of financial assets
Is unrealized potential loss from securities and other financial assets measured at fair value through profit or loss, which is the negative difference between the fair value of securities and other financial assets on the reporting date and the fair value of securities and other financial assets in the previous period. d. increase in fair value of financial liabilities Is unrealized potential loss from financial liabilities measured at fair value through profit or loss, which is the negative difference between the fair value of financial liabilities on the reporting date and the fair value of financial liabilities in the previous period.

positive between the fair value of financial liabilities on the reporting date and the fair value of such financial liabilities in the previous period. e. Loss on sale of financial assets Is the realized loss from the sale of financial assets. f. Loss from equity method investments Is the loss obtained by the reporting PPI from investments in other companies (investee) using the equity method, which is a proportional recognition of losses experienced by the investee. g. Financial asset impairment expense Is the expense for forming financial asset impairment provisions, detailed by type of financial asset, namely bank placements, held securities, loans granted, and other financial assets. h. Salary and allowance expenses Is the expense for basic salaries, wages, allowances, honoraria, and other human resource expenses outside of salaries, wages, allowances, and honoraria.
i. Business development expenses
Is the expense directly related to the business activities of the reporting PPI, including consultant expenses, field survey expenses, and other activity costs, excluding salary and allowance expenses as referred to in item h above. j. Depreciation and amortization expenses Is the depreciation expense for fixed assets and amortization expense for intangible assets. k. General and administrative expenses Is the operational expense that can be grouped into general and administrative expenses, including rental expenses and office operational expenses.
l. Other operational expenses
Is the operational expense that does not fall into any of the groups a through k above.

II. OPERATING PROFIT (LOSS)

Operating profit
Is the positive difference between operating income and operating expenses.
Operating loss
Is the negative difference between operating income and operating expenses.

III. NON-OPERATING INCOME AND EXPENSES

Non-operating income
Is all income/profit obtained other than from the main activities of the reporting PPI, including gains from the sale of fixed assets.
Non-operating expenses
Is all expenses/losses borne by the reporting PPI that are not related to the business activities of the reporting PPI.

IV. PROFIT (LOSS) BEFORE INCOME TAX

Profit before income tax
Is the positive difference between operating profit (loss) plus/minus non-operating income/expenses.
Loss before income tax
Is the negative difference between operating profit (loss) plus/minus non-operating income/expenses.

V. INCOME TAX

Estimated income tax
Is the estimated income tax calculated on the profit for the current year period up to the reporting date.
Deferred tax
a. Deferred tax expense
Is the amount of deferred tax expense related to the recognized deferred tax liability for the current year period up to the reporting date. This item is presented in the income statement on a compensation (offset) basis with the Deferred Tax Income item. b. Deferred tax income Is the amount of deferred tax income related to the recognized deferred tax asset for the current year period up to the reporting date. This item is presented in the income statement on a compensation (offset) basis with the Deferred Tax Expense item.

VI. NET PROFIT (LOSS)

Net profit
Is the profit after income tax for the current period.
Net loss
Is the loss after income tax for the current period.

FORM I.4: STATEMENT OF CHANGES IN EQUITY
Filling Instructions:
The statement of changes in equity is a report showing the changes in the equity of the reporting PPI, depicting the increase or decrease in net assets or company wealth during the reporting period, i.e., from the beginning of the year to the current reporting month. For PPIs with a cooperative legal entity, adjustments to the presentation of financial statement items may be made according to cooperative characteristics. Every transaction affecting the value of equity is reported in the corresponding equity items, namely:

