SEOJK Regarding the Report on the Implementation of Good Corporate Governance for Financing Companies

To:

1. The Board of Directors of Financing Companies; and
2. The Board of Directors of Sharia Financing Companies,
   At your place.

COPY
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 15/SEOJK.05/2016 REGARDING THE REPORT ON THE IMPLEMENTATION OF GOOD CORPORATE GOVERNANCE FOR FINANCING COMPANIES

In accordance with the mandate of Article 58 paragraph (3) of the Financial Services Authority Regulation Number 30/POJK.05/2014 concerning Good Corporate Governance for Financing Companies (State Gazette of the Republic of Indonesia Year 2014 Number 365, Supplement to the State Gazette of the Republic of Indonesia Number 5639), it is necessary to regulate the form and structure of the report on the implementation of good corporate governance for financing companies and Sharia financing companies in this Circular Letter of the Financial Services Authority as follows:

I. GENERAL PROVISIONS

1. Company means financing companies and Sharia financing companies.

2. Financing Company means a business entity that conducts financing activities for the procurement of goods and/or services.

3. Sharia Financing Company means a Financing Company whose entire business activities conduct Sharia financing.

4. Good Corporate Governance for Companies, hereinafter referred to as Good Corporate Governance, is the structure and process used and applied by the Company's organs to improve the achievement of business results objectives and optimize the Company's value for all stakeholders in an accountable manner and based on legislation and ethical values.

5. General Meeting of Shareholders, hereinafter abbreviated as GMS, is the general meeting of shareholders as referred to in the laws concerning limited liability companies for Companies that are legal entities in the form of a limited liability company or equivalent to the GMS for Companies that are legal entities in the form of a cooperative.

6. Board of Directors:
   a. for Companies in the form of a limited liability company, means the board of directors as referred to in the laws concerning limited liability companies; or b. for Companies in the form of a cooperative legal entity, means the management as referred to in the laws concerning cooperatives.

7. Board of Commissioners:
   a. for Companies in the form of a limited liability company, means the board of commissioners as referred to in the laws concerning limited liability companies; or b. for Companies in the form of a cooperative legal entity, means the supervisors as referred to in the laws concerning cooperatives.

8. Sharia Supervisory Board, hereinafter abbreviated as SS Board, is part of the Company's organ that has the task and function of supervising the implementation of the Company's activities to be in accordance with Sharia principles.

9. Independent Commissioner means a member of the Board of Commissioners who is not affiliated with shareholders, members of the Board of Directors, other members of the Board of Commissioners and/or members of the SS Board, namely does not have financial, management, share ownership and/or family relationships with shareholders, members of the Board of Directors, other members of the Board of Commissioners and/or members of the SS Board or other relationships that can influence their ability to act independently.

10. Financial Services Authority, hereinafter abbreviated as OJK, is an independent institution as referred to in the laws concerning the Financial Services Authority.

II. IMPLEMENTATION OF GOOD CORPORATE GOVERNANCE

Principles of Good Corporate Governance include:

1. Transparency, namely openness in the decision-making process and openness in the disclosure and provision of relevant information regarding the Company, which is easily accessible by stakeholders in accordance with financing legislation, standards, principles, and practices of healthy financing business operations;
2. Accountability, namely clarity of function and implementation of responsibility of the Company's Organs so that Company performance can run transparently, fairly, effectively, and efficiently;
3. Responsibility, namely the suitability of Company management with financing legislation and ethical values, standards, principles, and practices of healthy financing business operations;
4. Independence, namely the state of the Company being managed independently and professionally and free from conflicts of interest and influence or pressure from any party that is not in accordance with financing legislation, ethical values, standards, principles, and practices of healthy financing business operations; and
5. Fairness and Justice, namely equality, balance, and justice in fulfilling the rights of stakeholders arising from agreements, legislation, ethical values, standards, principles, and practices of healthy financing business operations.

III. REPORT ON THE IMPLEMENTATION OF GOOD CORPORATE GOVERNANCE

1. Companies are required to prepare a report on the implementation of Good Corporate Governance at the end of each fiscal year.
2. The report on the implementation of Good Corporate Governance as referred to in number 1 must contain at least:
   a. transparency of the implementation of Good Corporate Governance which includes at least the disclosure of all aspects of the implementation of Good Corporate Governance principles as referred to in Section II; b. self-assessment of the implementation of Good Corporate Governance; and
   c. action plan which includes necessary corrective actions and completion time as well as obstacles/difficulties in completion, if there are still deficiencies in the implementation of Good Corporate Governance.

IV. TRANSPARENCY OF THE IMPLEMENTATION OF GOOD CORPORATE GOVERNANCE

1. Transparency of the implementation of Good Corporate Governance as referred to in Section III number 2 letter a includes:
   a. the implementation of the duties and responsibilities of the Board of Directors, Board of Commissioners, and SS Board; b. the completeness and implementation of the duties of the audit committee or functions that assist the Board of Commissioners in monitoring and ensuring the effectiveness of the internal control system;
   c. the implementation of compliance functions, internal auditors, and external auditors;
   d. the implementation of risk management and internal control systems; e. the implementation of remuneration policies and other facilities for members of the Board of Directors, Board of Commissioners, SS Board, and employees; f. transparency of the Company's financial and non-financial conditions not yet disclosed in other reports; g. long-term plans as well as annual work and budget plans; h. disclosure of share ownership by members of the Board of Directors and Board of Commissioners reaching 50% (fifty percent) or more;
   i. disclosure of financial relationships and family relationships of members of the Board of Directors and Board of Commissioners with other members of the Board of Directors, members of the Board of Commissioners, members of the SS Board, and/or shareholders of the Company;
   j. disclosure of other important matters, at least including:

1. resignation or dismissal of Independent Commissioners;
2. resignation or dismissal of external auditors;
3. certification;
4. foreign workers;
5. material transactions with related parties;
6. conflicts of interest that are ongoing and/or may occur;
7. number of internal deviations (internal fraud);
8. legal issues;
9. corporate business ethics; and
10. other material information regarding the Company related to Good Corporate Governance.

2. Transparency of the implementation of Good Corporate Governance as referred to in Section III number 2 letter a is prepared by the Company based on the format as contained in Appendix I which is an integral part of this OJK Circular Letter.

V. SELF-ASSESSMENT OF THE IMPLEMENTATION OF GOOD CORPORATE GOVERNANCE

1. Self-assessment of the implementation of Good Corporate Governance as referred to in Section III number 2 letter b is conducted by the Company based on the Good Corporate Governance guidelines.
2. Self-assessment as referred to in number 1 is formulated in the self-assessment worksheet as contained in Appendix II which is an integral part of this OJK Circular Letter.
3. Filling out the self-assessment worksheet is done in the following stages:
   a. preparing a self-assessment analysis, by comparing the fulfillment of each criterion/indicator with the Company's condition based on relevant data and information. b. based on the results of the analysis, the ranking of each criterion/indicator is determined. The ranking criteria are as follows:

1. Rank 1:
   The results of the Company's self-assessment show that the implementation of Good Corporate Governance is very suitable with the criteria/indicators.
2. Rank 2:
   The results of the Company's self-assessment show that the implementation of Good Corporate Governance is suitable with the criteria/indicators.
3. Rank 3:
   The results of the Company's self-assessment show that the implementation of Good Corporate Governance is quite suitable with the criteria/indicators.
4. Rank 4:
   The results of the Company's self-assessment show that the implementation of Good Corporate Governance is less suitable with the criteria/indicators.
5. Rank 5:
   The results of the Company's self-assessment show that the implementation of Good Corporate Governance is not suitable with the criteria/indicators.
   c. preparing a general conclusion on the results of the self-assessment.

