KEPUTUSAN TERTULIS CIRCULAR RESOLUTION OF

PARA PEMEGANG SAHAM SEBAGAI PENGGANTI SHAREHOLDERS IN LIEU OF EXTRAORDINARY

RAPAT UMUM PEMEGANG SAHAM LUAR BIASA GENERAL MEETING OF SHAREHOLDERS OF
[NAMA PERUSAHAAN] [COMPANY NAME]

Yang bertanda tangan di bawah ini: The undersigned below:

1. [SHAREHOLDER 1], perusahaan yang didirikan 1. [SHAREHOLDER 1], a company established

dan tunduk berdasarkan hukum negara and existing under the law of [Country
[Nama Negara], beralamat di [alamat resmi], Name], having its registered address at
pemilik dari [jumlah saham] saham atau [registered address], as the holder and
yang mewakili [persen]% dari jumlah modal owner of [shares amount] shares or
yang ditempatkan dan disetor Perseroan; representing [percent]% of the total issued
and paid-up capital of the Company;

2. [SHAREHOLDER 2], perusahaan yang didirikan 2. [SHAREHOLDER 2], a company established

dan tunduk berdasarkan hukum negara and existing under the law of [Country
[Nama Negara], beralamat di [alamat resmi], Name], having its registered address at
pemilik dari [jumlah saham] saham atau [registered address], as the holder and
yang mewakili [persen]% dari jumlah modal owner of [shares amount] shares or
yang ditempatkan dan disetor Perseroan; representing [percent]% of the total issued
and and paid-up capital of the Company; and

3. [SHAREHOLDER 3], Warga Negara [Nama 3. [SHAREHOLDER 3], a [Country Name] Citizen,
Negara], pemegang KTP dengan No. Induk holder of Indonesian ID Card No. [ID
Kependudukan [NIK], beralamat di [alamat NUMBER], having [his/her] address at
resmi], pemilik dari [jumlah saham] saham [registered address], as the holder and
atau yang mewakili [persen]% dari jumlah owner of [shares amount] shares or
modal yang ditempatkan dan disetor representing [percent]% of the total issued
Perseroan; and paid-up capital of the Company;

(selanjutnya bersama-sama disebut sebagai “Para (hereinafter shall jointly be referred to as the
Pemegang Saham”); “Shareholders”);

Para Pemegang Saham mewakili seluruh [TOTAL The Shareholders represent all [TOTAL ISSUED
ISSUED SHARES] saham yang telah dikeluarkan oleh SHARES] shares which have been issued by PT.
PT. [COMPANY NAME] (“Perseroan”), berkedudukan [COMPANY NAME] (“Company”), having its
di [LEGAL DOMICILE], yang anggaran dasarnya domiciled in [LEGAL DOMICILE], which the articles
sebagaimana termuat Akta Pendirian No. [NOMOR of association as contained in Deed of
AKTA] tanggal [TANGGAL AKTA], dibuat di hadapan Establishment No. [DEED NUMBER] dated [DEED
[NAMA NOTARIS], Notaris di [KEDUDUKAN NOTARIS] DATE], made before [NOTARY NAME], Public
(“Anggaran Dasar”) sebagaimana diumumkan Notary in [NOTARY DOMICILE] (“Article of
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dalam Berita Negara Republik Indonesia No. Association”) as announced in State Gazette of the
[NOMOR BNRI], Tambahan No. [NOMOR TBNRI] Republic of Indonesia No. [STATE GAZETTE
tanggal [TANGGAL BNRI]. Anggaran Dasar Perseroan NUMBER], Supplement No. [SUPPLEMENT
lalu selanjutnya disesuaikan untuk mematuhi NUMBER] dated [STATE GAZETTE DATE]. The Article
Undang-Undang No. 40 tahun 2007 tentang of Association was amended to comply with Law
Perseroan Terbatas (“UUPT”) sebagaimana No. 40 of 2007 concerning Limited Liability
tercantum dalam Akta No. [NOMOR AKTA] tanggal Company (“Company Law”) as contained in Deed
[TANGGAL AKTA], dibuat di hadapan [NAMA No. [DEED NUMBER] dated [DEED DATE], made
NOTARIS], Notaris di [KEDUDUKAN NOTARIS], yang before [NOTARY NAME], Public Notary in [NOTARY
telah disetujui oleh Menteri Hukum dan Hak Asasi DOMICILE], which has been approved by the
Manusia (“Menkumham”) melalui Keputusan No. Ministry of Law and Human Rights (“MoLHR”)
[NOMOR SK] tanggal [TANGGAL SK]. Perubahan through Decree No. [DECREE NUMBER] dated
terakhir Anggaran Dasar adalah sebagaimana [DECREE DATE]. The latest amendment to the
termuat dalam Akta No. [NOMOR AKTA] tanggal Articles of Association is stated in Deed No. [DEED
[TANGGAL AKTA], dibuat di hadapan [NAMA DATE], made before [NOTARY NAME], Public
NOTARIS], Notaris di [KEDUDUKAN NOTARIS], yang Notary in [NOTARY DOMICILE], which has been
telah disetujui oleh Menkumham melalui Keputusan approved by MoLHR through Decree No. [DECREE
No. [NOMOR SK] tanggal [TANGGAL SK] (“Akta NUMBER] dated [DECREE DATE] (“Deed [DEED
[NOMOR]/[TAHUN]”). NUMBER]/[DEED YEAR]”).

