PT.

CEMARA PLASAGUNG SEJATI

GENERAL CONTRACTORS & TRADINGS Komplek Taman Villa Baru Jl. Boulevard Raya Blok B No.14
Pekayon Jaya - Bekasi Selatan 17148, Indonesia , Telp. : +62-21 89462877, 89465646, E-mail :
cemarasejati@yahoo.co.id

In accordance with Articles 2 through 5 of the Due Diligence Convention and the Federal Banking
Commission Circular of December 1998, and under the US Patriot Act of 2002, as amended in
February 2003 concerning the prevention of money laundering and 305 of the Swiss Criminal Code,
the following information may be supplied to banks and/or other financial institutions for
purposes of verification of identity and activities of the Client described below, and the nature
and origin of the funds which are to be utilized. Therefore going is subject to agreement by all parties
to whom this information is provided that they are obligated to respect the privacy right soft the
Client and all individuals described herein, as well as the generally accepted professional standards
relating to the maintenance of confidential information, and to take all appropriate precautions to
protect the confidentiality of the information contained herein, This legal obligation shall remain
in full force indefinitely without restriction.
I hereby submit the following information for your consideration. I understand that this information
will be relied upon, unconditionally, as statements by me of material fact.

CUSTOMER INFORMATION SHEET (CIS)

 Company Information :

Company Name PT. CEMARA PLASAGUNG SEJATI

Company Address Komplek Taman Villa Baru
Jl. Boulevard Raya Blok B No. 14 Pekayon Jaya
Bekasi Selatan, West Java, Indonesia 17148
Company Incorporation Certificate No AHU-006158.AH.01.02.TAHUN 2020
Represented By Mr. SISWONO
Title Executive Director
Passport Number C259974
Country of Issue Indonesia
Issue Date 17 December 2018
Expiration Date 17 December 2023
Nationality Indonesia

 Bank Information :

Bank Name PT. BANK RAKYAT INDONESIA (Persero) Tbk.

Bank Address Jl. Gunung Sahari No. 280 Jakarta 10720
Indonesia
Account Name PT CEMARA PLASAGUNG SEJATI
Account No 034501001498305 (EUR)
Account Signatory Mr. SISWONO
Bank Officer Name Mrs. VIVIN YULIA ANGGRIANI
Bank Officer Tel. +62 21 6006272 ; +62 21 6006274
Bank Officer Email
SWIFT Code BRINIDJAXXX

 Affirmation
 PT. CEMARA PLASAGUNG SEJATI
GENERAL CONTRACTORS & TRADINGS Komplek Taman Villa Baru Jl. Boulevard Raya Blok B No.14
Pekayon Jaya - Bekasi Selatan 17148, Indonesia , Telp. : +62-21 89462877, 89465646, E-mail :
cemarasejati@yahoo.co.id

I hereby swear under the full penalty of perjury, that the information provided herein is both true and
accurate. I am in control of the assets stated bellow and have signatory authority on the aforementioned
bank account and have full authority to execute all contracts and agreements relating to pleading the assets
for a loan. The funds are in full compliance with the anti-money laundering policies set forth by Financial
Action Task Force (FATF) 6/01.

Signed January, 2th, 2023

SIGNATORY
Name : SISWONO
Tittle : Executive Director
PASSPORT / KTP No : C 259974
Country of Issuance : INDONESIA
Date of Issue : 17 DECEMBER 2018
Date of Expiry : 17 DECEMBER 2023
 PT. CEMARA PLASAGUNG SEJATI
GENERAL CONTRACTORS & TRADINGS Komplek Taman Villa Baru Jl. Boulevard Raya Blok B No.14
Pekayon Jaya - Bekasi Selatan 17148, Indonesia , Telp. : +62-21 89462877, 89465646, E-mail :
cemarasejati@yahoo.co.id

Annex: PASSPORT
 PT. CEMARA PLASAGUNG SEJATI
GENERAL CONTRACTORS & TRADINGS Komplek Taman Villa Baru Jl. Boulevard Raya Blok B No.14
Pekayon Jaya - Bekasi Selatan 17148, Indonesia , Telp. : +62-21 89462877, 89465646, E-mail :
cemarasejati@yahoo.co.id

Annex:
COMPANY IN CORPORATION CERTIFICATE