4. For each question in the self-assessment, a value is given as follows in the table:
   Indicator Value
   Yes 5
   1 5
   2 4
   3 3
   4 2
   5 1
   No 1

5. To obtain the value of each factor, the Company uses the following formula:
   The weight of each factor is determined as follows in the table:
   a. for Financing Companies
   No. Factor Weight (%)

6. Implementation of duties and responsibilities of the Board of Directors and Board of Commissioners. 30.00

7. Completeness and implementation of the duties of the audit committee or functions that assist the Board of Commissioners:
   a. For Financing Companies that have total assets above Rp200,000,000,000.00 (two hundred billion rupiah); or b. For Financing Companies that have total assets up to Rp200,000,000,000.00 (two hundred billion rupiah). 5.00

8. Implementation of compliance functions, internal auditors, and external auditors. 7.50

9. Implementation of risk management and internal control systems. 10.00

10. Implementation of remuneration policies and other facilities. 2.50

11. Transparency of the Company's financial and non-financial conditions. 15.00

12. Long-term plans as well as annual work and budget plans. 7.50

13. Disclosure of share ownership. 5.00

14. Financial relationships and family relationships for the Board of Directors. 2.50

15. Financial relationships and family relationships for the Board of Commissioners. 2.50

16. Disclosure of other important matters 12.50
    TOTAL 100.00

b. for Financing Companies that have Sharia business units and Sharia Financing Companies No. Factor Weight (%)

1. Implementation of Duties and Responsibilities of the Board of Directors, Board of Commissioners, and SS Board. 37.50
2. Completeness and implementation of the duties of the audit committee or functions that assist the Board of Commissioners:
   a. For Financing Companies that have Sharia business units and Sharia Financing Companies that have total assets above Rp200,000,000,000.00 (two hundred billion rupiah); or b. For Financing Companies that have Sharia business units and Sharia Financing Companies that have total assets up to Rp200,000,000,000.00 (two hundred billion rupiah). 5.00
3. Implementation of compliance functions, internal auditors, and external auditors. 5.00
4. Implementation of risk management and internal control systems. 10.00
5. Implementation of remuneration policies and other facilities. 2.50
6. Transparency of the Company's financial and non-financial conditions. 15.00
7. Long-term plans as well as annual work and budget plans. 7.50
8. Disclosure of share ownership. 2.50
9. Financial relationships and family relationships for the Board of Directors. 2.50
10. Financial relationships and family relationships for the Board of Commissioners. 2.50
11. Disclosure of other important matters 10.00
    TOTAL 100.00
12. To obtain the composite value, the Company sums the values of all factors. Based on the composite value, the Company determines the composite value as follows in the table:
    Value Ranking Predicate
    84-100 1 Very Good
    68-83 2 Good
    52-67 3 Fairly Good
    36-51 4 Less Good
    20-35 5 Not Good
13. The self-assessment worksheet and supporting documents for self-assessment must be documented well so as to facilitate tracing by interested parties.

VI. ACTION PLAN

1. The action plan is prepared in order to improve or perfect the implementation of Good Corporate Governance as a follow-up to the results of the self-assessment. The action plan includes necessary corrective actions and completion time as well as obstacles/difficulties in completion, if there are still deficiencies in the implementation of Good Corporate Governance.
2. The action plan as referred to in Section III number 2 letter c is prepared by the Company according to the format as contained in Appendix III which is an integral part of this OJK Circular Letter.

VII. TIME FOR SUBMISSION OF THE REPORT ON THE IMPLEMENTATION OF GOOD CORPORATE GOVERNANCE

1. Companies are required to submit the report on the implementation of Good Corporate Governance for the current year to the OJK no later than April 30 of the following year.
2. If April 30 is a holiday, then the deadline for submitting the report is the next working day.

VIII. PROCEDURES FOR SUBMISSION OF THE REPORT ON THE IMPLEMENTATION OF GOOD CORPORATE GOVERNANCE

1. Companies are required to submit the report on the implementation of Good Corporate Governance which has been signed by the Board of Directors to the Executive Head of Insurance, Pension Funds, Financing Institutions, and Other Financial Service Institutions, with the following provisions:
   a. the cover letter for the submission of the report on the implementation of Good Corporate Governance signed by the Board of Directors is submitted in the form of computer printout (hardcopy); and b. the content of the report on the implementation of Good Corporate Governance is submitted in electronic form (softcopy).
2. Submission address for Financing Companies:
   Executive Head of Insurance, Pension Funds, Financing Institutions, and Other Financial Service Institutions Financial Services Authority u.p. Director of Financing Institution Supervision Menara Merdeka Tower, 19th Floor Jl. Budi Kemuliaan I Number 2 Jakarta 10110
3. Submission address for Financing Companies that have Sharia business units:
   Executive Head of Insurance, Pension Funds, Financing Institutions, and Other Financial Service Institutions Financial Services Authority u.p. Director of Financing Institution Supervision Menara Merdeka Tower, 19th Floor Jl. Budi Kemuliaan I Number 2 Jakarta 10110; and copied to:
   Director of Sharia IKNB
   Menara Merdeka Tower, 23rd Floor
   Jl. Budi Kemuliaan I Number 2
   Jakarta 10110
4. Submission address for Sharia Financing Companies:
   Executive Head of Insurance, Pension Funds, Financing Institutions, and Other Financial Service Institutions Financial Services Authority u.p. Director of Sharia IKNB Menara Merdeka Tower, 23rd Floor Jl. Budi Kemuliaan I Number 2 Jakarta 10110
5. In the event of a change in the OJK office address for the submission of reports as referred to in numbers 2, 3, and 4, the OJK will convey notification regarding the change of address via letter or announcement.

IX. CLOSING

Provisions in this OJK Circular Letter shall take effect on the date of determination.
Determined in Jakarta on May 9, 2016
EXECUTIVE HEAD OF INSURANCE, PENSION FUNDS,
FINANCING INSTITUTIONS, AND
OTHER FINANCIAL SERVICE INSTITUTIONS
FINANCIAL SERVICES AUTHORITY, signed
FIRDAUS DJAELANI

Copy in accordance with the original
Director of Law 1
Legal Department signed
Yuliana

APPENDIX I
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 15/SEOJK.05/2016 REGARDING THE REPORT ON THE IMPLEMENTATION OF GOOD CORPORATE GOVERNANCE FOR FINANCING COMPANIES

TRANSPARENCY OF THE IMPLEMENTATION OF GOOD CORPORATE GOVERNANCE A. Implementation of duties and responsibilities of the Board of Directors, Board of Commissioners, and SS Board.

