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PT SIMAS REINSURANCE BROKERS

Dalam dokumen Kata Pengantar - OJK (Halaman 138-143)

167. PT WILLIS INDONESIA

35. PT SIMAS REINSURANCE BROKERS

Otoritas Jasa Keuangan Indonesia Indonesia Financial Services Authority Susunan Pemegang Saham / Shareholders Composition

1. PT Jaya Kapital Indonesia Rp1.200.000.000 60,00%

2. Sri Hadiah Watie, B.Sc, SH, Rp400.000.000 20,00%

AAIK(HC),QIP

3. PT Nasorasudha Artha Rp200.000.000 10,00%

Investama

4. Theophilus Hartono Rp200.000.000 10,00%

Izin Usaha / Lisences Tanggal Keputusan / Decision Date Alamat / Address

Telepon / Telephone Faksimili / Facsimile Situs / Website Surel / Email

Dewan Direksi / Board of Directors 1. Direktur Utama /

President Director 2. Direktur / Director

Dewan Komisaris / Board of Commissioners 1. Komisaris / Commissioner

Susunan Pemegang Saham / Shareholders Composition

1. Farouk Budi Rp553.700.000 31,64%

2. Bambang Prasudi Budiono Rp422.800.000 24,16%

3. R. Saroso Rp336.000.000 19,20%

4. Palma Punta Hertyanto Rp262.500.000 15,00%

5. Rubiyanto Rp87.500.000 5,00%

6. Agoes C. Bisrie Rp87.500.000 5,00%

: S-129/MK.17/2000 : 13 April 2000

: Graha Binakarsa Lantai 4 Jalan HR Rasuna Said Kav C-18 Jakarta 12940

: 021-5276 871, 021-5277134 : 021-5276 872

: www.parare-intl.com : [email protected]

Bambang Prasudi Budiono Raden Saroso

Farouk Budi

32. PT PARARE INTERNATIONAL

Izin Usaha / Lisences Tanggal Keputusan / Decision Date Alamat / Address

Telepon / Telephone Faksimili / Facsimile Situs / Website Surel / Email

: KEP-627/KMK.017/1996 : 4 Nopember 1996

: Jalan Dewi Sartika Nomor 371 Cawang Jakarta Timur 13630

: 021-80890020 : 021-80890019 : -

: [email protected]

33. PT PIALANG REASURANSI DEKAI INDONESIA

Dewan Direksi / Board of Directors 1. Direktur / Director

Dewan Komisaris / Board of Commissioners 1. Komisaris / Commissioner

Susunan Pemegang Saham / Shareholders Composition

1. Savira Anggraini Rp370.000.000 37,00%

2. Prido Monang Lumbantoruan Rp370.000.000 37,00%

3. Krisvinia Arie Previana Rp160.000.000 16,00%

4. Kenia Truasdini Gusnaeni Rp100.000.000 10,00%

Normansyah

S.E. Ferdianto

Achmad Gusnaeni

Izin Usaha / Lisences Tanggal Keputusan / Decision Date Alamat / Address

Telepon / Telephone Faksimili / Facsimile Situs / Website Surel / Email

Dewan Direksi / Board of Directors 1. Direktur / Director

Dewan Komisaris / Board of Commissioners 1. Komisaris / Commissioner

Susunan Pemegang Saham / Shareholders Composition

1. PT Bethanindo Pratama Rp1.368.000.000 76,00%

2. THB Asia Pasific Rp432.000.000 24,00%

: KEP-05/KM.10/2011 : 6 Januari 2011

: Rasuna Office Park 4th Floor #UOM 20, Kawasan Rasuna Epicentrum Jalan H.R.

