GOVERNMENT OF GIANYAR REGENCY

PAYANGAN SUB-DISTRICT

JALAN GIRI KESUMA, Phone No.(0361)974198

MICRO AND SMALL SCALE BUSINESS LICENSE

Number: S03/38/ IUMK /PYN/2021

Pursuant to Presidential Regulation Number 98 of 2014 concerning Licensing for

Micro and Small Scale Businesses (State Gazette of Republic of Indonesia Number 222 of
2014), Regulation of Minister of Home Affairs of Republic of Indonesia Number 83 of 2014
concerning Guidelines for the Issuance of Micro and Small Scale Business License,
Regulation of Regent of Gianyar Number 60 of 2015 concerning Delegation of Authority for
the Implementation of Micro and Small Scale Business Licensing (IUMK) to the Head of
Sub-Districts in Gianyar Regency, hereby we grant license to:

Name : SANG AYU MADE ARJANI

ID Card Number : 5104075907740001

Address : BR. GERIA, Kel. Melinggih, Kec. Payangan, Kab.

Gianyar, Bali Province

Telephone Number : 081916423777

To establish Micro and Small Scale Business which include basic licensing such as: to
occupy a location/domicile, to perform business activities either the production or sale of
goods and services under the following identity:

Name of Business : WARUNG NASI KEDEWATAN

Type of Company : Individual

Amount of Business Capital : Rp.50,000,000.00

Type of Business : Trade Business (Rice)

T.I.N : -
Business Address : BR. GERIA, Kel. Melinggih, Kec. Payangan, Kab.
Gianyar, Bali Province

Owner : I Made Cetig Mulyana

Registration Number : 38

Validity Period : March 4, 2026

This basic business license is granted with the provisions that it cannot be transferred and
the holder of this license shall meet the prevailing legislations, maintain the cleanliness of
the environment, and return this license if the holder of the license relocate its business
place, change the scale of business, and to renew this license once in 5 (five) Years in the
place of IUMK.

Herewith this license is granted for the Intended Purpose.

[photograph] Issued In: Payangan

On: March 4, 2021
Head Of Payangan Sub-District
[Sealed And Signed]
Dr. I Ketut Mudana, S.H., MBA
Junior Superintendent
NIP. 196901011988031004