1. Number, job title, date of passing and number of fit and proper test, date of appointment by GMS, term of office, nationality, and domicile of members of the Board of Directors, Board of Commissioners, and SS Board.
   No. Name Job Title Date Passed and Number of Fit and Proper Test Date of Appointment by GMS and term of office (years) Nationality Domicile 1. 2. Etc. Licensing Data for Board of Directors and Board of Commissioners of Foreign Nationality No. Name Job Title KITAS IMTA Work Permit Validity Period Permit Number Validity Period 1. 2. Etc. -Short biography of the Board of Directors, work history in the last five years, Education, and professional titles. -Short biography of the Board of Commissioners, work history in the last five years, Education, and professional titles. -Short biography of the SS Board, work history in the last five years, Education, and professional titles. In the event that there are changes in the composition of members of the Board of Directors, Board of Commissioners, and SS Board during the reporting year, the previous composition of members of the Board of Directors, Board of Commissioners, and SS Board must be stated in a table as follows:
   No. Name Job Title Date of Appointment by GMS Date of Dismissal by GMS
2. Duties and responsibilities of each member of the Board of Directors, Board of Commissioners, and SS Board
   -Short description-
3. Concurrent positions of the Board of Directors, Board of Commissioners, and SS Board
   a. Board of Directors
   No. Name Position at Company Position at Other Company Name of Other Company Business Field

Etc.
2. 1.
2.
Etc.
Etc. b. Board of Commissioners
No. Name Position at Company Position at Other Company Name of Other Company Business Field

1. 1.

Etc.
2. 1.
2.
Etc.
Etc.
c. SS Board
No. Name Position at Company Position at Other Company Name of Other Company Business Field

1. 1.

Etc.
2. 1.
2.
Etc.
Etc.
4. Training for the Board of Directors, Board of Commissioners, and SS Board.
Training related to improving the capabilities of the Board of Directors, Board of Commissioners, and SS Board in achieving the Company's vision and mission. a. Board of Directors No Name Workshop/training/seminar Date Organizer Place 1. 2. Etc b. Board of Commissioners No Name Workshop/training/seminar Date Organizer Place 1. 2. Etc
c. SS Board
No Name Workshop/training/seminar Date Organizer Place 1.
2.
Etc
5. Implementation of activities and recommendations of the Board of Commissioners and SS Board
-Short description-
6. Implementation of Independent Commissioner duties
-Short description-
7. Frequency of Board of Directors meetings, Board of Commissioners meetings, and SS Board meetings held in 1 (one) year
a. Board of Directors Meetings
-Short description regarding the implementation of meetings including the number of meetings- No. Name Number of Attendances % Attendance Physical Electronic Media 1. 2. Etc. b. Board of Commissioners Meetings -Short description regarding the implementation of meetings including the number of meetings- No. Name Number of Attendances % Attendance Physical Electronic Media 1. 2. Etc.
c. SS Board Meetings
-Short description regarding the implementation of meetings including the number of meetings- No. Name Number of Attendances % Attendance Physical Electronic Media 1. 2. Etc. B. Completeness and implementation of the duties of the audit committee or functions that assist the Board of Commissioners in monitoring and ensuring the effectiveness of the internal control system, consisting of:

1. Structure, membership, and expertise of the audit committee
   -Short description-
2. Duties and responsibilities of the audit committee
   -Short description-
3. Frequency of audit committee meetings
   No. Name of Audit Committee Members Audit Committee Meetings Number of Attendances % Attendance 1.

Etc.
4. Audit committee work program and its realization
-Short description-
5. Structure of other committees
-Short description-
6. Work programs related to the duties and responsibilities of other committees
-Short description-
C. Implementation of compliance functions, internal auditors, and external auditors.

1. Compliance Function
   a. Board of Directors members who oversee the compliance function -Short description- b. Work units or employees who carry out the compliance function -Short description-
   c. Compliance with legislation
   -Short description of the work unit's duties in the compliance function to ensure policies, regulations, systems, and procedures, as well as business activities carried out by the Company in accordance with legislation d. Company's financial health status -Short description regarding capital adequacy ratios, financing receivables quality/productive asset quality, profitability, and liquidity in the reporting period e. Ownership of work units or functions related to the implementation of anti-money laundering and counter-terrorism financing programs No. Person in Charge Unit Leader/Executor of the Function f. Ownership of work units or functions in handling and resolving complaints submitted by consumers No. Person in Charge Unit Leader/Executor of the Function
2. Internal Auditor Function
   Effectiveness and scope of implementation of internal auditor duties in assessing all aspects and elements of activities a. Scope of audit work -Short description- b. Structure or position of the internal audit work unit -Short description-
   c. Independence of internal auditors
   -Short description- d. Description of the internal audit work unit's duties -Short description- e. Profile of the head of the internal audit work unit -Short description- f. Number of employees in the internal audit work unit -Short description- g. Reports on the results of internal audit tasks. -Short description examples: branch office audits, head office audits, and information system technology audits -
3. External Auditor Function
   Effectiveness of the implementation of external auditor duties and company compliance with regulations, including regarding the provision of all accounting records and supporting data necessary for external auditors, so that external auditors can provide their opinion on the fairness, compliance, and suitability of the company's financial reports with applicable audit standards -Short description- Public Accounting Firm that conducted the Company's Financial Report audit in the last 5 (five) years Year Public Accounting Firm Name of Accountant (Individual) and Registration Number at OJK External Auditor Cost D. Implementation of risk management and internal control systems
4. Active supervision by the Board of Commissioners, Board of Directors, and SS Board
   -Short description example ensuring that Financing Companies and Sharia Financing Companies implement Good Corporate Governance
5. Sufficiency of policies, procedures, and risk limit determinations
   -Short description-
6. Sufficiency of risk identification, measurement, monitoring, and control processes
   -Short description-
7. Risk management information systems
   -Short description-
8. Comprehensive internal control systems
   -Short description-
   E. Implementation of remuneration policies and other facilities for members of the Board of Directors, Board of Commissioners, SS Board, and employees
9. Disclosure regarding remuneration policies and other facilities for members of the Board of Directors, Board of Commissioners, and SS Board
   a. Remuneration in non-natura form, including salaries and other fixed income, including allowances (benefits), stock-based compensation, dividends, and other forms of remuneration

b. Brief description of other facilities in the form of non-cash/non-cash, namely other non-fixed income, including allowances for housing, transportation, health insurance, and other facilities.