Paid-in capital.
Share premium (Share discount)
Reserves, consisting of:
a. General reserves b. Specific purpose reserves
c. Other reserves
Grants
Retained Earnings
Other comprehensive income
Transactions affecting equity are detailed as follows:
I. Beginning balance of the year
Is the beginning balance of the reporting period for each equity item.
II. Changes in accounting policies
Is the amount of adjustment to the beginning balance of equity items that change due to changes in accounting policies in the current period.
III. Prior year corrections
Is the amount of adjustment to the beginning balance of equity items that change due to recording errors from previous years that were only discovered in the current period.
IV. Restated beginning balance of the year
Is the amount of the beginning balance of the reporting period for equity items after adjustment due to changes in accounting policies and prior year corrections.
V. Revaluation surplus/deficit of fixed assets
Is the gain/loss from the revaluation of fixed assets.
VI. Unrealized gains (losses) from holding financial assets
Is gains/losses that cannot yet be recognized as income in the income statement from the ownership of financial assets.
VII. Net gains (losses) not recognized in the income statement
Is gains (losses) recognized in other comprehensive income.
VIII. Net profit (loss) for the current period
Is the cumulative net profit (loss) from the beginning of the year to the reporting month.
IX. Formation of reserves
Is the formation of reserves from the allocation of net profit after deducting tax (general reserves) or the allocation of the portion of profit after deducting tax for specific purposes (specific purpose reserves) carried out by the reporting PPI.
X. Dividends
Is the amount of dividends paid by the reporting PPI from the beginning of the year to the reporting month.
XI. Issuance of shares
Is the amount received by the reporting PPI from the issuance of new shares.
XII. Others
Is all transactions affecting equity items other than I – XI above.
XIII. Balance as of reporting month
Is the balance of each equity item as of the end of the reporting month.

FORM I.5: STATEMENT OF CASH FLOWS
Filling Instructions:
Cash flows are financial reports prepared using the cash basis. All items in the cash flow statement are created and calculated based on the involvement of cash and cash equivalents from the beginning of the reporting year to the reporting date. This applies to both receipt and payment items. For reporting PPIs with a cooperative legal entity, adjustments to the presentation of financial statement items may be made according to cooperative characteristics.
I. Net Cash from Operating Activities

Cash receipts from operating activities
a. Receipts of interest on loans granted
This account contains all receipts of interest on infrastructure loans granted by the reporting PPI to other parties, including interest receipts, provisions, or late payment penalties on installments. b. Receipts of principal on loans granted This account contains all principal receipts on infrastructure loans granted by the reporting PPI to other parties.
c. Fee receipts
This account contains all receipts of consideration for providing financing support, including guarantees. d. Dividend receipts This account contains dividend receipts from equity investments made by the reporting PPI in other companies. e. Receipts of interest from bank fund placements This account contains interest receipts on fund placements in banks made by the reporting PPI. f. Receipts from other operating activities This account contains all cash receipts from operational activities other than the main operational activities above.
Cash payments for operating activities
a. Disbursement of loans granted
This account contains all expenditures related to the loan granting activities carried out by the reporting PPI, including direct loans, refinancing, and subordinated loans. b. Payments for guarantee activities This account contains all expenditures related to guarantee activities carried out by the reporting PPI, including guarantee claim payments to customers.
c. Payment of business costs
This account contains all expenditures directly related to the business activities of the reporting PPI that are not included in letters a and b above. d. Payment of loan interest This account covers expenditures made by the reporting PPI to pay loan interest to creditors. e. Other payments for operational activities This account holds all cash expenditures for operational activities that are not included in the accounts above.
II. Net Cash from Investing Activities
Cash receipts from investing activities
a. Receipts of interest from investments in securities This account contains interest receipts from the company's investment activities in securities. b. Receipts from the sale of securities This account contains cash receipts from the sale of securities.
c. Receipts from the sale of fixed assets
This account contains cash receipts from the sale of fixed assets, including: land, buildings, and equipment. d. Receipts from the disposal of equity investments This account contains the proceeds from the disposal of equity investments involving cash and other related income. e. Other receipts from investing activities This account contains other cash receipts not included in the accounts above but are part of the company's investment activities and involve cash.
Cash payments for investing activities
a. Payments for the acquisition of securities
This account contains all cash expenditures for investments in securities. b. Payments for the purchase of fixed assets This account contains cash expenditures for fixed asset purchase transactions, including land, buildings, and equipment involving cash.
c. Payments for equity investments.
This account contains cash expenditures to obtain ownership through equity investments in other companies. d. Other payments for investing activities. This account holds the recording of all cash expenditures for investment activities not included in the accounts above.
III. Net Cash from Financing Activities
Cash receipts from financing activities
a. Receipts from capital deposits
This account contains every deposit/capital addition by the reporting PPI from shareholders. b. Receipts from the issuance of debt securities This account contains funds obtained from the issuance of bonds and other forms of debt securities.
c. Loan receipts
This account contains loan funds obtained from the Government of the Republic of Indonesia, foreign governments, multilateral institutions, and banks and financial and financing institutions, both domestic and foreign. d. Receipts from grants This account contains funds obtained from grants in rupiah or foreign currency. e. Other receipts from financing activities This account holds all cash receipts for financing activities not included in the accounts above.
Cash payments for financing activities
a. Loan principal payments
This account covers expenditures made by the reporting PPI to repay loan principal to creditors. b. Dividend payments This account covers every dividend payment made by the reporting PPI to the company's shareholders.
c. Payments for the repurchase of shares and debt securities
This account holds cash expenditures for transactions involving the repurchase of share capital and debt securities, including the settlement of maturing bonds, carried out by the reporting PPI. d. Other payments for financing activities This account holds the recording of all cash expenditures for financing activities not included in the accounts above.
IV. Net Increase (Decrease) in Cash and Cash Equivalents
This account contains the net increase or decrease in cash and cash equivalents up to the reporting date period.
V. Effect of Exchange Rate Changes
This account contains the difference between cash and cash equivalents in foreign currency and the value that should be recorded on the reporting date.
VI. Cash and Cash Equivalents at the Beginning of the Period
The position of cash and cash equivalents at the beginning of the reporting fiscal year of the reporting PPI.
VII. Cash and Cash Equivalents at the End of the Period
The position of cash and cash equivalents on the reporting date of the reporting PPI.

