PT. INFOMAP GEO SURVEY V Sie su 0 var UAV TSC rng 14, RT. Ke Semple aa, Ke, Samara La at PT. INFOMAP ra amar Pron 065680200, ‘Samarinda, 16 Agustus 2023 Nomor. o1/sP-tes/viy2023 Perial ‘Surat Permohonan Penerbitan Persetujuan dan Assessment Ruang Udara, Kepada Yih, General Manager Perum LPPNPI Cabang Balikpapan Di Tempat Kami dari PT Inforap Geo Survey yang berkedudukan di J Ringroad 3/ HM. Ardans I, Keluaranan Sempia Utara, Kecamatan Samarinda Utara, Kota Samarinda, Provnsi Kalimantan Timur. Bersama dengan surat ini, Kami mengajukan Petmohonan Penertitan Perseujuan dan Assessment Ruang Udare dengan rncian sebagal brut 1. Berdasarkan Peraturan Menteri Perhubungan Nomor PM 37 Tahun 2020 tentang Pengoperasian Pesawal Udara Tanpa Awak di Ruang Udara yang dilayani Indonesia, 2. Pekerjaan ini dimaksudkan untuk Untuk Keglatan Pembuatan Peta Foto Menggunakan Pesawat Udara Nit Awak (PUNA) dalam Rangka Pendattaran Tanah Sistemaik Lengkap di Kementrian Agraria dan Tate Ruang/ Badan Pertanahan Nasional (BPN) Kantor Pertanahan Kabupaten Kata KartanegaraProvnsi Kalimantan Timur 3. Menindaklanjuti butir 1 (satu) di atas, dengan hormat kami sempaikan perhomohan assessment rencana pengoperasian Pesawat dar Nir Auak (PUNA) dengan data sebaca bert ores abupaten Penajam Paser Ulara Kecamatan Penajam anggal [30 Agustus — 30 OWbber 2025 Na (0800-7600 Wie Wahana Tegasus 250 VTOL femote PTotTn Command aang Agung Samide sual Observer i Sigit Dwi Pranala [pede Saputa Iroanur Untuk koordinas lebih lanjut dapat menghubungi- Slamet Riad (Nomor HP : 085246862310). DDemikian permohonan kami, atas perhatan dan kerjasamanya kami ucapkan banyak terimakasih Hoxmat Kar ek SSLAMET RIAD,PT. INFOMAP PT. INFOMAP GEO SURVEY Survey & Mapping GPSIGNSS I Kacasval I Topograf I Batimet Citra Satelit Foto Udara UAV I SIG I Training ane: LM Adar goad RT, Kel Serpe a, Kec Samarra ir Kota Samara. Kaiaian Tr, rane 82482510 Prosedur Pengoperasian Foxtech Pegasus-230 VTOL Gambar 1. Foxtech Pegasus-230 VTOL Spesifikasi Teknis Airbome Systems: ‘Spesifikasi Alrbone Systems ype Pegasus 230 VTOL Manufucture Foxtech Category Vertical Take Off and Landing (VTOL) Wingspan 2.50 meter Transmission distance Up to 1S kilometer Cruising Speed 18.20 Max take off weight 1 kilogram Flight Time 110 Menit Wind Resistance, 5 Sms (12.Smph17.Smph) Working Voltage 24V (6s LIPO) Working Temperature 10°C. 40°C Spesifikasi Teknis Ground Systems: ‘Spesifikasi Ground Systems Software. QGround Control (QGC) Device MX16 Ground Control Station Prosedur Pengoperasian Extended Visual Line Of Sight (EVLOS) Maksud dan Tujuan Pengoper rasian:@ PT. INFOMAP GEO SURVEY “Sar gi. Sept Si see ini PT.INFOMAP| iSussaye - Penerbangan Unmanned Aerial Vehicle (UAV) ini bermaksud untuk Pembuatan Peta Foto dalam Rangka Pendaftaran Tanah Sistematik Lengkap di Kabupaten Penajam Paser Utara. Rencana Terbang : Lokasi Kegiatan berada di Kelurahan/Desa, meliputi No] Keluraban / Desa ‘Kecamatan o Cia Pensa (2 Tawe hwo Penaiam 3 ‘Nenang Penajam 4 Sungai Pa Penajam © Lokasi Kepiatan Koordinat Titik I: Latitude: 1°1441.98"S ; Longitude :11684620.52%E Koordinat Titik 2: Latitude; 1°2222.54"S; Longitude : 116°45'59.28°E Koordinat Titik 3 Latitude: 1°2212.39"S; Longitude : 116°38%43,23"E Koordinat Titik 4 Latitude} 1°1437.92"S; Longitude 116°39°7.21" © Las Arca: 6.188 Ha © Wakes = 08.00- 16.00 WIB © Tanggal ~ 30 Agustus 2023 ~ 30 Oktober 2023, © Tinggi Terbang ~ 100 300 meter Above Ground Level (AGL) Lokasi kegiatan Keterangan Lokasi kegitan akusisi dataKEMENTERIAN PERHUBUNGAN DIREKTORAT JENDERAL PERHUBUNGAN UDARA DIREKTORAT KELAIKUDARAAN DAN PENGOPERASIAN PESAWAT UDARA, JI. C3, Gedung Perkantoran Bandara Soekarno-Hatta, Tangerang, Banten-Indonesia 15126 Telp.: (46221) 225 66288, (+6221) 256 08887 Fax. : (+6221) 225 66399 Website : hubud.dephub.go.id; e-mail: daao_dgca@dephub.go.id SERTIFIKAT REMOTE PILOT Nama