-Uraian singkat

2. Disclosure of remuneration packages or policies in 1 (one) year
   a. Remuneration packages or policies and other facilities for members of the Board of Directors, Board of Commissioners, and Sharia Supervisory Board (DPS) established by the Annual General Meeting of Shareholders (RUPS) -Uraian singkat b. Remuneration and other facilities for all members of the Board of Directors, Board of Commissioners, and DPS must at least cover the number of Board of Directors members, the number of Board of Commissioners members, the number of DPS members, and the total number of remuneration policies and other facilities.

-Uraian singkat

Amount received in one year	Remuneration *)	Other facilities in the form of natura )
Board of Directors
Number of Directors	Nominal (Millions of Rupiah)
Board of Commissioners
Number of Commissioners	Nominal (Millions of Rupiah)
DPS
Number of DPS	Nominal (Millions of Rupiah)

Note:
*) Includes salary and other fixed income, including allowances (benefits), share-based compensation, tantiem, and other forms of remuneration in non-natura form. ) Housing, transportation, health insurance, etc.

c. The number of Board of Directors, Board of Commissioners, and DPS members who received remuneration packages in 1 (one) year, grouped according to income level as follows:

Total Remuneration Per Person in 1 (one) year in cash	Number of Directors	Number of Commissioners	Number of DPS
Above Rp2,000,000,000.00 (two billion rupiah)
Above Rp1,000,000,000.00 (one billion rupiah) to Rp2,000,000,000.00 (two billion rupiah)
Above Rp500,000,000.00 (five hundred million rupiah) to Rp1,000,000,000.00 (one billion rupiah)
Rp500,000,000.00 (five hundred million rupiah) and below

-Uraian singkat

3. Ratio of highest and lowest salaries
   The salaries compared in the salary ratio are the compensation received by members of the Board of Directors, Board of Commissioners, and employees in the last month of the reporting year.

The ratio of highest and lowest salaries, on the following comparison scale:

1. ratio of highest and lowest employee salaries;
2. ratio of highest and lowest Board of Directors member salaries;
3. ratio of highest and lowest Board of Commissioners member salaries; and
4. ratio of highest Board of Directors member salary to highest employee salary.

-Uraian singkat

F. Transparency of the Company's financial and non-financial conditions not yet disclosed in other reports -Uraian singkat Examples: disclosure of the company's rating results conducted by rating agencies, transparency regarding financing services presented in the form of brochures, leaflets, and other promotional media as well as on the company website, transparency regarding complaint procedures and dispute resolution for Debtors, and share buy-backs.

-G. Long-term plans as well as annual work and budget plans

1. Long-term plans and work plans
   -Uraian singkat
2. Annual budget
   -Uraian singkat

H. Disclosure of share ownership by Board of Directors and Board of Commissioners members reaching 50% (fifty percent) or more, including the type and number of share certificates

No.	Name	Category of Share Ownership *)	Total	Nominal Share Ownership	Percentage of Share Ownership
1.	A
	B
	C
	D
2.	A
	B
	C
	D
...	A
	B
	C
	D

Note:
A. The Company itself;
B. Other financing companies;
C. Financial service companies other than financing companies; and
D. Other companies located inside or outside the country, including shares obtained through the stock exchange.

I. Disclosure of financial relationships and family relationships of Board of Directors and Board of Commissioners members with other Board of Directors members, Board of Commissioners members, DPS members, and/or shareholders of the Company

No.	Name	Relationship with	Form of Relationship	Notes
		Financial	Family
		Yes	No	Yes	No
1.	Other Directors	Board of Commissioners	DPS	Shareholders
2.	Other Directors	Board of Commissioners	DPS	Shareholders
...	Other Directors	Board of Commissioners	DPS	Shareholders

Note:
Financial Relationship is when a person receives income, financial assistance, or loans from Board of Commissioners and/or Board of Directors members, companies whose Controlling Shareholders are Board of Commissioners and/or Board of Directors members of the Company, and/or Controlling Shareholders of the Company. Family Relationship is having a family relationship up to the second degree, both vertical and horizontal, including in-laws, so that family includes biological/step/adoptive parents, biological/step/adoptive siblings along with their spouses, biological/step/adoptive children, biological/step/adoptive grandparents, biological/step/adoptive grandchildren, biological/step/adoptive siblings of parents along with their spouses, in-laws, spouses of biological/step/adoptive children, grandparents of spouses, spouses of biological/step/adoptive grandchildren, and biological/step/adoptive siblings of spouses along with their spouses.

J. Disclosure of other important matters:

1. Resignation or dismissal of Independent Commissioners
   -Uraian singkat
2. Resignation or dismissal of external auditors
   -Uraian singkat
3. Certification

No.	Certification Material	Place/Date of Organizer
1.
2.
...

4. Foreign Workers

No.	Name	Position	Fit and Proper Test Number	KITAS IMTA Permit Number	Work Permit Number	Validity Period of Permit	Validity Period
1.
2.
...

5. Material transactions with related parties
   -Uraian singkat
6. Conflicts of interest that are ongoing and/or may occur
   Examples of conflicts of interest that are ongoing and/or may occur include the purchase of company assets by Board of Directors members, Board of Commissioners members, DPS members, and/or company employees.

No.	Name and Position of Party with Conflict of Interest	Name and Position of Decision Maker	Type of Transaction	Transaction Value (Millions of Rupiah)	Notes *)
1.
2.
...

Note:
*) Not in accordance with applicable systems and procedures

-Uraian singkat regarding conflicts of interest

7. Number of Internal Deviations (Internal Fraud)

Internal Deviations in 1 (one) year	Number of cases committed by Board of Commissioners Members, DPS Members, and Board of Directors Members	Employees (Permanent)	Employees (Non-Permanent)	Total Deviations
Completed
In Process of Resolution Internally
Resolution Not Yet Attempted
Action Taken Through Legal Process

8. Legal Issues

Legal Issues	Number of Cases
Civil	Criminal
Has obtained a decision with permanent legal force
a.
b.
In the process of resolution in Court and Alternative Dispute Resolution Institutions for Civil cases
a.
b.
Total

9. Company Business Ethics
   -Uraian singkat regarding the business ethics values of the Company that serve as guidelines for the Company's organs and all employees.

10. Other material information regarding the Company related to the implementation of RUPS authority and the implementation of Good Corporate Governance, including but not limited to owner intervention, internal disputes, or problems arising as a result of remuneration policies on the Company.

-Uraian singkat

Approved,

THE BOARD OF DIRECTORS

Established in Jakarta on 9 May 2016

HEAD OF EXECUTIVE SUPERVISOR
OF INSURANCE, PENSION FUNDS,
FINANCING INSTITUTIONS, AND
OTHER FINANCIAL SERVICE INSTITUTIONS
FINANCIAL SERVICES AUTHORITY,

signed

FIRDAUS DJAELANI

Copy in accordance with the original

Legal Director 1
Legal Department

signed

Yuliana

APPENDIX II
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 15/SEOJK.05/2016 REGARDING THE REPORT ON THE IMPLEMENTATION OF GOOD CORPORATE GOVERNANCE FOR FINANCING COMPANIES

SELF-ASSESSMENT ON THE IMPLEMENTATION OF GOOD CORPORATE GOVERNANCE

The filling out of the Questionnaire on the Implementation of Good Corporate Governance for Financing Companies is conducted by the respective Financing Companies and Sharia Financing Companies. The filling out of this questionnaire is done by providing answers to the questions/statements in the said questionnaire.

