Document Cover Sheet

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Document Cover Sheet

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PRO-FORMA INVOICE

Engineering, Procurement and Construction (EPC) Inside Battery Limits (ISBL) and Outside Battery Limit (OSBL) for The Refinery Development Master Plan (RDMP) Project

RU V Balikpapan To : PT Kilang Pertamina Balikpapan

Attn : Director of Development

Date : 20 September, 2021

Invoice No. : 26071-INV-IDR-HS-030 Contract No. : 25/C00000/2018-S0 Contract dated : 10 December, 2018 1st Amendment dated : 05 September, 2019 2nd Amendment dated : 05 February, 2020 Tripartite Agreement dated : 30 March, 2020 3rd Amendment dated : 15 January, 2021

Project No. : 26071

Amount

HMU & SRU (IDR) Inside Battery Limits (ISBL) and Outside Battery Limit (OSBL) for

The Refinery Development Master Plan (RDMP) Project RU V Balikpapan Payment of Inside Battery Limits (ISBL) and Outside Battery Limit (OSBL) for The Refinery Development Master Plan (RDMP) Project

RU V Balikpapan dated 10 December 2018, FIRST AMENDMENT OF CONTRACT entered in on 05 September 2019, SECOND AMENDMENT OF CONTRACT entered in on 05 February 2020, TRIPARTITE AGREEMENT

entered in on 30 March 2020, and THIRD AMENDMENT OF CONTRACT entered in on 15 January 2021 between PT. Pertamina (Persero), PT Kilang Pertamina Balikpapan and RDMP Balikpapan JO.

period 26.07.2021 ~ 25.08.2021

PAYMENT

A. Performance Sums Payment IDR 54,479,819,226

B. Provisional Sum IDR 23,570,179,800

C. Contract Change Order

D. Total Invoice (A+B+C) IDR 78,049,999,026

Repayment of Advance Payment

E. Amount of Advance Payment IDR 4,383,922,953

F. Invoice Amount Payable Total (D-E) IDR 73,666,076,073

TAX

G. Add : VAT (10% x F) IDR 7,366,607,607

TOTAL AMOUNT Including VAT (F+G) IDR 81,032,683,680 Value in words : Eighty-One Billion Thirty-Two Million Six Hundred Eighty-Three Thousand Six Hundred Eighty

ID Rupiah (including VAT)

Amount Lumpsum Price

1. Total Contract of HMU & SRU in IDR (Lump Sum Price Only) IDR 1,702,494,350,809

2. Advance Payment IDR 87,678,459,067

3. Invoice Amount Payable Unit Up to Previous Period IDR 336,412,883,720

4. Current Invoice Amount Payable IDR 50,095,896,273

4.1 Repayment of Advance Payment Up to Previous Period IDR 74,526,690,202 5. Total Invoice of HMU & SRU in IDR (Lump Sum Price Only)

Cumulative Invoice Amount (2 + 3 + 4 - 4.1) IDR 399,660,548,858

6. Balance of Lumpsum Price (1-5) IDR 1,302,833,801,951

7. Repayment of Advance Payment Cumulative IDR 78,910,613,155

8. Balance of Advance Payment (2-7) IDR 8,767,845,912

Provisional Sum Price

6. Total Contract of HMU & SRU in IDR (Provisional Sums Price Only) IDR 62,647,020,610 7. Invoice Amount Payable Unit Up to Previous Period IDR 20,841,634,880

8. Current Invoice Amount Payable IDR 23,570,179,800

9. Total Invoice Cumulative Invoice Amount (7 + 8) IDR 44,411,814,680

10. Balance of Provisional Sum (6 - 9) IDR 18,235,205,930

Please remit the above amount to :

Account Name : RDMP Balikpapan JO RDMP Balikpapan JO

Bank Name : Bank Mandiri

Branch : Jakarta Gatot Subroto

Gedung Menara Jamsostek Jl. Jend. Gatot Subroto No. 38 Jakarta 12710

Account No. : 0700009788915

Swift Code No.: BMRIIDJA

Kim Yun Dong Project Manager

Description

JO PMC OWNER

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PERFORMANCE SUMS PAYMENT BREAKDOWN SHEET FOR ADDITIONAL WORK UNIT

Engineering, Procurement and Construction (EPC) Inside Battery Limits (ISBL) and Outside Battery Limit (OSBL) for The Refinery Development Master Plan (RDMP) Project RU V Balikpapan

