Rekomendasi Pengesahan KIMPER

(1)

Kepada Yth.

Kepala Teknik Tambang

PT. Manunggal lnti Arlamas (PT.M|A) Di-

Tempat

Sesuai dengan Kepmen. No. 555.M26IMP.E/1995 pasal 42 tentang persyaratan dan kewajiban karyawan menggunakan identitas, maka bersama ini selaku pengetota Safety PT, Pusaka Mitra Artha mengajukan rekomendasi permohonan _pengesahan

Demikian surat rekomendasi permohonan pengesahan KIMPER ini dibuat sebagai persyaratan walin

unfurc

ⁱ

areal tambang kamisampaikan, atas perhatian dan kerjasama*ya disampaikan terimakasih.

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nama-nama karyawan sebaqai beriku

No. NIK

NAttlA

Date of Hire POSITION JENIS SIMISIO

MASA

BERLAKU KETERANGAN cv1103 T,IARDIANTO 12-Aua-23 Vlechanic Elechtrial BI UMUM 18-05-2024 SIM MATI

I v3069 -EGIMAN 26-Dec-21 Jperator Grader BIIUMUM 31.12.2A23 SIM MATI

J v3290 [lHD. JAMIL 01-Apr-23 ]oerator Exca _TTDAKADA Sllvl/Slc

4 v3297 PAUZEN l?-t{av-23 Driver Water Tank TIDAK ADA SIM

E v3371 ROEBY SAPUTRA 29-Nov-23 Driver MH Soare TIDAK ADA SIM

o v3372 DEKA IRWANDI 17-Dec-23 Driver WT _TIDAKADA SIM

7 v3376 PRANAANDREANSYAH _A2-Jan-24 3perator Greader TIDAK ADA SIM/SIO 8 v3340 ALDI KRIS MMANDA 21-l'/rar-Zfi Driver Water Truk TIDAK ADA SIM

I

^v3343 ^TOLIP^BILMAKFUR 07-lliav-Z4 Manhaul Driver _TIDAKADA SIM 10. v 3075 SYAMSUL BAHRI 03-Aus-24 f,perator Bulldozer TIDAKADA SIMISIC

11 v 3076 CRIZAL 03-Auo-34 Joerator Bulldozer _TIDAKADA SIM/SIC

12 v 3081 fUSMARIZAL 12-Seo-24 lriver LYT TIDAKADA SIM

1n v 3082 MARHADI 29-Sep-24 fperatorVibro TIDAK ADA SIMI$IC

14 v 3087 TEYHAN ALFAREZ 03-Nov-24 lriver MH TIDAKADA SIM

16 c2155 JURISMAN 9-May-23 lriver DT Bil 10.12.2024 _{SIM MATI}

17 c2168 -UHUR EFENDISIREGAR 214ct-23 )perator Buildozer TIDAKADASIfuUSIC 18 c225g AND}SYAFRIJAL 14-Jul24 Operator Exca slo 23_12.2A24 SIM MATI 19 c2201 AFSUDIN MANGAMJA 30-Jul-24 Cperator Exca TIDAKADA SIM/SIC 20 c2018 RADES HENDM 2S-Oct-21 Cperator Exca BIIUMUM 27.12.2024 _{SIM MATI} 21 c2033 ZAINALABIDIN 21-Mar-22 Driver DT B II UMUM 11.10.2023 SIM MATI

22 C2O5B LENDRI 06-Jun-22 Driver DT B II UMUh/ 28.03.2024 SIM MATI

23 c2108 SUDIRMAN 09-Feb-23 Driver DT Bil $.14.2423 SIM MATI

24 20100403s ROSIDIN 10-Seo-22 PJS Site Coordinator SIMA 06.06.2023 SfM MATI

25 JP1030723 SLAMET HIDAYAT 01-Jul-23 ]nerator exca TIDAK ADA SIMISIC

zo JPL071223 /ICTOR HUTA JAYA 26-Dec-23 Jperator Bulldozer TIDAK ADA SIM/SIC

zl JPL1 10524 {ADI KUSYANTO A7-Mav-24 Jnerator Grader TIDAKADA _SIM/SIC

28 JPL120724 DELPI SUSIANTO 01-Jul-24 0perator Exca TIDAK ADA SIMISIC

29 JPL130724 ADIWIJAYA 01-Jul24 Operator Bulldozer TIDAKADA SIM/SIO

30 JPL160924 THOMA$J. NAINGGOLAN 01-okt-24 Onerabr Excavator TIDAKADASIMIS}C

31 33020231 RICKY ADHAM 27-Jul21 Sov. HRGA SIMA 06.09.2024 _{SIM MATI}

a, 33030222 {NANIUS ANCHELLMUS ^'10-Nov-21 _{FM. HRGA} _SIMA 21.44.2023 _{SIM MATI} 33 36240222 SENDRI PUTRA 14-Ocl-21 FM. Produksi BIIUMUM 12.12.2024 SIM MATI 34 36220s22 _RIWAYAT 19-Mav-22 FM. Produksi BIIUMUM 02.07.2023 SIM MATI