A. Implementation of duties and responsibilities of the Board of Directors, Board of Commissioners, and DPS.

1. Board of Directors

No.	Question/Statement
1.	Company Directors reside in Indonesia.	Yes No
2.	Companies with foreign ownership, direct or indirect, have at least 50% (fifty percent) of Board of Directors members who are Indonesian citizens.	Yes No
3.	Foreign nationality Directors have a residence permit.	Yes No
4.	Foreign nationality Directors have a work permit from the competent authority.	Yes No
5.	Directors have relevant knowledge for their position as Directors.	1 2 3 4 5
6.	Directors do not hold concurrent positions as Directors in other companies.	Yes No
7.	Each Director has passed the competency and propriety test.	Yes No
8.	Directors are able to act with good faith, honesty, and professionalism.	1 2 3 4 5
9.	Directors act in the interest of the Company and other stakeholders.	1 2 3 4 5
10.	Directors prioritize the interest of the Company and/or other stakeholders over personal interests.	1 2 3 4 5
11.	Directors are able to make decisions based on independent assessment for the interest of the Company and debtors, creditors, and/or other stakeholders.	1 2 3 4 5
12.	Directors are able to be objective for the interest of the Company and debtors, creditors, and/or other stakeholders.	1 2 3 4 5
13.	Directors comply with laws and regulations, the Articles of Association, and other internal regulations of the Company in carrying out their duties.	1 2 3 4 5
14.	Directors manage the Company in accordance with their authority and responsibility.	1 2 3 4 5
15.	Directors are able to account for the implementation of their duties to the RUPS.	1 2 3 4 5
16.	Directors have ensured that the Company pays attention to the interests of all parties, especially the interests of debtors, creditors, and/or other stakeholders.	1 2 3 4 5
17.	Directors have provided timely and complete information regarding the Company to the Board of Commissioners and DPS.	1 2 3 4 5
18.	Directors have assisted and provided facilities and/or resources for the smooth implementation of the duties and authority of the Company's organs and DPS.	1 2 3 4 5
19.	Directors are able to avoid transactions that have Conflicts of Interest with the Company's activities where the respective Director holds office.	1 2 3 4 5
20.	Directors are able not to utilize their position at the Company where they hold office for personal, family, and/or third-party interests that harm or reduce the profit of the Company where they hold office.	1 2 3 4 5
21.	Directors are able to avoid acts of taking and/or receiving personal benefits from the Company where they hold office, other than remuneration and facilities established based on RUPS decisions.	1 2 3 4 5
22.	Directors are able to avoid shareholder requests related to the operational activities of the Company where they hold office, other than those established in the RUPS.	1 2 3 4 5
23.	Directors follow training related to improving the Company's human resource capabilities in achieving the Company's vision and mission.	Yes No
24.	The Company's Board of Directors holds Board of Directors meetings periodically at least 1 (one) time in 1 (one) month.	Yes No
25.	Directors attend at least 50% (fifty percent) of the total Board of Directors meetings in a 1 (one) year period.	Yes No
26.	Board of Directors meeting results are recorded in the Board of Directors meeting minutes.	1 2 3 4 5
27.	Meeting minutes that are joint decisions of all Board of Directors members have been well documented.	1 2 3 4 5
28.	Board of Directors decisions have been recorded in the meeting minutes, including dissenting opinions that occurred clearly.	1 2 3 4 5
29.	The number of Board of Directors meetings held and the attendance of each Board of Directors member are included in the report on the implementation of Good Corporate Governance.	Yes No
30.	Directors are able to guarantee effective, precise, and fast decision-making, and can act independently, without interests that can disturb their ability to carry out duties independently and objectively.	1 2 3 4 5

2. Board of Commissioners

No.	Question/Statement
1.	The Company has at least 1 (one) Board of Commissioners member residing in Indonesia.	Yes No
2.	Foreign nationality Board of Commissioners members have a work permit from the competent authority.	Yes No
3.	Foreign nationality Board of Commissioners members have a residence permit from the competent authority.	Yes No
4.	Board of Commissioners members do not hold concurrent positions as Board of Commissioners in more than 3 (three) other companies.	Yes No
5.	Each Board of Commissioners member has passed the competency and propriety test.	Yes No
6.	Board of Commissioners members follow training related to improving the Company's human resource capabilities in achieving the Company's vision and mission.	Yes No
7.	The Board of Commissioners is able to carry out supervisory duties and provide advice to the Board of Directors.	1 2 3 4 5
8.	The Board of Commissioners is able to supervise the Board of Directors in maintaining the balance of interests of all parties.	1 2 3 4 5
9.	The Board of Commissioners prepares a Board of Commissioners activity report which is part of the report on the implementation of Good Corporate Governance.	Yes No
10.	The Board of Commissioners is able to monitor the effectiveness of the implementation of Good Corporate Governance.	1 2 3 4 5
11.	The Board of Commissioners is able to give approval when DPS requires the assistance of committee members whose organizational structure is below the Board of Commissioners.	1 2 3 4 5
12.	The Board of Commissioners is able to ensure that the Board of Directors has followed up on audit findings and recommendations from the Company's internal audit work units, external auditors, OJK supervision results, and/or other authority supervision results.	1 2 3 4 5
13.	Board of Commissioners members are able not to conduct transactions that have Conflicts of Interest with the Company's activities where they hold office.	1 2 3 4 5
14.	Board of Commissioners members are able not to utilize their position at the Company where they hold office for personal, family, and/or third-party interests that can harm or reduce the profit of the Company where they hold office.	1 2 3 4 5
15.	Board of Commissioners members are able to avoid acts of taking and/or receiving personal benefits from the Company where they hold office, other than remuneration and facilities established based on RUPS decisions.	1 2 3 4 5
16.	Board of Commissioners members are able not to interfere with the operational activities of the Company which are the responsibility of the Board of Directors.	1 2 3 4 5
17.	The Board of Commissioners forms other committees besides the audit committee to support the implementation of the Board of Commissioners' duties.	Yes No
18.	The Company's Board of Commissioners members hold Board of Commissioners meetings periodically at least 1 (one) time in 3 (three) months.	Yes No
19.	Board of Commissioners members attend at least 75% (seventy-five percent) of the total Board of Commissioners meetings in a 1 (one) year period.	Yes No
20.	Board of Commissioners meeting results are recorded in the Board of Commissioners meeting minutes.	1 2 3 4 5
21.	Meeting minutes that are joint decisions of all Board of Commissioners members have been well documented.	1 2 3 4 5
22.	Board of Commissioners decisions have been recorded in the meeting minutes, including dissenting opinions that occurred clearly.	1 2 3 4 5
23.	The number of Board of Commissioners meetings held and the attendance of each Board of Commissioners member are included in the report on the implementation of Good Corporate Governance.	Yes No
24.	The Board of Commissioners is able to guarantee effective, precise, and fast decision-making and can act independently in carrying out duties.	1 2 3 4 5

3. Sharia Supervisory Board (DPS) (Filled only by Sharia Financing Companies and Financing Companies with Sharia business units).

