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‘DocuSign Envelope 10, O365AAFC-3807-4829-AGDS-4BB8BFCABBIS AstraZeneca 2 ‘SPONSORSHIP AGREEMENT ‘dr. Hadi Susatyo Sp.PD MARS FINASIM RS Royal Surabaya JI. Rungkut industri No.2 04/08/22 Dear, CaReMe RS Royal Surabaya 1 THE PURPOSE The Agreement will apply 2022-08-16, and shall continue for the uration of the Support. ‘The Support is intended to be used to CaReMe RS Royal Surabaya Preventing Cardio-Renal Complications, Improving Quality of Life dengan rincian sebagai berikut: Institution Fee: 1.250.000 Meals 1.500.000 Total 2.750.000 2 THE SUPPORT ‘Any payments from AstraZeneca to the Organisation will be made by bank transfer to a bank account in the name of the Organisation as stated below: Bank Name: BRI Bank Account Number: (0086-01-002201-30-8 ‘Tax Number (NPWP}: (02.007.933.1-615.000 and will not be made in cash or to any person other than the Organisation kepada Yth. dd. Hadi Susatyo Sp.PD MARS FINASIM RS Royal Surabaya JJ. Rungkut Industri No.2 04/08/22 Dengan Hormat, CaReMe RS Royal Surabaya TUWUAN Perjanjian ini akan beriaku 2022-08-16, dan berlaku selama jangke waktu atas dukungan Dukungan yang dimaksudkan digunakan untuk CaReMe RS Royal Surabaya Preventing Cardio-Renal Complications, improving Quality of Life dengan rincian sebagai berikut: Institution Fee: 1.250.000 Meals 41,500,000 Bakuncan ‘2.750.000 Setiap pembayaran dari Astrazeneca ke (Organisasi akan dilakukan melalui bank transfer ke rekening bank atas nama Organisasi sebagaimana tercantum di bawah ini: Nama Bank: BR Bank Nomor Rekening: (0096-01-002201-30-8, Nomer Pajak (NPWP): 02,007.933.1-615.000 dan tidak akan dilakukan secara tunai atau kepada orang lain selain Organisasi ‘Doeusign Envelope I, O36SAAFC-3007-4829-A0DS-4B886F CARNE Organisation shall issue an invoice for ‘this payment). Astrazeneca may ask ‘you to issue a receipt for the above payment. Otherwise, the document Issued for the bank transfer by AstraZeneca shall be deemed valid evidence of the receipt of the above payment, Astrazeneca has agreed to provide the Support on the condition that itis used solely for the Purpose in the manner described to AstraZeneca and not in Violation of the applicable laws or regulations, ‘The Organization agrees to comply with all applicable laws and regulations, in the event all or part of the Support provided by Astrazeneca is used to engage services conducted by Healthcare Professionals, including seeking permission from the healthcare organization for which the healthcare professionals work, and ensuring that the payment to the Healthcare Professional is provided based on fair- market value and with legitimate cost breakdowns which is in line with the stipulation in such laws and regulations. If the Organisation wishes to change the Purpose or the way that the Support is used, you should contact AstraZeneca immediately in order to discuss and agree the manner in which the balance of any Support is to be used. If the actual costs of achieving the Purpose are less than AstraZeneca’s agreed commitment of Support for any reason, including _ termination, Astrazeneca? Onganisesi wajib menerbitken tagihan (invoice) asi atas pembayaran ini). AstraZeneca mungkin akan meminta tanda terima atas pembayaran dlatas. ka tidak, dokumen yang. dlikeluarkan sebagai bank transfer oleh Astrazeneca dianggap bukti yang sah atas penerimaan pembayaran tersebut diatas AstraZeneca telah menyetujui untuk memberikan dukungan dengan kondisi bahwa dukungan tersebut akan

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