FORM I.6: ADMINISTRATIVE ACCOUNTS
Filling Instructions:
Administrative accounts refer to rupiah and foreign currency transactions that on the reporting date have not effectively caused changes in assets and liabilities. These administrative accounts are detailed as follows:
I. Commitment Receivables

Loan facilities received and not yet drawn
Included in this account are loan facilities obtained by the reporting PPI and not yet used, originating from the Government of the Republic of Indonesia, foreign governments, multilateral institutions, and banks and financial and financing institutions, both domestic and foreign.
Others
Included in this account are all commitment receivables, including receivables related to subrogation of guarantee activities, that cannot be classified into the account above.
II. Commitment Liabilities
Loan facilities granted that have not been drawn
Included in this account are loan facilities still provided by the reporting PPI to borrowers and not yet drawn.
Others
Included in this account are all commitment liabilities of the reporting PPI that cannot be classified into the account above.
III. Contingent Receivables
Reinsurance received
Included in this account is the value of reinsurance received by the reporting PPI.
Others
Included in this account are all contingent receivables of the reporting PPI that cannot be classified into the account above.
IV. Contingent Liabilities
Guarantees given
Included in this account is the value of guarantees, both in rupiah and foreign currency, issued by the reporting PPI for customer interests that are still outstanding on the reporting date.
Others
Included in this account are all contingent liabilities of the reporting PPI that cannot be classified into the account above.