No.	Question/Statement
1.	DPS is appointed by RUPS based on the recommendation of the National Sharia Council – Indonesian Ulema Council.	Yes No
2.	The appointment of DPS by RUPS is recorded in a notarial deed.	Yes No
3.	DPS members provide recommendations regarding the implementation of Board of Directors' duties concerning Sharia aspects of the Company's operational activities.	Yes No
4.	DPS is able to act as a representative of the Sharia Financing Company or Sharia Business Unit (UUS) at the National Sharia Council – Indonesian Ulema Council.	1 2 3 4 5
5.	DPS members have passed the competency and propriety test.	Yes No
6.	DPS members do not hold concurrent positions as Board of Directors or Board of Commissioners members in the same Financing Company.	Yes No
7.	DPS members do not hold concurrent positions as Board of Directors, Board of Commissioners, or DPS members in more than 4 (four) other Sharia financial institutions.	Yes No
8.	DPS members follow training related to improving the Company's human resource capabilities in achieving the Company's vision and mission.	Yes No
9.	DPS is able to act with good faith, honesty, and professionalism.	1 2 3 4 5
10.	DPS is able to act in the interest of the Sharia Financing Company, UUS, and/or other stakeholders.	1 2 3 4 5
11.	DPS is able to prioritize the interest of the Sharia Financing Company, UUS, and/or other stakeholders over personal interests.	1 2 3 4 5
12.	DPS is able to make decisions based on independent and objective assessment for the interest of the Sharia Financing Company, UUS, and/or other stakeholders.	1 2 3 4 5
13.	DPS is able to avoid the abuse of authority to obtain improper personal benefits or cause losses to the Sharia Financing Company and UUS.	1 2 3 4 5
14.	The DPS of the Sharia Financing Company and UUS is able to guarantee effective, precise, and fast decision-making and act independently, without interests that can disturb their ability to carry out duties independently and objectively.	1 2 3 4 5
15.	DPS is able to carry out responsibilities in the form of providing advice and suggestions to the Board of Directors so that the activities of the Sharia Financing Company or UUS are in accordance with Sharia principles.	1 2 3 4 5
16.	DPS carries out supervision and provides advice and suggestions regarding Sharia Financing activities.	1 2 3 4 5
17.	DPS carries out supervision and provides advice and suggestions regarding Sharia Financing contracts marketed by the Sharia Financing Company and UUS.	1 2 3 4 5
18.	DPS carries out supervision and provides advice and suggestions regarding Sharia Financing marketing practices conducted by the Sharia Financing Company and UUS.	1 2 3 4 5
19.	In carrying out duties, DPS is assisted by committee members and/or employees whose organizational structure is below the Board of Commissioners and/or Board of Directors.	Yes No
20.	DPS members receive complete and timely information from the Board of Directors regarding the Sharia Financing Company and UUS.	1 2 3 4 5
21.	DPS members hold meetings periodically at least 6 (six) times in 1 (one) year.	Yes No
22.	DPS member meeting results are recorded in the DPS meeting minutes.	1 2 3 4 5
23.	Meeting minutes that are joint decisions of all DPS members have been well documented.	1 2 3 4 5
24.	DPS decisions have been recorded in the meeting minutes, including dissenting opinions that occurred clearly.	1 2 3 4 5
25.	The number of DPS meetings held and the attendance of each DPS member are included in the report on the implementation of Good Corporate Governance.	Yes No
26.	DPS members are able not to conduct transactions that have conflicts of interest with the activities of the Sharia Financing Company and UUS where they hold office.	1 2 3 4 5
27.	DPS members are able not to utilize their position for personal, family, and/or third-party interests that reduce assets or reduce the profit of the Sharia Financing Company and UUS where they hold office.	1 2 3 4 5
28.	DPS members do not take and/or receive personal benefits from the Sharia Financing Company and UUS where they hold office, other than remuneration and other facilities established based on RUPS.	1 2 3 4 5
29.	DPS requests explanations from Board of Directors members regarding policies or actions of Board of Directors members that are not in accordance with Sharia Principles concerning Sharia Financing activities, Sharia Financing contracts marketed by the Financing Company and UUS, and Sharia Financing marketing practices conducted by the Sharia Financing Company and UUS.	1 2 3 4 5
30.	DPS reports completely and comprehensively to OJK and copies the Board of Directors since the explanation of Board of Directors members is received by DPS regarding the Board of Directors' rejection of the DPS assessment results on the implementation of Sharia Principles by the Board of Directors.	1 2 3 4 5
31.	DPS immediately reports completely and comprehensively to OJK and copies the Board of Directors since it is known that Board of Directors members do not make improvement efforts as requested by DPS to be in accordance with Sharia Principles.	1 2 3 4 5

B. Completeness and implementation of duties of the audit committee or function that assists the Board of Commissioners in monitoring and ensuring the effectiveness of the internal control system a. For Companies with total assets more than Rp200,000,000,000.00 (two hundred billion rupiah)

No.	Question/Statement
1.	The Company has an audit committee.	Yes No
2.	The Chairman of the audit committee is one of the Independent Commissioners.	Yes No
3.	The audit committee is able to assist the Board of Commissioners in monitoring and ensuring the effectiveness of the internal control system and external auditors by monitoring and evaluating the planning and implementation of audits in order to assess the adequacy of internal controls including the financial reporting process.	1 2 3 4 5
4.	The Board of Commissioners forms other committees besides the audit committee to support the implementation of the Board of Commissioners' duties.	Yes No
5.	The Company has a committee structure.	Yes No
6.	Each committee member has expertise in carrying out their duties.	Yes No
7.	The audit committee holds meetings regularly.	1 2 3 4 5
8.	The audit committee has a committee work program.	Yes No
9.	The audit committee reports on the realization of the committee work program.	Yes No

b. For Companies with total assets less than Rp200,000,000,000.00 (two hundred billion rupiah)

No.	Question/Statement
1.	The Company has a work unit or employees who monitor the implementation of audits.	Yes No

No. Question/Statement
2. The work unit or employee who monitors the implementation of independent audits.
1 2 3 4 5
3. The work unit or employee who monitors the implementation of audits monitors and ensures the effectiveness of the internal control system and external auditors by monitoring and evaluating the planning and implementation of audits to assess the adequacy of internal controls, including the financial reporting process.
1 2 3 4 5
4. The Company establishes another work unit to support the implementation of the Board of Commissioners' duties.
Yes No
5. The work unit or employee who monitors the implementation of audits has a structure.
Yes No
6. The work unit or employee who monitors the implementation of audits has expertise in performing their duties.
Yes No
7. The work unit or employee who monitors the implementation of audits regularly holds meetings.
1 2 3 4 5
8. The work unit or employee who monitors the implementation of audits has a work program.
Yes No

