FORMULIR PELAPORAN HADIAH
GIFT REPORTING DISCLOSURE 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 Penerima: Recipient’s Name: No. Pegawai: Employee Number: Divisi:
Division:
Menyampaikan Laporan Penerimaan Hadiah sebagai berikut: Reporting the Receipt of Gif as Follows:
Jenis Hadiah:
Type of Gratification: Perkiraan Nilai Rp.: Est. Value (Rp)
Tanggal dan Tempat Penerimaan: Date & Place of Receipt:
Nama Pemberi: Giver’s Name: Alamat Pemberi: Address:
Hubungan Pemberi dengan PT Elnusa Tbk Relationship with PT Elnusa Tbk:
Bukti (lampiran): Evidence (Attachment):
Demikian disampaikan atas perhatiannya diucapkan terima kasih. Thus we conveyed, thank you for your attention.
Hormat kami, Sincerely yours