Rasuna Said, Kuningan Jakarta 12960 : 021-93903990, 021-83786273 : -

: -

: [email protected]

Bimo Setiawan

Kukuh Prihadi

34. PT PROTEKSI WAHANA SENTOSA

Izin Usaha / Lisences Tanggal Keputusan / Decision Date Alamat / Address

Telepon / Telephone Faksimili / Facsimile Situs / Website

: KEP-412/KMK.017/1996 : 11 Juni 1996

: Komplek Mega Grosir Cempaka Mas Blok L Nomor 5-6 Jalan Let. Jend. Suprapto Jakarta 10640

: 021-4288 6767 : 021-426 8936 : -

35. PT SIMAS REINSURANCE BROKERS

Industri Keuangan Non Bank Non Bank Financial Industry Direktori Dana Pensiun / Pension Fund Directory 03

Direktori Lembaga Keuangan Khusus / Specialized Financial Institutions Directory

04 Direktori Lembaga Keuangan Mikro /

Micro Finance Institution Directory

05 Asosiasi dan Lembaga /

Association and Institution 06

Direktori Perasuransian / Insurance Directory

01 Direktori Lembaga Pembiayaan /

Finance Institutions Directory 02

Surel / Email

Dewan Direksi / Board of Directors 1. Direktur Utama /

President Director 2. Direktur / Director

Dewan Komisaris / Board of Commissioners 1. Komisaris Utama /

President Commissioner 2. Komisaris / Commissioner

Susunan Pemegang Saham / Shareholders Composition

1. PT Kalibesar Raya Utama Rp250.000.000 50,00%

2. PT Sinar Mas Tunggal Rp250.000.000 50,00%

: [email protected]

Erick A. Wayong Thomas Budi Atmadja

Indra Widjaja Gandi Sulistianto S

Izin Usaha / Lisences Tanggal Keputusan / Decision Date Alamat / Address

Telepon / Telephone Faksimili / Facsimile Situs / Website Surel / Email

Dewan Direksi / Board of Directors 1. Direktur Utama /

President Director

Dewan Komisaris / Board of Commissioners 1. Komisaris Utama /

President Commissioner 2. Komisaris / Commissioner

Susunan Pemegang Saham / Shareholders Composition

1. Herris Simandjuntak Rp550.000.000 55,00%

2. Drs. Agus Subrata Rp450.000.000 45,00%

: KEP-13/NB.1/2016 : 25 Februari 2016

: Jl. Makmur No.47 RT. 006/003,Kel.

Kebayoran Lama Utara, Kec. Kebayoran Jakarta Selatan

: 021-27514915 : 021-27514951 : -

: -

Hari Suryadi

Saiful Ali

Ir. M.A. Sri Rahayu Cholilulloh

36. PT SMARTINDO PIALANG REASURANSI

Izin Usaha / Lisences Tanggal Keputusan / Decision Date

: KEP-365/KM.5/2005 : 31 Oktober 2005

37. PT TALA RE INTERNATIONAL

Alamat / Address

Telepon / Telephone Faksimili / Facsimile Situs / Website Surel / Email

Dewan Direksi / Board of Directors 1. Direktur / Director

Dewan Komisaris / Board of Commissioners 1. Komisaris / Commissioner

Susunan Pemegang Saham / Shareholders Composition

1. Kapler Marpaung Rp914.000.000 53,76%

2. Drs,Herris Simajuntak Rp374.000.000 22,00%

3. Drs.Agus Subrata Rp272.000.000 16,00%

4. Iwan Syamsir Agus Rp70.000.000 4,12%

5. Rudy Damanik Rp70.000.000 4,12%

: Graha Mustika Ratu, Lt.6

Jl.Gatot Subroto Kav.74-7 Jakarta 12870 : 021-8306663

: 021-8306662 : -

: -

Kapler A.Marpaung

Parker Damanik

Izin Usaha / Lisences Tanggal Keputusan / Decision Date Alamat / Address

Telepon / Telephone Faksimili / Facsimile Situs / Website Surel / Email

Dewan Direksi / Board of Directors 1. Direktur / Director

Dewan Komisaris / Board of Commissioners 1. Komisaris / Commissioner

Susunan Pemegang Saham / Shareholders Composition

1. Tulsi Tolani Rp400.000.000 80,00%

2. Anggraini E.Syaftari Rp100.000.000 20,00%

: KEP-412/KM.6/2003 : 21 Nopember 2003

: Cyber 2 Tower Lantai 6 Jalan H.R. Rasuna Said Blok X-5 No.13 Jakarta Selatan 12950 : 021-29021617, 021-29021615 : 021-29021615