No. Question/Statement
9. The work unit or employee who monitors the implementation of audits reports the realization related to the work program to the Board of Commissioners.
Yes No
C. Implementation of Compliance Function, Internal Auditor, and External Auditor

1. Compliance Function
   No. Question/Statement
2. The Company has a Board of Directors member who oversees the compliance function.
   Yes No
3. The Company has a work unit or employee who performs the compliance function.
   Yes No
4. The Board of Directors member who oversees the compliance function is able to ensure that the Company's policies, regulations, systems, procedures, and business activities comply with applicable laws and regulations.
   1 2 3 4 5
5. The Board of Directors member who oversees the compliance function is able to ensure the Company's compliance with commitments made by the Company to the OJK and/or other competent supervisory authorities.
   1 2 3 4 5
6. The work unit or employee who performs the compliance function
   1 2 3 4 5

No. Question/Statement assists the Board of Directors in ensuring compliance with laws and regulations in the financing business and other applicable laws and regulations.
6. The work unit or employee who performs the compliance function is able to account for the implementation of their duties to the Board of Directors member who oversees the compliance function.
1 2 3 4 5
2. Internal Auditor Function
No. Question/Statement

1. The Company has an internal auditor.
   Yes No
2. The internal auditor has an audit work scope.
   Yes No
3. The internal auditor has an organizational structure.
   Yes No
4. The internal auditor is independent.
   Yes No
5. The internal auditor reports the results of the internal audit task implementation.
   Yes No
6. External Auditor Function
   No. Question/Statement
7. The Company uses external auditor services.
   Yes No
8. The external auditor is proposed by the Board of Commissioners upon the proposal of the Audit Committee.
   Yes No

No. Question/Statement
3. The external auditor is appointed by the General Meeting of Shareholders (GMS).
Yes No
4. The Company provides all accounting records and data required by the external auditor.
Yes No
5. The external auditor is independent.
Yes No
6. The Company has used the same Public Accountant Office in the last 6 (six) years.
Yes No
D. Implementation of Risk Management and Internal Control System

1. Execution of Independent Commissioner's Main Duties
   No. Question/Statement
2. The Independent Commissioner reports to the OJK no later than 10 (ten) calendar days from the discovery of violations of laws and regulations in the financing field.
   Yes No
3. The Independent Commissioner reports to the OJK no later than 10 (ten) calendar days from the discovery of conditions or estimated conditions that may endanger the Company's business continuity.
   Yes No
4. Active Supervision of the Board of Commissioners
   No. Question/Statement
5. The Company implements
   Yes No

No. Question/Statement risk management and internal control systems.
2. Active supervision of the Board of Commissioners and Board of Directors, including conducting assessments to identify, analyze, evaluate, and manage risks.
1 2 3 4 5
3. The Company implements risk management by identifying, evaluating, monitoring, and managing risks effectively.
1 2 4 5 5
4. Risk management is appropriate to the Company's objectives, business policies, size, and complexity of business, as well as the Company's capabilities.
1 2 4 5 5
3. Adequacy of Policies, Procedures, and Risk Limit Determination
No. Question/Statement

1. The Company's risk management implementation considers the adequacy of policies in risk management.
   Yes No

2. The Company's risk management implementation considers procedures in risk management.
   Yes No

3. The Company's risk management implementation considers the determination of risk limits in risk management.
   Yes No

4. Adequacy of Risk Identification, Measurement, Monitoring, and Control Processes
   No. Question/Statement

5. The Company's risk management implementation considers the adequacy of the identification process in risk management.
   Yes No

6. The Company's risk management implementation considers measurement in risk management.
   Yes No

7. The Company's risk management implementation considers monitoring and control of risks.
   Yes No

8. Risk Management Information System
   No. Question/Statement

9. The risk management information system presents reports on operational activities in the financing field.
   Yes No

10. The risk management information system presents reports on financial activities in the financing field.
    Yes No

11. The risk management information system presents reports on compliance with laws and regulations in the financing field.
    Yes No

12. Comprehensive Internal Control System
    No. Question/Statement

13. The comprehensive internal control system is implemented optimally.
    1 2 3 4 5

14. The comprehensive internal control system considers reporting mechanisms in the event of discrepancies.
    Yes No
    E. Implementation of Remuneration Policies and Other Facilities

15. Disclosure Regarding Remuneration Policies and Other Facilities for Board of Directors, Board of Commissioners, and DPS Members
    No. Question/Statement

16. The Company implements remuneration policies for Board of Directors members, Board of Commissioners members, DPS members, and employees that encourage prudent behavior aligned with the Company's long-term interests and fair treatment of debtors, creditors, and/or other stakeholders.
    1 2 3 4 5

17. Remuneration policies consider financial performance and the fulfillment of the Company's obligations as regulated by applicable laws and regulations.
    1 2 3 4 5

18. Remuneration policies
    1 2 3 4 5

No. Question/Statement consider individual performance.
4. Remuneration policies consider fairness with the Company and/or peer group levels.
1 2 3 4 5
5. Remuneration policies consider considerations of the Company's long-term goals and strategies.
1 2 3 4 5
6. Board of Directors, Board of Commissioners, and DPS members receive remuneration in non-natura form.
Yes No
7. Board of Directors, Board of Commissioners, and DPS members receive remuneration in natura form.
Yes No
2. Disclosure of Remuneration Packages or Policies in 1 (one) year
No. Question/Statement

1. Remuneration packages or other facilities for Board of Directors, Board of Commissioners, and DPS members determined by the GMS.
   Yes No
2. Remuneration and other facilities for all Board of Directors, Board of Commissioners, and DPS members must at least include the number of Board of Directors members, the number of Board of Commissioners members, the number of DPS members, and the total number of remuneration policies and other facilities.
   Yes No

No. Question/Statement
3. The number of Board of Directors, Board of Commissioners, and DPS members receiving remuneration packages in 1 (one) year, grouped by income level.
Yes No
3. Ratio of Highest and Lowest Salaries
No. Question/Statement

1. The Company submits the ratio of highest to lowest salaries.
   Yes No
   F. Transparency of Company's Financial and Non-Financial Conditions No. Question/Statement
2. The Company implements transparency of financial and non-financial conditions to stakeholders.
   1 2 3 4 5
3. The Company provides complete and timely data and information to the OJK.
   1 2 3 4 5
4. The Company explains financing agreements as well as the rights and obligations of debtors in each financing transaction.
   1 2 3 4 5
5. The Company has a reliable financial reporting system for supervision and other stakeholders.
   1 2 3 4 5
6. The Company conducts promotions
   Yes No

No. Question/Statement regarding financing services.
6. The Company transparently submits the complaint handling and dispute resolution procedures to debtors.
Yes No
G. Long-Term Plans, Work Plans, and Annual Budgets No. Question/Statement