Komposisi pemegang saham Perseroan terakhir The latest Company’s shareholders composition is
sebagaimana dinyatakan dalam Akta No. [NOMOR as stated in Deed No. [DEED DATE], made before
AKTA] tanggal [TANGGAL AKTA], dibuat di hadapan [NOTARY NAME], Public Notary in [NOTARY
[NAMA NOTARIS], Notaris di [KEDUDUKAN DOMICILE], which the changes has been accepted
NOTARIS], yang perubahannya telah diterima dan and recorded in Legal Entity Administration System
dicatat dalam Sistem Administrasi Badan Hukum of the MoLHR through Letter of Acceptance of
Kemenkumham RI berdasarkan Surat Penerimaan Notification for Change of the Company Data No.
Pemberitahuan Perubahan Data Perseroan No. [DECREE NUMBER] dated [DECREE DATE] (“Deed
[NOMOR SK] tanggal [TANGGAL SK] (“Akta [DEED NUMBER]/[DEED YEAR]”).
[NOMOR]/[TAHUN]”).

Susunan Direksi dan Dewan Komisaris terakhir The latest Company’s Board of Directors and Board
adalah sebagaimana tencantum dalam Akta No. of Commissioner composition is stated in Deed
[NOMOR AKTA] tanggal [TANGGAL AKTA], dibuat di Number [DEED DATE], made before [NOTARY
hadapan [NAMA NOTARIS], Notaris di [KEDUDUKAN NAME], Public Notary in [NOTARY DOMICILE],
NOTARIS], yang perubahannya telah diterima dan which the changes has been accepted and
dicatat dalam Sistem Administrasi Badan Hukum recorded in Legal Entity Administration System of
Kemenkumham RI berdasarkan Surat Penerimaan the MoLHR through Letter of Acceptance of
Pemberitahuan Perubahan Data Perseroan No. Notification for Change of the Company Data No.
[NOMOR SK] tanggal [TANGGAL SK] (“Akta [DECREE NUMBER] dated [DECREE DATE] (“Deed
[NOMOR]/[TAHUN]”). [DEED NUMBER]/[DEED YEAR]”).

BAHWA, berdasarkan Pasal [PASAL] ayat [AYAT] WHEREAS, pursuant to Article [ARTICLE] paragraph
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Anggaran Dasar Perseroan jo. Pasal 91 Undang- [PARAGRAPH] of the Article of Association of the
Undang No. 40 Tahun 2007 tentang Perseroan Company in conjunction with Article 91 of Law No.
Terbatas, Para Pemegang Saham dapat juga 40 of 2007 concerning Limited Liability Company,
mengambil keputusan yang sah tanpa mengadakan the Shareholders can make a binding resolution
Rapat Umum Pemegang Saham, dengan ketentuan without convening a General Meeting of
Para Pemegang Saham telah diberitahukan secara Shareholders, provided that the Shareholders have
tertulis dan Para Pemegang Saham memberi been notified in writing and the Shareholders give
persetujuan mengenai usul yang diajukan secara their approval in writing for the submitted
tertulis serta menandatangani persetujuan proposal and sign the resolution. The decisions
tersebut. Keputusan yang diambil dengan cara taken in this way have the same power as
demikian mempunyai kekuatan yang sama dengan decisions taken legally at the General Meeting of
keputusan yang diambil dengan sah dalam Rapat Shareholders.
Umum Pemegang Saham.