: - : -

Tulsi Tolani

Uung Hamidi Ischak SE

38. PT TRINITY RE

Izin Usaha / Lisences Tanggal Keputusan / Decision Date

: KEP-328/KM.10/2010 : 29 Juni 2010

39. PT UNITED PIALANG REASURANSI

137

Alamat / Address

Telepon / Telephone Faksimili / Facsimile Situs / Website Surel / Email

Dewan Direksi / Board of Directors 1. Direktur / Director

Dewan Komisaris / Board of Commissioners 1. Komisaris / Commissioner

Susunan Pemegang Saham / Shareholders Composition

1. Hendro Satrijo Rp400.000.000 40,00%

2. Muhammad Ramali Afandi Rp400.000.000 40,00%

3. Irma Setino Rp200.000.000 20,00%

: The Plaza Office Tower Level 20 - Unit D Jalan MH Thamrin Kav 28-30 Jakarta 10350 : 021-2992 2070

: 021-2992 2070 : -

: [email protected]

Muhammad Ramali Afandi

Hendro Satrijo

Izin Usaha / Lisences Tanggal Keputusan / Decision Date Alamat / Address

Telepon / Telephone Faksimili / Facsimile Situs / Website Surel / Email

Dewan Direksi / Board of Directors 1. Direktur Utama /

President Director

Dewan Komisaris / Board of Commissioners 1. Komisaris Utama /

President Commissioner 2. Komisaris / Commissioner

Susunan Pemegang Saham / Shareholders Composition

1. Hartati Indra Rp750.000.000 60,00%

2. Ma'un Amin Rp100.000.000 24,00%

3. Nuraina Rp100.000.000 8,00%

4. Polly Poerdana Diredja Rp300.000.000 8,00%

: KEP-645/KM.10/2012 : 30 Nopember 2012

: Graha Pulo, 4th Floor. Jl.Buncit Raya No.89 Jakarta Selatan 12710

: 021-79188265 : 021-7899420 : -

: -

Mohamad Rusli

Mochammad Johnny Djaffar Polly Poerdana Diredja

40. PT VIVA BROKER REASURANSI INDONESIA

Otoritas Jasa Keuangan Indonesia Indonesia Financial Services Authority Alamat / Address

Telepon / Telephone Faksimili / Facsimile Situs / Website Surel / Email

Dewan Direksi / Board of Directors 1. Direktur / Director

Dewan Komisaris / Board of Commissioners 1. Komisaris / Commissioner

Susunan Pemegang Saham / Shareholders Composition

1. Hendro Satrijo Rp400.000.000 40,00%

2. Muhammad Ramali Afandi Rp400.000.000 40,00%

3. Irma Setino Rp200.000.000 20,00%

: The Plaza Office Tower Level 20 - Unit D Jalan MH Thamrin Kav 28-30 Jakarta 10350 : 021-2992 2070

: 021-2992 2070 : -

: [email protected]

Muhammad Ramali Afandi

Hendro Satrijo

Izin Usaha / Lisences Tanggal Keputusan / Decision Date Alamat / Address

Telepon / Telephone Faksimili / Facsimile Situs / Website Surel / Email

Dewan Direksi / Board of Directors 1. Direktur Utama /

President Director

Dewan Komisaris / Board of Commissioners 1. Komisaris Utama /

President Commissioner 2. Komisaris / Commissioner

Susunan Pemegang Saham / Shareholders Composition

1. Hartati Indra Rp750.000.000 60,00%

2. Ma'un Amin Rp100.000.000 24,00%

3. Nuraina Rp100.000.000 8,00%

4. Polly Poerdana Diredja Rp300.000.000 8,00%

: KEP-645/KM.10/2012 : 30 Nopember 2012

: Graha Pulo, 4th Floor. Jl.Buncit Raya No.89 Jakarta Selatan 12710

: 021-79188265 : 021-7899420 : -

: -

Mohamad Rusli

Mochammad Johnny Djaffar Polly Poerdana Diredja

40. PT VIVA BROKER REASURANSI INDONESIA

Industri Keuangan Non Bank Non Bank Financial Industry Direktori Dana Pensiun / Pension Fund Directory 03

