Counterparty On-boarding Form/Know Your Counterparty (KYC)

1) Counterparty Legal/Registered Name PT MAHKOTA NIAGA ENERGI

2) Trading/Business Address Jl Radio Dalam No.9A RT10/RW13 Gandaria Utara , Kebayoran Baru
Jakarta Selatan 12140
(Physical Address only, No PO Box)

Tel Number (021) 79524700 Fax Number - Website https://mahkotaniagaenergi.co.id/

3) Registered Address: Wijaya Grand Center Blok H No 12 Jl Panglima Polim - Jakarta Selatan
(If different from business address)

4) Counterparty Details:
Company Registration Number: 9120105740649

Date of Incorporation: 31 Mei 2019

5) Brief Description of Counterparty (Including Principal Business Activity)

MNE is part of ABS group, in ABS Group we have PT. Gandasari Energi (Port facilty), PT ABS
SHIPYARD (Shipyard Facility),PT. Pelnas Wibowo Bersaudara (Shipping Company), PT IDEKA (Fuel Transporter) and
PT MNE (INU Holder)

6) Is this Counterparty Regulated by a Financial Authority?

Yes
----- No
If Yes, please provide regulator name

7) Is this Counterparty Listed on an Exchange?

Yes
----- No
If Yes, please provide exchange name & ticker

8) Is this Counterpart a Government Owned Entity?

Yes
----- No

9) Is the Parent Company Listed/Regulated?

Yes
----- No
If Yes, please provide name of parent company

* Any incomplete/missing information will delay the processing of the application

10) Name of Directors or if not a company, Principals/Officers
Name DOB (DD/MM/YY) Country of Residence Country of Nationality Title Gender
Lalu Didit Winardi 28 December 2021 Jakarta Indonesia Mr Male

**If counterparty is not a company, Principal/Officer is an individual that has control on day to day functioning of the Counterparty**

**Please provide First, Middle and Last name for individuals**

11) Ultimate Beneficial Owners

Name DOB(DD/MM/YY) Country of Residence Country of Nationality % of Ownership

Alfian Shidqi 28 December 2021 Jakarta Indonesia 80%

PT ABS Consultant 28 December 2021 Jakarta Indonesia 20%

**Ultimate Beneficial Owner/s (UBO) is/are individual/s who directly, indirectly, through any contract, arrangement, understanding,
relationship, intermediary, tiered entity or otherwise, owns more than 25 percent of the equity interest in the counterparty**
**If there is no individual who satisfies the above, then please state as such in the above section**
**Please provide First, Middle and Last name for individuals**

12) Tax Information

Country of Tax Residency Kemayoran Jakarta Pusat (DKI JAKARTA)

Tax Number/Identifier: (Tax ID, VAT, GST, etc) 71.992.215.5.027.000

Additional Country of Tax Residency

Additional Tax Number/Identifier: (Tax ID, VAT, GST, etc)

Is the ultimate beneficial owner, a U.S. person that owns 10% of more in this counterparty?

**Tax Number Mandatory if Tax Resident of US or EU Country**

**Effective 1 Jan, 2015, all Non-US corporate Counterparty that require a Form W-8 BEN will need to provide the Form W-8BEN-E
(February 2014 version)**

* Any incomplete/missing information will delay the processing of the application

13) Regulatory Information for Trade Reporting

LEI Number: -

Dodd Frank Compliance: -

Remit Compliance: -

EFET Agreement: -

EMR Entity Type: -

ISDA Portfolio Reconciliation: - EMIR PortRec Interface: -

Other EMIT PortRec Interface: - Preferred trade repository: -

DECLARATION

• I/We hereby declare the information contained in this application form and documents submitted are true,
complete and correct
• I/We warrant that I/we have provided all individuals whose Personal Data are to be provided to you in relation to
the counterparty on-boarding procedure (“Data Subjects”) with a copy of Noble Resources Trading Holdings
Limited’s Personal Information Collection Statement in relation to the Counterparty On-boarding Procedure (the
“PICS”) and:
a) If we are not providing EU data, I/We warrant that the Data Subjects consent to their Personal Data being
provided to Noble Resources Trading Holdings Limited (i) to be held, used, processed or disclosed to such
parties and for such purposes as set out in the PICS and (ii) to be transferred for the purposes and to the
types of transferee as set out in the PICS; or (iii) in any event, in accordance with any applicable rights; or
b) If we are providing Personal Data from EU Data Subjects, I/We warrant that I/we comply with General Data
Protection Regulation (EU) 2016/679 dated April 27, 2016 (“GDPR”) and, in any event, with any applicable
Data Protection law (including the UK Data Protection Act 2018), an that, as a consequence, the Data
Subjects are fully aware that their Personal Data are provided to Noble Resources Trading Holdings Limited
on the grounds set forth in the PICS:
a. to be processed, within the meaning set out in article 4(2) of the GDPR or UK Data
Protection Act 2018 or disclosed to such parties and for such purposes as set out in the
PICS, and
b. to be transferred for the purposed and to the types of transferee as set out in the PICS.

