‘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