Form Pemberian Hadiah dan Hiburan Bilingual

FORMULIR PEMBERIAN HADIAH DAN HIBURAN

GIFT & ENTERTAINMENT PRESENTING FORM

Kepada/To :

Corporate Secretary

Cc: ... selaku Atasan Langsung (as Direct Supervisor/Manager)

Dalam rangka menegakkan prinsip-prinsip Good Corporate Governance serta menerapkan budaya dan nilai-nilai pokok Perseroan: Clean-Respectful-Synergy, maka saya yang bertandatangan di bawah ini:

In order to uphold the principles of Good Corporate Governance and implement culture and core values of the Company: Clean-Respectful-Synergy, then I am the undersigned:

Nama: Name:

No. Pegawai:

Employee Number: Divisi:

Division:

Menyampaikan rencana pemberian Hadiah/Hiburan sebagai berikut:

Reporting the Giving of Gift/Entertainment as Follows:

Jenis Hadiah/Hiburan: Type of Gift/Entertainment: Perkiraan Nilai Rp.:

Est. Value (Rp) Nama Penerima: Recipient’s Name: Alamat Penerima: Address:

Hubungan Penerima dengan PT Elnusa Tbk

Relationship with PT Elnusa Tbk: Alasan Pemberian:

Giving Reason:

Demikian disampaikan dan mohon diberikan keputusan. Thus we conveyed and please give the decision.

Hormat kami, Sincerely yours