Contract No. 25/C00000/2018-S0

Contract dated 10 December, 2018

1st Amendment dated 05 September, 2019 2nd Amendment dated 05 February, 2020 Tripartite Agreement dated 30 March, 2020 3rd Amendment dated 15 January, 2021

Project No. 26071

Payment Period for HMU SRU 26.07.2021 ~ 25.08.2021 Payment Period for HCU 26.07.2021 ~ 25.08.2021

NO DESCRIPTION CONTRACT PRICE (LUMPSUM) PYSICAL AMOUNT OF INVOICE

TOTAL TOTAL PROGRESS PREVIOUS CUMULATIVE INVOICE PRESENT PAYMENT MONTH TOTAL CUMULATIVE INVOICE

USD IDR EPC USD IDR USD IDR USD IDR

A B E F G H = J-F I = K-G J = AxE K = BxE

( I ) HMU & SRU 231,733,374.00 1,702,494,350,809 22.96% 45,790,514.70 336,412,883,720 7,415,467.97 54,479,819,226 53,205,982.67 390,892,702,946

( II ) HCU 108,606,638.00 837,835,204,671 8.69% 7,711,071.30 59,486,299,532 1,726,845.54 13,321,579,754 9,437,916.84 72,807,879,286

JO PMC OWNER

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PROVISIONAL SUMS BREAKDOWN SHEET FOR ADDITIONAL WORK UNIT

1st Amendment dated 05 September, 2019

2nd Amendment dated 05 February, 2020

Tripartite Agreement dated 30 March, 2020

3rd Amendment dated 15 January, 2021

Project No. 26071

Payment Period for HMU SRU 26.07.2021 ~ 25.08.2021

Payment Period for HCU 26.07.2021 ~ 25.08.2021

NO DESCRIPTION UNIT CONTRACT PRICE

UNIT RATE IDR / UNIT

HMU. SRU HCU HMU, SRU HCU HMU, SRU HCU HMU, SRU HCU

A B B* C C* D = E - C D = E* - C* E = A x B E* = A x B*

PILING

a. Micro Piles Dia 200 mm LM 1,065,000 - - - - - -

b. Micro Piles Dia 250 mm LM 1,164,000 - - - - - -

c. Spun Piles Dia 300 mm LM 672,000 - - - - - -

d. Spun Piles Dia 400 mm LM 895,000 - - - - - -

e. Spun Piles Dia 500 mm LM 1,206,000 7,904.10 - - 9,532,344,600.00 - 9,532,344,600 -

f. Spun Piles Dia 600 mm LM 1,499,000 9,364.80 - - 14,037,835,200.00 - 14,037,835,200 -

g. Spun Piles Dia 800 mm LM 3,030,000 - - - - - -

h. Steel Pipe Piles Dia 1000 mm , t=19 mm LM 7,464,000 - - - - - -

i. Steel Pipe Piles Dia 800 mm , t=14 mm LM 4,533,000 - - - - - -

j. Steel Pipe Piles Dia 400 mm , t=12 mm LM 2,009,000 - - - - - -

k. Steel Pipe Piles Dia 1500 mm , t=24 mm LM 19,576,000 - - - - - -

l. Steel Pipe Piles Dia 1500 mm , t=30 mm LM 22,479,000 - - - - - -

m. Bore Piles Dia 600 mm LM 2,098,000 - - - - - -

n. Bore Piles Dia 800 mm LM 3,187,000 - - - - - -

PILING SUBTOTAL 17,268.90 - - - 23,570,179,800.00 - 23,570,179,800 -

STONE COLUMN M3 958,000 21,755.36 - 20,841,634,880 - - - 20,841,634,880 -

TOTAL 39,024.26 - 20,841,634,880.00 - 23,570,179,800 - 44,411,814,680.00 -

IDR QUANTITY

CUMULATIVE PREVIOUS CUMULATIVE INVOICE PRESENT PAYMENT MONTH TOTAL CUMULATIVE INVOICE

AMOUNT OF INVOICE

JO PMC OWNER

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ADVANCE PAYMENT REPAYMENT BREAKDOWN SHEET FOR ADDITIONAL WORK UNIT

1st Amendment dated 05 September, 2019 2nd Amendment dated 05 February 2020 Tripartite Agreement dated 30 March, 2020 3rd Amendment dated 15 January, 2021