Form Completed by:

Name Admiraldin Catur Putra Title/Department Operation

Signature Date October 28, 2022

* Any incomplete/missing information will delay the processing of the application

 NOBLE RESOURCES TRADING HOLDINGS LIMITED

Personal Information Collection Statement

in relation to the Counterparty On-boarding Procedure

“Personal Data” refers to any information relating to an identified or identifiable natural person, who can be identified
directly or indirectly, or any data which directly or indirectly identifies you, or is capable of doing so, by reference to an
identifier (i.e. name, identification number, location data, online identifier or one or more factors specific to the
physical, physiological, genetic, mental, economic, cultural or social identity) (the “Data Subjects”).

Noble Resources Trading Holdings Limited and its subsidiaries or associated companies (together the “NRTHL”, “we”
or “us”) may collect and use the Data Subjects’ Personal Data for the following purposes, and purposes directly
relating to any of the following purposes: ‐

• entering into and maintaining a trading relationship or business with our counterparties, comprising: ‐
o you, and/or
o the company which employs the Data Subjects (and/or its parents, subsidiaries and/or associated companies),
and/or
o a company in respect of which either the Data Subjects are directly or indirectly the ultimate beneficial owner,
(together, the “Counterparties”);
• verifying you or the Data Subjects’ identity and of those authorized to act for our Counterparties and carrying out
other due diligence, including where we engage specialist third parties to assist us and by screening you and/or the
Data Subjects’ details against risk prevention and financial crime databases;
• managing our trading relationship with our Counterparties, including determining the terms of trade;
• carrying out transactions with our Counterparties;
• performing internal statistical and other analyses; and
• ensuring compliance with relevant tax, regulatory, anti‐money laundering and other applicable laws.

Personal Data which we may ask the Data Subjects to provide include, but are not limited to, general identification and
contact information, and copies of identification documents.

Some Personal Data we request is mandatory for our on‐boarding and compliance processes. We shall store the Data
Subjects’ Personal Data collected accordingly as long as the trading relationship above-mentioned will be maintained.
As soon as the trading relationship expires or is otherwise terminated, NRTHL shall erase any Personal Data from their
records, except as otherwise provided by the relevant laws. In the event that the Counterparty does not, or stops to
provide any mandatory Personal Data requested, we may not be able to conduct business, or maintain a trading
relationship with such Counterparty.

We represent that NRTHL does not include any automated decision-making, including profiling.

We will take all mandatory and reasonable steps to keep the Personal Data secure and to prevent their unauthorized
use and disclosure. We will transfer and securely store copies of the Personal Data on NRTHL’s servers. Solely for the
above‐mentioned purposes for which the Personal Data are to be used, we may also transfer the Personal Data that

* Any incomplete/missing information will delay the processing of the application

we have collected to subsidiaries and associated companies within the NRTHL, our professional advisers, and service
providers engaged in contractual activities on our behalf (“Transferees”). If such Personal Data is from EU Data
Subjects, all of those Transferees being under an obligation of confidentiality, located in the European Union or in any
third country on the basis of an adequacy decision within the meaning of article 45 of GDPR or the relevant equivalent
in the applicable law, or to any other third party countries upon the conditions that we provide appropriate safeguards
and that data subjects rights and effective legal remedies are available to Data Subjects. The Data Subjects may
address a request to the NRTHL, should they want to be informed of the nature of said safeguards. Such Transferees
may be located in Hong Kong, Singapore, London, Jakarta elsewhere, provided that such Transferee abides by the
relevant data protection laws. We may disclose Personal Data when required or authorized to do so by law, including
but not limited to, in response to court orders, as requested by law enforcement and regulatory authorities, or to
protect our legal rights.

Any EU Data Subjects has a right to request access to rectify and to erase, within the conditions of article 17 of the
GDPR, their Personal Data stored in the NRTHL’s servers and records. We may charge such EU Data Subject a
reasonable fee for processing any access request to the Personal Data when such request is manifestly unfounded or
excessive, in particular because of their repetitive character. If any EU Data Subject wishes to exercise their rights, or
has any enquiry regarding their Personal Data and our privacy policy, they may contact the NRTHL team at the
following email address: DataPrivacy@thisisnoble.com

Our privacy policy statement, which is available upon request, contains further information on the EU Data Subject’s
rights to access and correction, the EU Data Subject’s your rights to lodge a complaint with a supervisory authority and
recourse, and our policy on any transfer of the Personal Data.

Version date: 11.04.2022

* Any incomplete/missing information will delay the processing of the application