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DOCUMENT REQUIREMENTS FOR BUSINESS & OPERATIONAL ASSESSMENT

Company Types : A. Private Company or its Trading Arm : • Companies belong to this category are private companies which do not belong to other categories. • Companies belong to this category are eligible to participate in Pertamina’s Crude and / or Condensate and / or Refinery Products tender.

B. KKKS or its Trading Arm : 1. Companies belong to this category are those which are appointed by SKK Migas to sell Crude Oil / Condensate & Domestic LPG or its trading arm. 2. Companies belong to this category are not eligible to participate in Pertamina’s Crude Oil and / or Condensate and / or Refinery Products tender.

C. NOC or its Trading Arm : 1. Companies belong to this category are (NOC) or its Trading Arm. 2. Companies belong to this category are eligible to participate in Pertamina’s Crude Oil and / or Condensate and / or Refinery Products tender.

D. G-to-G : 1. Companies belong to this category are companies which hold a Government-to-Government Agreement between the Government of Indonesia and its counterparty; or its Trading Arm; 2. Companies belong to this category are not eligible to participate in Pertamina’s Crude Oil and / or Condensate and / or Refinery Products tender.

E. PI or its Trading Arm : 1. Companies belong to this category are companies which hold a Participating Interest / License / Concession in an area (for producer of crude) or proving ownership of refinery (for producer of refined product); or its Trading Arm; 2. Companies belong to this category are not eligible to participate in Pertamina’s Crude Oil and / or Condensate and / or Refinery Products tender.

Type A Type B Type C Type D Type E BUSINESS & OPERATIONAL Documents Company Company Company Company Company 1 Your esteemed Company’s Website address; Ѵ 2 Company Profile; Ѵ 3 Integrity Pact (format as attached); Ѵ 4 Statement Letter (format as attached); Ѵ 5 Know Your Counterparty (KYC) Form (format as Ѵ attached in excel sheet); 6 Documents and/or Sales and/or Purchase data Ѵ Ѵ Ѵ of Crude/Refined Products/LPG. *)

Notes : a) All required documents shall be provided in softcopy or hardcopy (based on request) b) Kindly send the PDF scanned copy (maximum 20MB/email) of complete required documents to our email [email protected] c) *) Documents number 6 (Contract, B/L, and Invoice) are optional as per request by PT Pertamina (Persero) or the third party consultant appointed by PT Pertamina (Persero) d) All documents submitted are confidential and used solely for counterparty registration / reregistration / due diligence purpose e) PT Pertamina (Persero) reserves the right not to assess uncompleted documents

(insert company letterhead)

INTEGRITY PACT

Name : Company Name : Position :

We certify that :

That the Company and the employees do not have a conflict of interest with PT Pertamina (Persero), which makes the Company be inappropriate to act as Business Partners of PT Pertamina (Persero), including : a. The direct economic interests, the association relationship or other relationship (whether personal or family) with joint venture companies PT Pertamina (Persero) or employee or the Commissioner or the Board of Directors or controlling shareholders or guarantors referred to the Joint Venture Company, or indirect economic interest that are material to the Joint Venture Company referred to; b. During the work process and thereafter will not act intentionally or unintentionally, including but not limited to accepting work from any party directly or indirectly, that have or result in a conflict of interest between the Company and PT Pertamina (Persero) or Joint Ventures referred to; c. That in the event of conflict of interest as intended, for the consideration of PT Pertamina (Persero), PT Pertamina (Persero) has the right and authority to: i) terminate the participation of Company in the process of the Works or; ii) terminate the Agreement / Contract in the case of Company designated as the Contractor and Company solely responsible for the legal consequences that happen as well as provide compensation if the result of a conflict of interest is detrimental to PT Pertamina (Persero) and other parties. If PT Pertamina (Persero) found any discrepancy in the future on such statements above, the Company would receive administrative sanctions in accordance with applicable provisions of PT Pertamina (Persero). We make this statement to be used properly in order to fulfill one of the requirements for the Procurement Process at PT Pertamina (Persero).