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Nomor

^:0'I/PMA-HSE/SO/K|MPER1II2025

Lampiran ^:4

^Bundel

Perihal

^:RekomendasiPermohonan Pengesahan KIMPER Kepada Yth,

Kepala Teknik Tambang

PT. Manunggal lnti Artamas (PT.MlA) Di-

Tempat

Sesuaidengan Kepmen. No. 555.1(26/MP,E/1995 pasal42 tentang persyaratan dan kewajiban karyawan menggunakan identitas, maka bersama iniselaku pengelola Safety PT. Pusaka Mitra Artha mengajukan rekomendasi permohonan pengesahan KIMPER kepada Kepala Teknik Tambang PT. Manunggal lntiArtamas (PT.MlA) Site Sepuh, Kuansing.

Adapun nama-nama karyawan sebagai berikut:

No, NIK

NAMA

^Date^ofHire POSITION

1 27UA92A BAYU KRISNA RYLIAN PUTRA f 7-Sep-1 8 Site Manaqer 2 28030920 BAMBANG SISWANTO 19-Apr-18 Spv. Cost Control 3 39031021 FAIZALARDHY WIBOWO 14-Jul21 FM. Loqistik

4 26030920 RUDIANTO 2-Jan-1 9 Sl. Produksi

5 261 50920 SUGIARTO 1 2-Nov-1 9 Spv. Produksi

o 26181120 ASRIYANTO 5-Nov-20 FM. Produksi

7

3il94122

MARTULUS 30-Sep-21 FM. Produksi

8 3624U22 ASEP SUPRIYADI 15-Jan-22 Spv. Drill & Blast

q 30421A22 DANY WAHYUDI 02-akt-22 Jr, Geoloqist

10 26090920 MULYADI 1 1-Sep-23 Spv. Produksi

11 36250923 OKTA PARIANSYAH 25-Sep-23 FM. Drill& Blast 12

$a70224

AGUS SAUT MARTUA TAMBUNAN 17-Feb-24 FM. HSE

13 36160920 TAHAN SIHOMBING 24-Feb-24 FM. Produksi

14 3708A324 IRGI RADITYA 14-l'tar-24 Jr. MPE

15 36171024 SIMON LUMBAN TOBING 19-0kt-24 FM. Produksi 16 23060920 LAMSON P. MANULLANG 20-Sep-21 Spv. HSE

17 33101124 DICKI NURDIANA 9-Nov-24 FM, HSElParamedik 1B 29020920 HENDRA SURYADI 19-Auq-20 HO. Reoresentative

19 CVlOOB EGIL YOHENDRIK 18-Oct-21 Junior Mechanic

20 cv1013 FEBRI ANATAMA 19-Ocl21 3ontrollinq EQ&Unit 21 cv1049 MARETINUS LASE 21-Aor-22 :lelper Mechanic Electric

22 cv1028 ALPENDI 07-Dec-21 Sr. Mechanic DT

23 cv1073 AHMAD RASYID DAULAY A7-Jun-22 Spv. Maintenance 24 cv1093 ABDUL HALIM SOFIAN ¹5-Jun-23 PJO

25 cv1100 ROY KARDO BUTAR BUTAR 24-Jun-23 Helper Mechanic LV 26 cv1106 EKO SETIYA BUDI 27-Aus-23 Sr. Mechanic A2B 27 cv1107 ROY FRANSISCO SINAGA 04-Sep-23 Mechanic I LV 28 cv1109 BUDI HARTO 09-Sep-23 Controllinq EQ&Unit

29 cv1118 ALFADIL A7-Jan-24 Mechanic

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30 cv1005 ^PANDI 06-Oct-21 Driver D, Truck 68 Sanv