1. The Company formulates the Company's long-term plan.
   Yes No
2. The Company formulates the Company's work plan.
   Yes No
3. The Company formulates the Company's annual budget.
   Yes No
4. The long-term plan, work plan, and annual budget of the Company are submitted to the OJK.
   Yes No
   H. Disclosure of Shareholdings of Board of Directors and Board of Commissioners Members Reaching 50% (Fifty Percent) or More No. Question/Statement
5. The Company reports shareholdings of Board of Directors and Board of Commissioners members reaching 50% (fifty percent) or more in the Company.
   Yes No
6. The Company reports shareholdings of Board of Directors and Board of Commissioners members reaching 50% (fifty percent) or more in other financing companies.
   Yes No

No. Question/Statement
3. The Company reports shareholdings of Board of Directors and Board of Commissioners members reaching 50% (fifty percent) or more in financial services companies other than Financing Companies.
Yes No
4. The Company reports shareholdings of Board of Directors and Board of Commissioners members reaching 50% (fifty percent) or more in other companies located domestically or abroad, including shares obtained through the stock exchange.
Yes No
I. Financial Relationships and Family Relationships for Board of Directors
No. Question/Statement

1. The Company reports the financial relationships of Board of Directors members with other Board of Directors members, Board of Commissioners members, DPS members, and/or shareholders of the Company where the respective Board of Directors members serve.
   Yes No
2. The Company reports the family relationships of Board of Directors members with other Board of Directors members, Board of Commissioners members, DPS members, and/or shareholders of the Company where the respective Board of Directors members serve.
   Yes No

J. Financial Relationships and Family Relationships for Board of Commissioners No. Question/Statement

1. The Company reports the financial relationships of Board of Commissioners members with other Board of Commissioners members, Board of Directors members, DPS members, and/or shareholders of the Company where the respective Board of Commissioners members serve.
   Yes No
2. The Company reports the family relationships of Board of Commissioners members with other Board of Commissioners members, Board of Directors members, DPS members, and/or shareholders of the Company where the respective Board of Commissioners members serve.
   Yes No
   K. Disclosure of Other Important Matters to the OJK
3. Resignation or Dismissal of Independent Commissioner, DPS, and/or External Auditor
   No. Question/Statement
4. The Independent Commissioner reports to the OJK no later than 10 (ten) calendar days from the discovery of violations of laws and regulations in the financing field.
   Yes No
5. The Independent Commissioner reports to the OJK no later than 10 (ten) calendar days from the discovery of violations of laws and regulations in the financing field and/or conditions or estimated conditions
   Yes No

No. Question/Statement that may endanger the Company's business continuity.
3. The Company discloses to the OJK regarding the resignation of the Independent Commissioner.
Yes No
4. The resigning Independent Commissioner submits reasons for resignation to the OJK.
Yes No
5. The Company discloses to the OJK regarding the dismissal of the Independent Commissioner.
Yes No
6. The Company submits the reasons for the dismissal of the Independent Commissioner to the OJK.
Yes No
7. The Company discloses to the OJK regarding the resignation of the DPS.
Yes No
8. The resigning DPS submits reasons for resignation to the OJK.
Yes No
9. The Company discloses to the OJK regarding the dismissal of the DPS.
Yes No
10. The Company submits the reasons for the dismissal of the DPS to the OJK.
Yes No
11. The Company discloses to the OJK regarding the resignation of the external auditor.
Yes No
12. The resigning external auditor
Yes No

No. Question/Statement submits reasons for resignation to the OJK.
13. The Company discloses to the OJK regarding the dismissal of the external auditor.
Yes No
14. The Company submits the reasons for the dismissal of the external auditor to the OJK.
Yes No
2. Material Transactions with Related Parties
No. Question/Statement

1. The Company has disclosed to the OJK regarding material transactions with other parties.
   Yes No
2. Conflicts of Interest
   No. Question/Statement
3. The Company has disclosed to the OJK regarding conflicts of interest currently ongoing with other parties.
   Yes No
4. The Company has disclosed to the OJK regarding Company transactions that have potential conflicts of interest with other companies.
   Yes No
5. Other Material Information Regarding the Company Related to Good Corporate Governance
   No. Question/Statement
6. There is no intervention from the Company's owners.
   1 2 3 4 5
7. There are no internal disputes
   1 2 3 4 5

No. Question/Statement within the Company.
3. There are no problems resulting from the Company's remuneration policies.
1 2 3 4 5
5. Internal Discrepancies
No. Question/Statement

1. There are no discrepancies committed by Board of Commissioners members, Board of Directors members, and DPS members.
   Yes No

2. There are no discrepancies committed by permanent employees.
   Yes No

3. There are discrepancies committed by non-permanent employees.
   Yes No

4. The Company provides mediation for resolving internal discrepancies.
   Yes No

5. The resolution of internal discrepancies involves legal processes.
   1 2 3 4 5

6. Legal Issues
   No. Question/Statement

7. The Company has legal issues that are civil cases.
   Yes No

8. The Company has legal issues that are criminal cases.
   Yes No

9. Business Ethics
   No. Question/Statement

10. The Board of Directors, Board of Commissioners, DPS, and Company employees are able not to offer or provide anything, directly or indirectly, to other parties, to influence decision-making related to financing transactions, in violation of applicable laws and regulations.
    1 2 3 4 5

11. The Board of Directors, Board of Commissioners, DPS, and Company employees are able not to receive anything for personal interests in violation of applicable laws and regulations, directly or indirectly, from anyone, which can influence decision-making related to financing transactions.
    1 2 3 4 5

12. The Company has guidelines on ethical behavior, containing business ethics values as a guide for the Company's organs and all Company employees.
    Yes No

L. General Conclusion of Self-Assessment Results
General Conclusion Description
Approving,
THE BOARD OF DIRECTORS
Established in Jakarta on May 9, 2016
EXECUTIVE HEAD OF INSURANCE, PENSION FUNDS,
FINANCING INSTITUTIONS, AND
OTHER FINANCIAL SERVICES INSTITUTIONS SUPERVISOR FINANCIAL SERVICES AUTHORITY, sd FIRDAUS DJAELANI Copy matches the original Legal Director 1 Legal Department sd Yuliana

APPENDIX III
CIRCULAR LETTER OF THE FINANCIAL SERVICES AUTHORITY NUMBER 15 /SEOJK.05/2016 REGARDING THE REPORT ON THE IMPLEMENTATION OF GOOD CORPORATE GOVERNANCE FOR FINANCING COMPANIES

ACTION PLAN
No. Action
Corrective Target Completion Obstacles
Completion Remarks
1.
2.
3.
Etc.
Approving,
THE BOARD OF DIRECTORS
Established in Jakarta on May 9, 2016
EXECUTIVE HEAD OF INSURANCE, PENSION FUNDS,
FINANCING INSTITUTIONS, AND
OTHER FINANCIAL SERVICES INSTITUTIONS SUPERVISOR FINANCIAL SERVICES AUTHORITY, sd FIRDAUS DJAELANI Copy matches the original Legal Director 1 Legal Department sd Yuliana