Project No. 26071

Payment Period for HMU SRU 26.07.2021 ~ 25.08.2021 Payment Period for HCU 26.07.2021 ~ 25.08.2021

NO DESCRIPTION CONTRACT PRICE

TOTAL TOTAL Present Advance Payment Month of Additional Unit

USD IDR USD IDR

A B C = A x 5,15% D = B x 5,15%

( I ) HMU & SRU 231,733,374 1,702,494,350,809 11,934,268 87,678,459,067

( II ) HCU 108,606,638 837,835,204,671 5,593,242 43,148,513,041

( III ) TOTAL ALL PACKAGE ( I ) + ( II ) 340,340,012 2,540,329,555,480 17,527,510.00 130,826,972,108

ADVANCE PAYMENT REPAYMENT OF ADDITIONAL UNIT

USD IDR USD IDR USD IDR

( I ) HMU & SRU 10,144,128 74,526,690,202 596,713.40 4,383,922,953 10,740,841.20 78,910,613,155

( II ) HCU 559,324 4,314,851,304 279,662.10 2,157,425,652 838,986.30 6,472,276,956

( III ) TOTAL ALL PACKAGE ( I ) + ( II ) 10,703,452 78,841,541,506 876,375.50 6,541,348,605 11,579,827.50 85,382,890,111 NO DESCRIPTION Previous Advance Payment Repayment Present Advance Payment Repayment Cumulative Advance Payment Repayment

JO PMC OWNER

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Faktur Pajak Separator Sheet

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Faktur Pajak

Pengusaha Kena Pajak

Pembeli Barang Kena Pajak / Penerima Jasa Kena Pajak Nama : PT. KILANG PERTAMINA BALIKPAPAN

Alamat : GEDUNG UTAMA LT.14 JL MEDAN MERDEKA TIMUR Blok 0 No.1A RT:000 RW:000 Kel.GAMBIR Kec.GAMBIR Kota/Kab.JAKARTA PUSAT DKI JAKARTA 00000

NPWP : 92.072.048.9-025.000

Kode dan Nomor Seri Faktur Pajak : 010.003-21.85386535

Nama : RDMP BALIKPAPAN JO

Alamat : JL BONGAS I , KOTA BALIKPAPAN NPWP : 90.850.448.3-729.000

No. Harga Jual/Penggantian/Uang

Muka/Termin Nama Barang Kena Pajak / Jasa Kena Pajak

78.049.999.026,00 1

Payment of Inside Battery Limits (ISBL) and Outside Battery Limit (OSBL) for The Refinery Development Master Plan (RDMP) Project RU V

Balikpapan

Rp 78.049.999.026 x 1

Harga Jual / Penggantian 78.049.999.026,00

0,00 Dikurangi Potongan Harga

4.383.922.953,00 Dikurangi Uang Muka

PPN = 10% x Dasar Pengenaan Pajak 7.366.607.607,00

0,00 Total PPnBM (Pajak Penjualan Barang Mewah)

Dasar Pengenaan Pajak 73.666.076.073,00

Sesuai dengan ketentuan yang berlaku, Direktorat Jenderal Pajak mengatur bahwa Faktur Pajak ini telah ditandatangani secara elektronik sehingga tidak diperlukan tanda tangan basah pada Faktur Pajak ini.