DENGAN DEMIKIAN, Para Pemegang Saham NOW THEREFORE, the Shareholders of the
Perseroan dengan ini memutuskan untuk Company hereby unanimously resolve to adopt the
menyetujui keputusan sebagaimana tersebut di resolutions mentioned herein below (“Circular
bawah ini (“Keputusan Tertulis”): Resolutions”):

1. MEMUTUSKAN, bahwa Para Pemegang Saham 1. RESOLVED, that the Shareholders of the
Perseroan dengan ini menyetujui pengunduran Company hereby approve the resignation of
diri [NAME OF RESIGNED [NAME OF RESIGNED
DIRECTOR/COMMISSIONER] dari jabatannya DIRECTOR/COMMISSIONER] from [his/her]
sebagai [DIREKTUR/KOMISARIS] Perseroan, position as [DIRECTOR/COMMISSIONER] of the
efektif sejak tanggal Keputusan Tertulis ini dan Company, effective as of the date of this Circular
dengan ini memberikan pembebasan dan Resolutions and hereby grant a release and
pelunasan (acquit et de charge) atas segala discharge (acquit et de charge) over all
tanggung jawab dan kewajibannya dalam responsibilities and obligations in [his/her]
jabatannya sebagai [DIREKTUR/KOMISARIS] position as [DIRECTOR/COMMISSIONER] of the
Perseroan sejauh tindakan tersebut tercermin Company to the extent that such actions were
dalam catatan Perseroan, dilakukan dengan reflected in the records of the Company, done
itikad baik dan dengan tanggung jawab penuh in good faith and with full responsibility in the
dalam kepentingan dan usaha Perseroan dan interest and the business of the Company and
sesuai dengan peraturan perundang-undangan in accordance with the prevailing laws and
yang berlaku selama masa jabatannya. regulations during his term of office.

2. MEMUTUSKAN, bahwa Para Pemegang Saham 2. RESOLVED, that the Shareholders of the
Perseroan dengan ini menyetujui pengangkatan Company hereby approve the appointment of
[NAME OF APPOINTED [NAME OF APPOINTED
DIRECTOR/COMMISSIONER] sebagai DIRECTOR/COMMISSIONER] as
[DIREKTUR/KOMISARIS] Perseroan, efektif sejak [DIRECTOR/COMMISSIONER] of the Company,
tanggal Keputusan Tertulis ini. effective since the date of this Circular
Resolutions.
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3. MEMUTUSKAN, bahwa sehubungan dengan 3. RESOLVED, that in relation to the resignation of
pengunduran diri [NAME OF RESIGNED [NAME OF RESIGNED
DIRECTOR/COMMISSIONER] dan pengangkatan DIRECTOR/COMMISSIONER] and appointment
[NAME OF APPOINTED of [NAME OF APPOINTED
DIRECTOR/COMMISSIONER], Para Pemegang DIRECTOR/COMMISSIONER], the Shareholders
Saham Perseroan dengan ini menyetujui untuk of the Company hereby approve to discharge all
memberhentikan dengan hormat dan members of the Board of Directors and Board of
mengangkat kembali seluruh anggota Direksi dan Commissioners since the date of this Circular
Dewan Komisaris sejak tanggal Keputusan Tertulis Resolutions.
ini.

Dengan demikian, susunan anggota Direksi dan Therefore, the new members of the Board of
Dewan Komisaris Perseroan yang baru Directors and Board of Commissioner of the
selanjutnya menjadi sebagai berikut: Company becomes as follows:

DIREKSI BOARD OF DIRECTORS

Presiden Direktur: President Director:
[NAME], lahir di [BIRTH PLACE], tanggal [DATE OF [NAME], born in [BIRTH PLACE], on [DATE OF
BIRTH], Warga Negara [COUNTRY], pemegang BIRTH], a [COUNTRY] Citizen, holder of [Kartu
[Kartu Tanda Penduduk/Paspor] Nomor [ID CARD Tanda Penduduk/Paspor] Number [ID CARD
NO], bertempat tinggal di [REGISTERED NO], having [his/her] address at [REGISTERED
ADDRESS]. ADDRESS].

Direktur: Director:
[NAME], lahir di [BIRTH PLACE], tanggal [DATE OF [NAME], born in [BIRTH PLACE], on [DATE OF
BIRTH], Warga Negara [COUNTRY], pemegang BIRTH], a [COUNTRY] Citizen, holder of [Kartu
[Kartu Tanda Penduduk/Paspor] Nomor [ID CARD Tanda Penduduk/Paspor] Number [ID CARD NO],
NO], bertempat tinggal di [REGISTERED having [his/her] address at [REGISTERED
ADDRESS]. ADDRESS].