[place], [date] [month] [year]

Sincerely, [company name]

( name ) Position :

(insert company letterhead)

SURAT PERNYATAAN DAN KOMITMEN SALE PURCHASE AGREEMENT/ STATEMENT LETTER AND COMMITMENT TO SALE PURCHASE AGREEMENT

Saya yang bertandatangan di bawah ini/ I the undersigned:

Nama/Name :______(pihak yang berotorisasi secara hukum / authorized person)

Jabatan /Position :______

Nama Perusahaan/Company :______

Menyatakan dengan sebenarnya dan setuju bahwa/ it is hereby declare and agree that:

1. Informasi yang disampaikan dan dilengkapi di Formulir Pendaftaran adalah benar dan tepat berdasarkan informasi dan keyakinan terbaik yang kami miliki. / The information and particulars furnished in the Form for Registration are true and correct to the best of my/our knowledge. 2. Data dan dokumen yang dilampirkan adalah benar. / Data and documents attached are correct. 3. Pengurus perusahaan tidak sedang menjalani perkara pidana. / Company Committee are not imposed by criminal court or justice. 4. Perusahaan tersebut di atas tidak sedang mempunyai perkara apapun melawan PT. Pertamina (Persero) atau Anak Perusahaan atau Perusahaan Terafiliasi Pertamina di pengadilan atau forum arbitrase manapun pada saat proses pendaftaran menjadi mitra usaha terseleksi oleh Integrated Supply Chain (ISC) PT. Pertamina (Persero) berlangsung. / The Company mentioned above is not undergoing any case proceeding or resolution against PT. Pertamina (Persero) or its subsidiary or its affiliated company at the time applying the registration process to become selected partner by Integrated Supply Chain (ISC) PT. Pertamina (Persero). 5. Perusahaan berkomitmen untuk menandatangani Sale Purchase Agreement dari PT Pertamina (Persero) beserta amandemen dari Perusahaan maupun dari PT Pertamina (Persero) apabila dinyatakan sebagai pemenang Tender. / The Company is committed to sign the Sale Purchase Agreement from PT Pertamina (Persero) and its amendment from the Company or from PT Pertamina (Persero) should the Company is announced as the winner of a Tender.

Apabila di kemudian hari PT. Pertamina (Persero) menemukan bahwa pernyataan ini adalah tidak benar atau palsu dan komitmen ini tidak dilaksanakan, maka PT. Pertamina (Persero) berhak untuk memberikan sanksi berupa dikeluarkan sebagai mitra usaha terseleksi, pembatalan pemenang pelelangan yang diadakan Integrated Supply Chain (ISC) PT. Pertamina (Persero), pemutusan perjanjian, dan sanksi lainnya sesuai peraturan yang berlaku di PT. Pertamina (Persero). / If in the future PT. Pertamina (Persero) find that this statement is faulty or false and the commitment is not implemented, PT. Pertamina (Persero) reserves the right to imposed sanction in the form of the cancelation of selected partner status, canceling any award in any tender held by Integrated Supply Chain (ISC) PT. Pertamina (Persero), termination of contract or any other sanction according to related regulation in PT. Pertamina (Persero).

Demikian pernyataan dan komitmen ini saya buat dengan sebenarnya dan penuh rasa tanggung jawab. / Thus I wrote this statement letter and commitment truthfully and with full responsibility.

______/______(tempat/Place) / (Tanggal/date)

TTD/Sign

______(Nama lengkap/Full name & Jabatan/Position)

ATTACHMENT 3

Form for Registration of Counterparties (Know Your Customer/KYC)

1. Corporate Details In keeping with the standard industry practice it is important that you provide us with the following background information.

Full registered company name Any trading name(s):

Incorporation date Country of Incorporation

Corporate status (Listed, Pvt. Ltd., Partnership, firm etc) If listed, please name Stock Exchange(s) and Name of the Chairman/ listing(s) President/ Managing Director

Registered street address

Post code Tax ID

Physical address of head office

Company registration number Town / City

Telephone number

Website

Parent/ Holding company, if any (and its main business) Subsidiary (ies), if any (and its main business)

Department/ Initial point of contact Mobile number for Pertamina at the Company:

Fax number E-Mail address

Please provide copies of the below documents. These documents should be provided in the English Language or with an English Translation. 2. Company Identification Details All document required in this KYC should be provided in hardcopy and compact disc (CD).