KOTA BALIKPAPAN, 04 Oktober 2021

KIM YUN DONG

Inv No. 26071-INV-IDR-HS-030

1 dari 1

PEMBERITAHUAN: Faktur Pajak ini telah dilaporkan ke Direktorat Jenderal Pajak dan telah memperoleh persetujuan sesuai dengan ketentuan peraturan perpajakan yang berlaku. PERINGATAN: PKP yang menerbitkan Faktur Pajak yang tidak sesuai dengan keadaan yang sebenarnya dan/atau sesungguhnya sebagaimana dimaksud Pasal 13 ayat (9) UU PPN dikenai sanksi sesuai dengan Pasal 14 ayat (4) UU KUP

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DIREKTORAT JENDERAL PAJAK

KEMENTERIAN KEUANGAN REPUBLIK INDONESIA

KANTOR WILAYAH DJP KALIMANTAN TIMUR DAN UTARA KANTOR PELAYANAN PAJAK PRATAMA BALIKPAPAN BARAT

JL. JENDERAL SUDIRMAN NO 889, DAMAI BAHAGIA SUDIRMAN OFFICE PARK BALIKPAPAN null

LAYANAN INFORMASI DAN KELUHAN KRING PAJAK (021) 500200 EMAIL [email protected]

ELEKTRONIK NOMOR SERI FAKTUR PAJAK

Nama

No : S-

216/PPN.NSFP/WPJ.14/KP.0903/2021 Tgl : 04 Januari 2021

Diterbitkan untuk PKP :

E - NOFA

: RDMP BALIKPAPAN JO : 90.850.448.3-729.000

No : PEM-

490575564/908504483/729/2021 Surat Pemberitahuan DJP

Surat Permohonan PKP NPWP

sampai dengan

Direktorat Jenderal Pajak memberikan Nomor Seri Faktur Pajak sebanyak 75 dmulai dari :

003.21.85386466

003.21.85386540

2021

DIREKTUR JENDERAL PAJAK MENYATAKAN BAHWA DOKUMEN INI TIDAK MEMERLUKAN TANDATANGAN DARI PEJABAT DIREKTORAT JENDERAL PAJAK.

NOMOR SERI FAKTUR PAJAK INI DIPERGUNAKAN UNTUK PEMBUATAN FAKTUR PAJAK DIMULAI DARI TANGGAL 04 Januari 2021 UNTUK TAHUN 2021 .

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PEMBUATAN FAKTUR PAJAK MENGIKUTI TATA CARA SEBAGAIMANA DIATUR DALAM PERATURAN PERPAJAKAN YANG MENGATUR TENTANG TATA CARA PEMBUATAN FAKTUR PAJAK.

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DALAM HAL NOMOR SERI YANG DIBERIKAN SUDAH HAMPIR HABIS, PENGUSAHA KENA PAJAK DIMINTA UNTUK MENGAJUKAN KEMBALI SURAT PERMOHONAN NOMOR SERI FAKTUR PAJAK SESUAI DENGAN KETENTUAN

PEMBERITAHUAN DIREKTORAT JENDERAL PAJAK :

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Doc. No. : 26071-100-GPP-GAB-00002 Job No. : 26071 Rev.005 1

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CONTRACT PRICE INVOICING PROCEDURE

PROJECT : Engineering, Procurement and Construction (EPC) Inside Battery Limits (ISBL) and Outside Battery Limit (OSBL) for The Refinery Development Master Plan (RDMP) Project RU V Balikpapan

LOCATION : Refinery Unit V Balikpapan, East Kalimantan,Indonesia OWNER : PT PERTAMINA (Persero)

005 03.04.2020 APPROVAL FOR DESIGN J.Y. KIM J.H. KIM Y.D. KIM 004 10.03.2020 APPROVAL FOR DESIGN J.Y. KIM J.H. KIM Y.D. KIM 003 19.11.2019 APPROVAL FOR DESIGN J.Y. KIM J.H. KIM Y.D. KIM 002 11.09.2019 APPROVAL FOR DESIGN J.Y. KIM J.H. KIM Y.D. KIM 001 12.06.2019 APPROVAL FOR DESIGN J.Y. KIM J.H. KIM Y.D. KIM 000 16.04.2019 APPROVAL FOR DESIGN J.Y. KIM J.H. KIM Y.D. KIM 00A 05.03.2019 ISSUED FOR APPROVAL J.Y. KIM J.H. KIM Y.D. KIM

REV. DATE DESCRIPTION PREPARED CHECKED APPROVED