CLIENT INFORMATION SHEET

Date: Sept 25TH, 2020

Client Information
Client/Signatory Name : Mr. Rudy Jundani Jojo Tarjono
Nationality : Indonesia
Passport Number : B7235575
Date of Issue : June 02ND, 2017
Expiration Date : June 02ND, 2022
Issued by : Indonesia
Social Security Number : n/a
Date of Birth : August 29TH, 1971
Place of Birth : Bogor
Telephone : +62-812-8044-6820
Facsmilie : n/a

Business Information
Business Name
Street address
Registered Office
Registered Number
Telephone
Facsmilie
Legal Advisor Name
Legal Advisor address
: PT. Starnegy
: Lobby Floor, Tower C, Oasis Mitra Apartment 135 – 137,
Senen Raya Boulevard, Jakarta, 10410 Indonesia
: Lobby Floor, Tower C, Oasis Mitra Apartment 135 – 137,
Senen Raya Boulevard, Jakarta, 10410 Indonesia
: 8120103871032
: +62-21-350 1590
: n/a
: Dodi Prawira Amtar
: Jatibening Estate G6, No. 11-12, Jatibening, Pondok Gede

Mailing Address Information

Street address : Lobby Floor, Tower C, Oasis Mitra Apartment 135 – 137,
Senen Raya Boulevard, Jakarta, 10410 Indonesia
City/State/ZIP : Central Jakarta/ DKI Jakarta/ 10410, Indonesia
E-mail address : rjundani@yahoo.com

Bank Information
Name of Bank : PT. BRI
Branch : Segitiga Senen
Street address : Cowell Tower Ground Floor, Suite G.05, Senen Raya
Boulevard No. 135, Jakarta, 10410 Indonesia
City/State/ZIP : Central Jakarta Jakarta/ DKI Jakarta/ 10410
Telephone : +6221 350 7966
Facsmilie : n/a
S.W.I.F.T. Code : BRINIDJA
Bank Officer #1 : Mrs. Anis
Bank Officer #2 : n/a
Account Name : PT. Starnegy
Account Number : 0361 01 000 669 301 (IDR Account)
Account Signatory : Mr. Rudy Jundani Jojo Tarjono

Brief description of Corporate activity:

PT. Starnegy is mainly a medical equipment distributor company and now has expanded
to financial investment, merger & acquisition.

I hereby swear under penalty of perjury, that I AM THE SIGNATORY of the account. The
information provided herein is accurate and true.

On Behalf of PT. Starnegy

Full Name: Mr. Rudy Jundani Jojo Tarjono

Designated: Managing Director
COPY OF PASSPORT(S)

Private and Confidential

COMPANY REGISTRATION