Direktori Lembaga Keuangan Khusus / Specialized Financial Institutions Directory

04 Direktori Lembaga Keuangan Mikro /

Micro Finance Institution Directory

05 Asosiasi dan Lembaga /

Association and Institution 06

Direktori Perasuransian / Insurance Directory

01 Direktori Lembaga Pembiayaan /

Finance Institutions Directory 02

Perusahaan Penilai Kerugian Asuransi

Insurance Loss Adjuster Company

Izin Usaha / Lisences Tanggal Keputusan / Decision Date Alamat / Address

Telepon / Telephone Faksimili / Facsimile Situs / Website Surel / Email

Dewan Direksi / Board of Directors 1. Direktur / Director

Dewan Komisaris / Board of Commissioners 1. Komisaris / Commissioner

Susunan Pemegang Saham / Shareholders Composition 1. Ma'un Amin

2. Nuraina

: KEP-447/KM.5/2004 : 23 Oktober 2004

: Jl Swasembada Barat XXIII No. 23 Kebon bawang - Tanjung priuk Jakarta : 021-43902110

: 021-4393588 : -

: -

Mohamad Rusli

Polly Poerdana Diredja

1. PT ARDILLA SOLORINA

Izin Usaha / Lisences Tanggal Keputusan / Decision Date Alamat / Address

Telepon / Telephone Faksimili / Facsimile Situs / Website Surel / Email

Dewan Direksi / Board of Directors 1. Direktur Utama /

President Director 2. Direktur / Director

: KEP-2565/MD/ /1986 : 21 April 1986

: Gedung Pusat Perfilman H. Umar Ismail Lt.2 Jl. HR Rasuna Said Kav. C-22, Kuningan Jakarta 12940

: 021-29110707 : 021-29110708 : www.axisadjusters.com : [email protected]

Gallacher William Alan

Febrizal

2. PT AXIS INTERNATIONAL INDONESIA

Dewan Komisaris / Board of Commissioners 1. Komisaris Utama /

President Commissioner

Susunan Pemegang Saham / Shareholders Composition 1. Polly Poerdana Diredja

2. Khaerudin

Khaerudin

Izin Usaha / Lisences Tanggal Keputusan / Decision Date Alamat / Address

Telepon / Telephone Faksimili / Facsimile Situs / Website Surel / Email

Dewan Direksi / Board of Directors 1. Direktur / Director

Dewan Komisaris / Board of Commissioners 1. Komisaris / Commissioner

Susunan Pemegang Saham / Shareholders Composition 1. Sulaeman Achmad

2. Axis holding Limited 3. Ir. Samuel J. Lumoindong 4. Bona Rafles Pandiangan 5. Evelyne Siallagan 6. Ruben Tandian

: KEP-4586/M/1988 : 3 Juni 1988

: Gd. Sentra Salemba Mas Jl. Salemba Raya No. 34-36 Kav. M Jakarta 10430

: 021-3907177, 021-3907130 : 021-3906887

: -

: [email protected]

Yayuk Nawangwulan

Antonius Sianipar

3. PT BAHTERA ARTHAGUNA PARAMA

Izin Usaha / Lisences Tanggal Keputusan / Decision Date

: KEP-064/KMK.017/1997 : 24 Nopember 1997

4. PT BAHTERA ARUNG PERSADA

139

Alamat / Address

Telepon / Telephone Faksimili / Facsimile Situs / Website Surel / Email

Dewan Direksi / Board of Directors 1. Direktur / Director

Dewan Komisaris / Board of Commissioners 1. Komisaris / Commissioner

Susunan Pemegang Saham / Shareholders Composition 1. Bona Rafles Pandiangan

2. Daniel Erhard 3. Ruben Tandian 4. Suyeti 5. Willy Ignatius

: Royal Palace Blok C9 JL. Prof. Dr. Soepomo NO.178 A Jakarta Selatan 12870

: 021-5204465 : 021-5204467 : -

: [email protected]