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

MONTHLY REPORT
Month… Year…
Infrastructure Financing Company

PROFILE OF INFRASTRUCTURE FINANCING COMPANY/PPI a. full name :
b. former name :
2. Taxpayer Identification Number (NPWP) :
3. Company status :
4. Business entity form :
5. Year of establishment :
6. Business license
a. number :
b. date :
7. Public listing license
a. number :
b. date :
8. Address
a. full address :
b. city name :
c. postal code :
d. building ownership status :
9. Capital :
a. limited liability company (PT)

basic capital :
placed and fully paid capital :
b. cooperative
principal savings :
mandatory savings :

Exchange rate :
Number of shareholders (I.1.1) :
Management (I.1.2)
a. number of commissioners/supervisors :
b. number of directors/managers :
Number of branch offices (I.1.3) :
Number of employees (I.1.4) :
a. headquarters :
b. branch offices :
Report preparer and supervisor
a. preparer

full name :
department/division :
telephone number :
fax number :
email :
b. supervisor
full name :
department/division :
telephone number :
fax number :
email :

FORM I.1

Company name :

FORM I.1.1
DETAILED LIST OF SHAREHOLDERS/MEMBERS
PT/Cooperative...
Month ... Year .....
I II III IV
Value
(million Rp)
No Name Owner Category
Ownership
Percentage (%)

FORM I.1.2
DETAILED LIST OF MANAGEMENT
PT/Cooperative...
Month ... Year .....
I II III IV
No Name Position
Date of appointment

FORM I.1.3
DETAILED LIST OF BRANCH OFFICES/REPRESENTATIVE OFFICES PT/Cooperative...
Month ... Year .....
I II IV V VI VII
Address
Complete Dati II Province Postal Code
NIHIL
Number of employees
Name of leader
III
No
Name of branch/representative office
Address
Telephone Fax

FORM I.1.4
DETAILED LIST OF EMPLOYEE EDUCATION LEVELS
PT/Cooperative...
Month...Year...
M F Total

Education level (excluding foreign personnel)
a. up to Junior High School b. Senior High School
c. DIII
d. S1/D IV e. S2 f. S3
Foreign Personnel
Branch Office:
Education level (excluding foreign personnel)
a. up to Junior High School b. Senior High School
c. DIII
d. S1/D IV e. S2 f. S3
Foreign Personnel
Total
Education Level and Foreign Personnel Total
Headquarters:

(in million rupiah)
No Items Rupiah FC Total
A ASSETS
1 Cash
2 Bank placements (I.2.1)
3 Held securities (I.2.2)
4 Accrued income
5 Loans granted (I.2.3) a. direct loans b. refinancing
c. subordinated loans
d. others
6 Equity investments (I.2.4)
7 Financial asset impairment provisions a. bank placements -/- b. held securities -/-
c. loans granted -/-
d. others -/-
8 Intangible assets
Accumulated amortization of intangible assets -/- 9 Fixed assets Accumulated depreciation of fixed assets -/- 10 Deferred tax assets 11 Other assets TOTAL ASSETS B Liabilities 1 Accrued expenses 2 Tax payables 3 Unearned revenue 4 Other current liabilities 5 Issued securities (I.2.5) 6 Guarantee claim payables 7 Loans received (I.2.6) a. Government of the Republic of Indonesia b. Foreign Governments
c. Multilateral Institutions
d. Banks/financial institutions
i. domestic
ii. foreign
8 Post-employment benefits
9 Deferred tax liabilities
10 Other liabilities
TOTAL LIABILITIES
C EQUITY
1 Capital a. paid-in capital b. share premium
c. share discount -/-
2 Reserves a. general reserves b. specific purpose reserves
c. other reserves
3 Grants (I.2.7)
4 Retained Earnings (Loss) a. profit b. loss -/- 5 Current Period Profit (Loss) a. profit b. loss -/- 6 Other comprehensive income:
a. gains b. losses -/-
TOTAL EQUITY
TOTAL LIABILITIES AND EQUITY
STATEMENT OF FINANCIAL POSITION
PT/Cooperative ......
As of ......