Lengkap (Full Name): MR. LANANG AGUNG SAMUDRO Alamat (Address): JL. HM. ARDANS 2 RINGEOAD 3,RT. 01, KEC. SAMARINDA UTARA, KOTA SAMARINDA KALIMANTAN TIMUR, TANGGAL LAHIR (DATE OF BIRTH) 28 MEI 1998 TINGGI BADAN (HEIGHT) 173 cm BERAT BADAN (WEIGHT) 2 67 kg Telah memenuhi standard yang tercantum dalam ketentuan PKPS Bagian 107 (Has met the standards prescribed in CASR Part 107) (LIMITATION) BATAGAN Pesawat Udara Kecil tanpa Awak (Small Unmanned Aircraft System) Tanggal Diterbitkan (Issuance Date) Berlaku Sampai (Valid Until) 03 FEBRUARI 2023, 03 FEBRUARI 2024 TANDA TANGAN DIREKTUR DKPPU (SIGN DIRECTOR DAAO) (ISSUED BY) DITERBITKAN OLEH TANDA TANGAN REMOTE PILOT (REMOTE PILOT'S SIGNATURE) DGCA Form No. 107-03 (Des 2019)KEMENTERIAN PERHUBUNGAN Ministry of Transportation DIREKTORAT JENDERAL PERHUBUNGAN UDARA Directorate General of Civil Aviation SERTIFIKAT PENDAFTARAN PESAWAT UDARA KECIL TANPA AWAK ‘Small Unmanned Aircratt Certificate of Registration Pemilik : SLAMET RIADI (Owner) si Alamat _ SLAW SYAHRANI 4 POROS NO .01 ,RT.01, KEL.SEMPAJA BARAT, KEC. SAMARINDA (Address) * UTARA, PROVINSI KALIMANTAN TIMUR Kategori (Category) : HELICOPTER Nama Model (Mode! Name) PEGASUS -230 VTOL Nomor Seri (Serial Number) * POS28001 Tanda Pendaftaran (Registration KLAJ-3-GXQ. Mark) Tanggal Terbit 97 JaNUARI 2023, (Issued) Berlaku Sampai 27 JANUARI 2026 (Valid until) DGCA Form No. 107-04 (Dec 2019) a.n. Direktur Jenderal Perhubungan Udara (On behalf of the Director General of Civil Aviation) DIREKTUR KELAIKUDARAAN DAN PENGOPERASIAN PESAWAT UDARA Sertifkat pendaftaran pesawat udara kecil tanpa awak ini bukan merupakan otorisasi untuk melakukan operasi penerbangan dengan pesawat udara kecil tanpa awak. Operasi harus dilakukan sesuai dengan persyaratan PKPS bagian 107. Operator pesawat udara kecil tanpa awak bertanggung jawab untuk mengetahui dan memahami persyaratan tersebut This Small UA Certificate of Registration is not an authorization to conduct flight operations with an Small UA Operations must be conducted in accordance with the applicable DGCA requirements. The operator of the small unmanned aircraft is responsible for knowing and understanding what those requirements are.Prosedur Kedaruratan 1. Kegagalan Komunikasi antara operator dengan pemandu lalu lintas dan atau pemandu komunikasi penerbang: a) Mendaratkan drone dengan segera ditempat yang aman b) Menghubungi menggunakan Panggilan WA atau Panggilan Selular 2. Kegagalan Komunikasi antara ground system dengan airborne systems: a) Menginformasikan kepada pemandu lalu lintas penerbangan dan pihak terkait yang bisa dihubungl b) Melakukan recovery dengan cara merestart ground systems, seperti remote control, device, dan aplikasinya 3. Sarana fasilitas komunikasi dan koordinasi Antara remote pilot dengan Visual Observer menggunakan Handy Talky (HT), sedangkan antara remote pilo koordinator dengan pemandu lalu lintas akan menggunakan WhatsApp (WA) ataupanggilan seluler, Adapun kontaknya adalah sebagal berikut: a) Team Leader! Koordinator PT. IGS : Slamet Riadi Nomor HP : 0852-4686-2310 b) Remote pilot PT. IGS : Lanang Agung Samudro Nomor HP : 0822-5059-4773 (WA) & 0822-5156-6840 (seluler)PT Asurans! MSIG Indonesia > MSIG 1 ees SE ‘ema: mia 8 asla.com Jakarta, 30 March 2023 Our Ref No, : 2960/CBS1/692/03/2023 Messrs, PT. INFOMAP GEO SURVEY Jalan MM. Ardans 11/ Ringroad i ‘Samarinda , Kalimantan Timur 75119 ‘Attn, Mr, Slamet Riad Dear Sir, ‘We have much pleasure in submitting you, our QUOTATION FOR DRONE INSURANCE. You may see details of terms and conditions as enclosed herein. {All other terms and conditions not specifically mentioned in this quotation shall follow the full version of the policy wordings. Kindly therefore examine the terms and conditions. We look forward to receiving your confirmation in due course and thank you in advance for your kind ‘attention and prompt