Wahyu Hidayatullah

Bona R. Pandiangan

Izin Usaha / Lisences Tanggal Keputusan / Decision Date Alamat / Address

Telepon / Telephone Faksimili / Facsimile Situs / Website Surel / Email

Dewan Direksi / Board of Directors 1. Direktur Utama /

President Director 2. Direktur / Director 3. Direktur / Director 4. Direktur / Director 5. Direktur / Director

Dewan Komisaris / Board of Commissioners 1. Komisaris Utama /

President Commissioner 2. Komisaris / Commissioner

Susunan Pemegang Saham / Shareholders Composition 1. Elly Fauziah

2. Etty Indrianie

: KEP-136/KM.13/1989 : 4 September 1989

: Plaza Park View Lt.3 Jl. Taman Kemang No.27 Jakarta 12730

: 021-7192507 : 021-5152248 : -

: -

Allan Gallacher

Ifwanto Davies Paul Hough Stuart James Devine Theodora Oyonita Sembiring

Christoper Michael panes Jansen Silalahi

5. PT CUNNINGHAM LINDSEY INDONESIA

3. Jansen Silalahi 4. Putro 5. Wibisono Ratno

Izin Usaha / Lisences Tanggal Keputusan / Decision Date Alamat / Address

Telepon / Telephone Faksimili / Facsimile Situs / Website Surel / Email

Dewan Direksi / Board of Directors 1. Direktur Utama /

President Director 2. Direktur / Director 3. Direktur / Director

Dewan Komisaris / Board of Commissioners 1. Komisaris Utama /

President Commissioner 2. Komisaris / Commissioner 3. Komisaris / Commissioner

Susunan Pemegang Saham / Shareholders Composition 1. Dharmala Sakti Sejahtera

2. Robertus Ismono 3. Soewondo

: KEP-2413/MD/1987 : 13 April 1987

: Plaza Ciputat Mas Blok E kav. A,B,C Jl. Ir. H. Juanda No. 5 A Ciputat Tangerang : 021-7432251

: 021-7432158 : -

: [email protected]

Ahmad Azuz

Robertus Ismono Djuhan Iskandar

Suhanda Wiraatmadja

Lydia Sutedja Christina Gondokusumo

6. PT DHARMA NILAITAMA

Izin Usaha / Lisences Tanggal Keputusan / Decision Date Alamat / Address

Telepon / Telephone Faksimili / Facsimile Situs / Website Surel / Email

: KEP-115/KM.12/2006 : 4 Oktober 2006

: Wisma Slipi Lt. 15 Jl. S. Parman Kav. 12 Slipi Jakarta 11480

: 021-5307168 : 021-5307167 : -

: [email protected]

7. PT GENERAL ADJUSTER INDONESIA

Otoritas Jasa Keuangan Indonesia Indonesia Financial Services Authority Alamat / Address

Telepon / Telephone Faksimili / Facsimile Situs / Website Surel / Email

Dewan Direksi / Board of Directors 1. Direktur / Director

Dewan Komisaris / Board of Commissioners 1. Komisaris / Commissioner

Susunan Pemegang Saham / Shareholders Composition 1. Bona Rafles Pandiangan

2. Daniel Erhard 3. Ruben Tandian 4. Suyeti 5. Willy Ignatius

: Royal Palace Blok C9 JL. Prof. Dr. Soepomo NO.178 A Jakarta Selatan 12870

: 021-5204465 : 021-5204467 : -

: [email protected]

Wahyu Hidayatullah

Bona R. Pandiangan

Izin Usaha / Lisences Tanggal Keputusan / Decision Date Alamat / Address

Telepon / Telephone Faksimili / Facsimile Situs / Website Surel / Email

Dewan Direksi / Board of Directors 1. Direktur Utama /

President Director 2. Direktur / Director 3. Direktur / Director 4. Direktur / Director 5. Direktur / Director