DETAILED LIST OF BANK PLACEMENTS
PT/Cooperative ......
As of ....
I II III IV V VI VII VIII X
Previous Period Reporting Period
Total
*)
FORM I.2.1
IX
No Bank Name Relationship with PPI Type Type of currency Tenor (days) Interest Rate Nominal Interest Income Net of tax Total Interest Income To be received *)

DETAILED LIST OF HELD SECURITIES
PT/Cooperative ......
As of .....
I II III IV V VIII IX X XII
Date of issuance Maturity Interest
Rate
Type of interest rate Previous Period Changes Reporting Period

Provisions for
Impairment
Loss
FORM I.2.2
VI VII XI
Type Type of currency Name of issuer
Country of issuer
Measurement
Category
Total
Interest Rate
Nominal Acquisition Price Premium/dis count
Tenor Total (Cost Amortized or Fair Value)

DETAILED LIST OF LOANS GRANTED
PT/Cooperative ......
As of ...
I II III IV V VI VII VIII IX X XIII XIV XVI
Date of issuance Maturity Interest Rate
Type of interest rate Previous Period Reporting Period

Number of accounts
Tenor
Relationship with PPI Ceiling (Rp)
Total (Cost Amortized or Fair Value)
FORM I.2.3
XI XII XV
Contract No. Account No.
Interest Rate
Borrower Name Nominal Type of loan
Total
Provisions for
Impairment
Loss
Type of use
Type of currency
Type of infrastructure
Measurement
Category

DETAILED LIST OF EQUITY INVESTMENTS
PT/Cooperative ......
As of ....
I II III IV V VI VII VIII IX
Name of investee Method of investment
Type of currency Purpose of investment Date of investment Share portion Acquisition Value Total *) Provisions for Impairment Loss Total FORM I.2.4

DETAILED LIST OF ISSUED SECURITIES
PT/Cooperative ......
As of...
I II III IV V VIII IX
Date of issuance Maturity Interest
Rate
Type of interest rate
Previous
Period
Reporting
Period
Country of buyer
Measurement
Category
Tenor Interest Rate
Total
FORM I.2.5
Type Type of currency Buyer Nominal Premium/diskount not yet amortized Total VI VII X

DETAILED LIST OF LOANS RECEIVED
PT/Cooperative ......
As of ...
I II III IV V VI IX
Date of issuance
Maturity
Interest Rate
Type of interest rate Previous Period Reporting Period

Measurement
Category
Tenor
Total
FORM I.2.6
Interest Rate
Nominal/ceiling/total loan
Total
VII VIII X
Source Type Type of currency Creditor Country of creditor

DETAILED LIST OF GRANTS RECEIVED
PT/Cooperative ......
As of...
I II III IV V
Grantor Relationship with PPI Country of origin Type Total FORM I.2.7 Total

FORM I.3
COMPREHENSIVE INCOME STATEMENT
PT/Cooperative ......
Period...
(in million rupiah)
Rupiah FC Total
I. a.
Interest income, provisions, and fees on loans granted

Direct Loans
Refinancing
Subordinated Loans
Others
b. Guarantee fee income
c. Consulting service income
d. Dividend income e. Investment interest income f. Increase in fair value of financial assets g. Decrease in fair value of financial liabilities h. Gains on sale of financial assets
i. Gains from equity method investments
j. Other operating income
Total operating income a. Loan interest, provisions and fees
Loan interest
Provision and fee expenses
b. Guarantee claim expenses
c. Decrease in fair value of financial assets
d. Increase in fair value of financial liabilities e. Losses on sale of financial assets f. Losses from equity method investments g. Financial asset impairment expenses
Bank placements
Held securities
Loans granted
Others
h. Salary and allowance expenses
i. Business Development Expenses
j. Depreciation and Amortization Expenses k. General and administrative expenses
l. Other operational expenses
Total operating expenses
II.
III.
V.