response. Yours faithfully, Ezer Permanawat) Head of Corporate Business Department ~ Section 1 att ' Pitaeen as are a ana of be pre no tao samen ‘Sinton ore ona Scanned by TapScannerNa ‘SECTION 1 ~ LEGAL LIABILITIES TO THIRD PARTIES Covering the legal liability of the insured to third Parties for: 1. Bodily Injury 2. Property damage arising out of the age of insureds Unmanned Aerial vehicle / Drone. ‘SECTION 2 ~LOSS OF or DAMAGE TO UAV/DRONE Covering physical loss of or damage to UAV and its ancillary equipment (subject to declared as interest insured) including disappearance. NAME PT. INFOMAP GEO SURVEY PERIOD OF INSURANCE _: TBA~1 Year After Confirmation Date at 12:00:00 refer to local time, using 24-hour time format in case time displayed = INTEREST INSURED ] amas | Hullvatue Estimated Yemegt | ates | ettaon | ay Seay | STA] Ree 7H |FORTEGH [IAT TSO SARTO ae Sie | lpegacues 00 | "3% sppean9.5000 7 | Vrow Baga ate Warch 2028 TORTS. -TOTALSUMINSURED = Section 1— Legal abilities to Third Parties DR. $0,000,000.- Combined Single Limit for Third Party Bodily injury and Third Party Property Damage any one occurrence and in aggregate for any one drone in the period of insurance. Section 2~| 1m: WV: YEAR OF BUILD | MAKE& MODEL | REMARKS | SUMINSURED | 230 TOL Dont | FORTEC Pegasus= 5 ween | Scanned by TapScanner‘Total time on UAV | UAV time past 12 months UAV time on Model ‘Accidents/Violations + Commercial purpose only (including photography, videography, and mapping) + Within Indonesia Territory Refer to MSIG Indonesia Drone Insurance Policy Wording, - Endorsement of Consumer's Protection = Compliance Endorsement Premium & Claim Payment Clause Premium Payment Warranty (60 days) = Currency clause ~ Terrorism and Sabotage Exclusion Endorsement = War and Terrorism Exclusion Clause - Marine Cyber Endorsement (LMA 5403) Institute Radioactive Contamination, Chemical, Biological, Bio-chemical and Electromagnetic Weapons Exclusion Clause c.370 - Asbestos Exclusion -Products/Completed Operation Hazards Exclusion Endorsement - Punitive Damages Exclusion - Earthquake Exclusion Clause = Waiver Clause Sanction Limitation and Exclusion Clause LMA 3100 (Amended) ~ Extended Commercial Drone Coverage Clause ~ Special Clause for Ancillary Equipment = Communicable Disease Exclusion LMAS396 Personal Accident Clause (for Approved Drone’s Pilot) = Automatic Reinstatement of Loss. Scanned by TapScanner~ Subject to approved pit only, Mr. Lanang Agung Samudro ~ Single Operated Drone Warranty (HZFO68) «= Subject to Pilot has active and maintain the active license and/or training certificate from APDI and/or FAS! and/or Ministry of ‘Transportation and/or Drone Manufacturer + Subject to nil loss record in last 3 years for the approved ‘operator/pilot and insured drone/ancillary equipment. ~ Subject to 1 year period - Unapproved Pilot Exclusion (HZFO69) = Night Flight Exclusion (H2FO70) = Voleanic Area Exclusion (H2FO71) + Subject to cover Hull #TPL = Mobile Phone Exclusion (H2FO72) = Excluding used for demo, security, defense, and military purposes. Excluding overseas shipping cost for repait = Subject to no double cover insurance coverage + Section 1: Nil Section 2; 15% of Recoverable Claim Amount, min. 1DR 1,000,000 = INSURANCE PREMIUM Coverage ‘Stamp Duty ‘Subjectivity: Subject to no deterioration of lass and no change in risk profile up to inception date. Otherwise, we reserve ‘the right to review the T/C state $8 Scanned by TapScanner@usic + nee ‘Thank you for your attention and best cooperation, ‘you agree with the terms and conditions mentioned above, please kindly give us your confirmation by ‘sign the authorized signature column below. We look forward to hearing from you soon and thank you for ‘your kind attention and best cooperation. ‘Please send the confirmation ; By mall to: Lita Seid msig-asia,com Scanned by TapScanner