Dewan Komisaris / Board of Commissioners 1. Komisaris Utama /

President Commissioner 2. Komisaris / Commissioner

Susunan Pemegang Saham / Shareholders Composition 1. Elly Fauziah

2. Etty Indrianie

: KEP-136/KM.13/1989 : 4 September 1989

: Plaza Park View Lt.3 Jl. Taman Kemang No.27 Jakarta 12730

: 021-7192507 : 021-5152248 : -

: -

Allan Gallacher

Ifwanto Davies Paul Hough Stuart James Devine Theodora Oyonita Sembiring

Christoper Michael panes Jansen Silalahi

5. PT CUNNINGHAM LINDSEY INDONESIA

3. Jansen Silalahi 4. Putro 5. Wibisono Ratno

Izin Usaha / Lisences Tanggal Keputusan / Decision Date Alamat / Address

Telepon / Telephone Faksimili / Facsimile Situs / Website Surel / Email

Dewan Direksi / Board of Directors 1. Direktur Utama /

President Director 2. Direktur / Director 3. Direktur / Director

Dewan Komisaris / Board of Commissioners 1. Komisaris Utama /

President Commissioner 2. Komisaris / Commissioner 3. Komisaris / Commissioner

Susunan Pemegang Saham / Shareholders Composition 1. Dharmala Sakti Sejahtera

2. Robertus Ismono 3. Soewondo

: KEP-2413/MD/1987 : 13 April 1987

: Plaza Ciputat Mas Blok E kav. A,B,C Jl. Ir. H. Juanda No. 5 A Ciputat Tangerang : 021-7432251

: 021-7432158 : -

: [email protected]

Ahmad Azuz

Robertus Ismono Djuhan Iskandar

Suhanda Wiraatmadja

Lydia Sutedja Christina Gondokusumo

6. PT DHARMA NILAITAMA

Izin Usaha / Lisences Tanggal Keputusan / Decision Date Alamat / Address

Telepon / Telephone Faksimili / Facsimile Situs / Website Surel / Email

: KEP-115/KM.12/2006 : 4 Oktober 2006

: Wisma Slipi Lt. 15 Jl. S. Parman Kav. 12 Slipi Jakarta 11480

: 021-5307168 : 021-5307167 : -

: [email protected]

7. PT GENERAL ADJUSTER INDONESIA

Industri Keuangan Non Bank Non Bank Financial Industry Direktori Dana Pensiun / Pension Fund Directory 03

Direktori Lembaga Keuangan Khusus / Specialized Financial Institutions Directory

04 Direktori Lembaga Keuangan Mikro /

Micro Finance Institution Directory

05 Asosiasi dan Lembaga /

Association and Institution 06

Direktori Perasuransian / Insurance Directory

01 Direktori Lembaga Pembiayaan /

Finance Institutions Directory 02

Dewan Direksi / Board of Directors 1. Direktur Utama /

President Director 2. Direktur / Director 3. Direktur / Director

Dewan Komisaris / Board of Commissioners 1. Komisaris / Commissioner

Susunan Pemegang Saham / Shareholders Composition

1. Joseph Hartanto Rp375.000.000 30,00%

2. Murwanto Rp313.000.000 25,04%

3. Adriana Ade Wenas Rp312.000.000 24,96%

4. Suwadji Warsito Rp250.000.000 20,00%

Joseph Hartanto Tjong putra

Daulat pantas Tampubolon Suwadji Warsito

Murwanto

Izin Usaha / Lisences Tanggal Keputusan / Decision Date Alamat / Address

Telepon / Telephone Faksimili / Facsimile Situs / Website Surel / Email

Dewan Direksi / Board of Directors 1. Direktur / Director

Dewan Komisaris / Board of Commissioners 1. Komisaris / Commissioner

Susunan Pemegang Saham / Shareholders Composition

1. Dikarioso Rp250.000.000 50,00%

2. Erixon Sirait Rp250.000.000 50,00%

: KEP-915/KM.10/2011 : 30 Desember 2011

: Grand Slipi Tower, Lt 16 D

Jl S Parman Kav 22-24 Jakarta 11480 : 021-29022202

: 021-29022203 : -

: -

Dikarioso

-

Dalam dokumen Kata Pengantar - OJK (Halaman 138-143)