Loss before income tax
INCOME TAX
OPERATING PROFIT (LOSS)
Items
OPERATING INCOME AND EXPENSES
Operating Income
Operating Expenses
Estimated income tax -/-
Operating profit
Operating loss
NON-OPERATING INCOME AND EXPENSES
Non-operating income
Non-operating expenses
IV. PROFIT (LOSS) BEFORE INCOME TAX
Profit before income tax
Deferred tax
a. Deferred tax expense -/- b. Deferred tax income
VI. NET PROFIT (LOSS)
Net profit
Net loss

FORM I.4
STATEMENT OF CHANGES IN EQUITY
PT/Cooperative ......
Period...
(in million rupiah)
Grants Retained earnings
General Specific Others
I Beginning balance of the year
II Changes in accounting policies
III Prior year corrections
IV Restated beginning balance of the year
V Revaluation surplus/deficit of fixed assets
VI Unrealized gains (losses) from holding financial assets VII Exchange differences from financial statement translation VIII Net gains (losses) not recognized in the income statement IX Net Profit/Loss for the current period X Formation of reserves XI Dividends XII Issuance of shares XIII Others XIV Balance as of reporting month Notes Other comprehensive income Paid-in capital Total equity Share premium (Share discount) Reserves

FORM I.5
CASH FLOW STATEMENT
PT/Cooperative ......
Period...
(in million Rupiah)
Rupiah Foreign Currency Total
I.

a. Receipts of interest from loans granted
b. Receipts of principal from loans granted
c. Receipts of fees
d. Receipts of dividends e. Receipts from other operating activities 2. a. Disbursement of loans granted b. Payments for guarantee activities
c. Payments for business expenses
d. Payments for other operational activities e. Cash and cash equivalents with restricted use II. 1. a. Receipts of interest from investment activities b. Receipts from the sale of securities
c. Receipts from the sale of fixed assets
d. Receipts from the disposal of equity investments e. Other receipts from investment activities. 2. a. Payments for the acquisition of securities b. Payments for the purchase of fixed assets
c. Payments for equity investments
d. Other payments for investment activities.
III a. Receipts from capital deposits b. Receipts from the issuance of debt securities
c. Receipts from loans
d. Receipts from grants e. Other receipts from financing activities a. Payments of loan principal b. Payments of loan interest
c. Payments of dividends
d. Payments for the withdrawal of shares and debt securities e. Other payments for financing activities IV V VI Conversion of Rupiah to Foreign Currency VII Cash Receipts from Investment Activities Items Net Cash Flow from Operating Activities Cash Receipts from Operating Activities Cash Disbursements for Operating Activities Net Cash Flow from Investment Activities Net Increase (Decrease) in Cash and Cash Equivalents Effect of Exchange Rate Changes Cash and Cash Equivalents at the Beginning of the Period Cash and Cash Equivalents at the End of the Period Cash Disbursements for Investment Activities Net Cash Flow from Financing Activities Cash Receipts from Financing Activities Cash Disbursements for Financing Activities

FORM I.6
ADMINISTRATIVE ACCOUNTS
PT/Cooperative ......
As of ...
(in million Rupiah)
Rupiah Foreign Currency Total
I.
1 Loan facilities received and not yet drawn
2 Others
II.
1 Loan facilities granted and not yet drawn
2 Others
III.
1 Reinsurance received
2 Others
IV.
1 Guarantees granted
2 Others
Total Contingent Claims
Contingent Liabilities
Total Contingent Liabilities
Net Contingent Amount
Net Commitment Amount
Items
Commitment Claims
Total Commitment Claims
Commitment Liabilities
Total Commitment Liabilities
Contingent Claims

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

10 years
Total
Rupiah 2) Foreign Currency 2) Total 2)
Notes:

In millions of Rupiah
In percentage
Already converted to 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 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 Signed. Signed. FIRDAUS DJAELANI Mufli Asmawidjaja ASSET AND LIABILITY MATCHING ANALYSIS REPORT PT/Cooperative... As of … Asset Age 1) Liabilities 1) Asset-to-Liability Ratio 2) Description Current Asset-to-Non-Current Asset Ratio Current Liability-to-Non-Current Liability Ratio

SEOJK on Monthly Reports of Infrastructure Financing Companies

Lineage: In force