Direktur: Director:
[NAME], lahir di [BIRTH PLACE], tanggal [DATE OF [NAME], born in [BIRTH PLACE], on [DATE OF
BIRTH], Warga Negara [COUNTRY], pemegang BIRTH], a [COUNTRY] Citizen, holder of [Kartu
[Kartu Tanda Penduduk/Paspor] Nomor [ID CARD Tanda Penduduk/Paspor] Number [ID CARD NO],
NO], bertempat tinggal di [REGISTERED having [his/her] address at [REGISTERED
ADDRESS]. ADDRESS].

DEWAN KOMISARIS BOARD OF COMMISSIONER

Komisaris Utama: President Commissioner:
[NAME], lahir di [BIRTH PLACE], tanggal [DATE OF [NAME], born in [BIRTH PLACE], on [DATE OF
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 BIRTH], Warga Negara [COUNTRY], pemegang BIRTH], a [COUNTRY] Citizen, holder of [Kartu
[Kartu Tanda Penduduk/Paspor] Nomor [ID CARD Tanda Penduduk/Paspor] Number [ID CARD NO],
NO], bertempat tinggal di [REGISTERED having [his/her] address at [REGISTERED
ADDRESS]. ADDRESS].

Komisaris: Commissioner:
[NAME], lahir di [BIRTH PLACE], tanggal [DATE OF [NAME], born in [BIRTH PLACE], on [DATE OF
BIRTH], Warga Negara [COUNTRY], pemegang BIRTH], a [COUNTRY] Citizen, holder of [Kartu
[Kartu Tanda Penduduk/Paspor] Nomor [ID CARD Tanda Penduduk/Paspor] Number [ID CARD NO],
NO], bertempat tinggal di [REGISTERED ADDRESS] having [his/her] address at [REGISTERED
ADDRESS]

LEBIH LANJUT MEMUTUSKAN, bahwa [UPLINER BE IT FURTHER RESOLVED, that [UPLINER NAME]
NAME] dan/atau [ASSOCIATE NAME] dan/atau and/or [ASSOCIATE NAME] and/or [ASSOCIATE
[ASSOCIATE NAME], seluruhnya adalah pegawai dari NAME] all of whom are employees of PT. RSM
PT. RSM Indonesia Mitradaya, berkedudukan di Indonesia Mitradaya, domiciled in South Jakarta,
Jakarta Selatan, dengan ini diberikan kuasa tanpa are hereby given the power of attorney without
hak substitusi untuk: the right of substitution to:
i. menghadap notaris untuk menyatakan i. appear before a notary to state the above
keputusan-keputusan tersebut di atas kedalam resolutions in a notarial deed;
akta notaris;
ii. melaporkan atau memberitahukan dan ii. report or notify and register with the
mendaftarkan kepada pihak yang berwenang competent authorities the resolutions
atas keputusan-keputusan yang diambil resolved herein;
bersama ini;
iii. untuk melakukan segala tindakan-tindakan, iii. to do and perform all other acts, deeds or
menandatangani akta-akta atau hal-hal yang things which may be required in carrying out
diperlukan dalam melaksanakan wewenang this authorization and power of attorney,
dan kuasa ini, tanpa terkecuali. nothing being excepted;
iv. untuk menegaskan kembali keputusan- iv. to re-affirm the above resolutions if needed.
keputusan tersebut di atas dimana diperlukan

Keputusan Tertulis Para Pemegang Saham ini dapat This Circular Resolutions of the Shareholders may
ditandatangani dalam setiap jumlah atas salinan be executed in any number of counterparts and
yang terpisah, dan semua salinan yang all counterparts taken together will be deemed to
ditandatangani bersama tersebut akan dianggap constitute one and the same document.
satu dan merupakan dokumen yang sama.

Tanggal efektif Keputusan Tertulis Para Pemegang The effective date of this Circular Resolution of the
Saham ini adalah tanggal terakhir ditanda- Shareholders is the latest signing date of this
tanganinya Keputusan Tertulis ini oleh Para Circular Resolution by the Shareholders of the

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Pemegang Saham Perseroan. Company.

Para Pemegang Saham/Shareholders of

PT [COMPANY NAME]

[SHAREHOLDER 1] [SHAREHOLDER 2]

____________________________________ ____________________________________
Nama/Name : [NAME] Nama/Name : [NAME]
Jabatan/Position : [POSITION] Jabatan/Position : [POSITION]
Tanggal/Date : Tanggal/Date :

[SHAREHOLDER 3] [SHAREHOLDER 4]

____________________________________ ____________________________________
Nama/Name : [NAME] Nama/Name : [NAME]
Jabatan/Position : [POSITION] Jabatan/Position : [POSITION]
Tanggal/Date : Tanggal/Date :