Mandatory documents to be provided Mandatory documents to Please Tick Please Tick (X) Reference No. be provided (X) 2.1 Certificate of Incorporation or Memorandum/ Articles 2.5 List of Shareholder and capital share of Association and Amendments 2.2 Register of Commerce issued by Government 2.6 List of Authorized signatories with (ACRA / Approved Oil Trader (AOT) / Global Trader signatures authentication Program (GTP) / business register / Surat Ijin Usaha Perusahaan (SIUP) & Tanda Daftar Perusahaan (TDP) or other related documents)

2.3 List Of Company Committee (Commissioners & 2.7 Copy of ID Card or Passport for authorized Directors) signatories (2.5)

2.4 Certificate of Residence / Domicile (For Indonesia Company only) Note: Documents above (2.1 and 2.2 ) shall be legalized by your Ministry of Foreign Affairs or your Ministry of Justice and legalized by Local Indonesia Embassy.

3. Financial Highlights

Mandatory Documents to be Provided Please Tick (X)

3.1 Please attach audited Annual Reports for each of the last 3 years.

3.2 Two Original Bank References

Reference Bank Name 1: Reference Bank Name 2:

3.3 In Addition, please provide summary of the financial data, in the following format

FINANCIAL DATA (in USD) 2016 2017 2018 Cash & Bank Short Term Marketable Securities Total Trade Receivables Current Assets Construction in Progress / Asset Under Construction Depreciation & Amortization Total Asset Current Liabilities Total Liabilities Total Equity Total Operating Revenue Total Revenue EBIT EAT ATTACHMENT 2

Form for Registration of Counterparties (Know Your Customer/KYC)

4 Banking Details Please provide the full banking details

4.1 Principal Bankers (Name of the Bank)

4.2 Swift BIC

4.3 Bank Branch Address Details

4.4 Bank City & Country

4.5 Bank Account Name (Beneficary Name)

4.6 Currency of Bank Account

4.7 Bank Account Number/ IBAN number

4.8 Name of Bank Account Manager & Contact Details

5. Business Details

5.1 Does your Company have more than 3 years of business activity specifically in Oil Trading?

In case the response to 3.1 is "No", please elaborate

5.2 Is your Company currently (or has been in the last 3 Independent Oil Please Please Tick Trading Please Tick years) registered with any of the following companies National Oil Company Company Tick (x) (x) Company (x) and/or any of their subsidiaries BP ADNOC Koch ConocoPhillips / Phillips 66 NNPC Noble Group Total Petredec Socar Others Others (detail) (detail)

5.3 Please Provide Physical Trade volume for Crude & Volume of Physical Purchase Transactions in MT Products for Past Three years in the following table *Inter company/group transactions may kindly be excluded* split by Purchase & Sell transactions. 2016 2017 2018

Crude Gasoline Diesel oil LPG Jet fuel / Avgas

Volume of Physical Sell Transactions in MT *Inter company/group transactions may kindly be excluded* 2016 2017 2018

Crude Gasoline oil LPG Jet fuel / Avgas

5.4 Does your Company or any of its affliated Subsidiary own and/or operate an ?

In case the response to 3.4 is "Yes", please provide Operate Refinery Name Capacity (kbpd) Ownership (%) details per below (Y / N) ATTACHMENT 2

Form for Registration of Counterparties (Know Your Customer/KYC)

5.5 Does your company own vessels that can be used to supply

In case the response to 3.5 is "Yes", please provide Number of Age of Vessel Vessel type details per below Vessel < 10 Years 10 - 20 Years > 20 Years ULCC / VLCC VLGC Suezmax Aframax Others

5.6 Does your company own / rent storage facilities in the region that may be used to supply

In case the response to 3.6 is "Yes", please provide Capacity Type Own / Rent details as per below (cubic meters) Crude

Product

LPG

6 Other Details

6.1 Does your company and your committee currently under dispute(s) with Pertamina and it's affiliate?

In case the response to 6.1 is "Yes", please elaborate

6.2 Any other relevant information

7 Declaration

7.1 It is hereby declared that the information and particulars furnished above are true and correct to the best of my/our knowledge and belief and that nothing has been misrepresented and/or concealed

7.2 If later found that the information above are not true and there is forgery, Pertamina has a right to impose an administrative sanction, to claim compensation, a civil lawsuit, canceling a Letter of Award (LOA) and terminate a contract or has a right to impose any sanction according to Pertamina regulation.

8 Signature

Name of authorized person completing this Date: Registration Form *

Position Location:

*) If Registration Form is filled by unauthorized person, please provide the Power of Attorney Letter (Legalized by Indonesia Embassy)