?{ cv1 038 AHMAD RIDO 06-Nov-21 Driver ^D.Truck 68 Sanv

32 cv1039 JAYUSMAN 19-Oct21 Driver D, Truck 77 Sany

33 cv1041 ALFIZAR 18-Oct-21 Driver D. Truck 71 Sany

34 cv1043 ALFIZAN 1B-Oct-21 Driver D. Truck 62 Sany

c2032 PERESNO 05-Aor-22 Driver D. Truck 66 Sany

JO c2034 NASRUN 18-Oct21 Driver D. Truck 61 Sany

37 c2047 RIANDES 21-ltar-2Z Driver ^D.Truck 66 Sanv

3B c2051 BUDI UTOMO 07-Aor-22 Driver D. Truck 83 SANY

39 c2061 MASWTR 02-Dec-21 Driver D. Truck 73 Sanv

40 c2063 MUHAMMAD ZAKIR 05-Feb-22 Driver D. Truck 61 Sanv 41 c2066 MANORSA OLOAN TAMBUNAN 08-Auq-22 Driver D. Truck 65 Sanv 42 c2067 ANDIWIDIANTO 30-Auq-22 Driver ^D.Truck 76 Sanv 43 c2070 BRAEN SESANDRA 01-Sep-22 Driver D. Truck 70 Sanv 44 c2478 RIZK1SAPUTRA 20-Seo-22 Driver D. Truck 72 Sany

45 c2085 ALPANDI 02-Ocl-22 Driver D. Truck 71 Sany

46 c2090 BAGUS SUGIANTO 12-Ocl-22 Driver D. Truck 80 SANY

47 c2091 SEGIANSYAH 30-Oct22 Driver D. Truck 70 Sanv

4B c2099 SUPYAN 01-Apr-23 Driver D. Truck 78 SANY

49 c2100 MURDIANTO 27-Nov-22 Driver D. Truck 87 SANY

50 c2101 SYUKIRMAN 27-Nov-22 Driver D. Truck 72 Sany

51 c2103 RAMLAN 05-Dec-22 Driver D. Truck 73 Sany

52 c2106 RENOL ANGGARA 06-Feb-23 Driver D. Truck BB Sanv

53 c2149 JODI ALBET SAPUTRA 1 6-Feb-23 JOKER

54 c2111 WARYAN 20-Feb-23 Driver D. Truck 87 SANY

55 c2124 TEDI RIZKI 0't-Aor-23 Driver D. Truck 83 SANY 56 c2124 DHANDY FERINDRA 02-Aor-23 Driver D. Truck 86 SANY 57 c2125 ENDANG SOPIAN HIDAYAT 02-Aor-23 Driver D. Truck 81 SANY 58 c2127 ISMET NONO 6-Apr-23 Driver D, Truck B'l SANY 59 c2129 MARZA HANDI SAPUTRA 8-Apr-23 Driver D. Truck 76 SANY

60 c2133 ROBISON 09-Apr-23 Driver D. Truck 82 SANY

61 c2134 RUPIMANTO 09-Apr-23 Driver D. Truck BB SANY

ot

c2135 KISWANTO 09-Apr-23 Driver D. Truck 67 SANY

63 c2136 TSRONI 1 1-Aor-23 Driver D. Truck 79 SANY

64 c2144 ^ASEF 1-Mav-23 Driver D. Truck Spare

65 c2148 LAMBOK HATOGUAN SIHOMBING 6-Mav-23 Driver D. Truck Spare

66 c2149 APRINALDI 6-Mav-23 Driver D. Truck Spare

67 c21s4 SAPRIADI 7-l,lav-23 Driver D. Truck Spare

68 c2159 ANTONI 29-Jul23 Driver D.Truck Spare

69 c2160 WARDI 29-Jul-23 Driver D.Truck Spare

70 c2161 ALMUZIL 30-Jul-23 Driver D.Truck Spare

71 c2164 RIVALDO POTABAS 13-Auo-23 Driver D.Truck Spare

72 c2174 ARFIZEN 21-Nov-23 Driver D.Truck Spare

73 c2171 AXEL MUJIYANDI 23-Nov-23 Driver D.Truck Soare

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1'lt1 c2173 ANDREAN MASFARI 31-Dec-23 Driver D, Truk Spare

75 C2182 ERISON 06-May-24 Driver D. Truk Spare

76 c2183 AHMADIN SULAEMAN 06-May-24 Driver D. Truk Spare

77 C2184 YULISMAN 06-Mav-24 Driver D. Truk Soare

7B c2187 ARI LTSTIAN 06-Mav-24 Driver D. Truk Soare

79 c2188 ALEXPRI 06-Mav-24 Driver D. Truk Spare

BO c2189 SUPRATMAN 06-Mav-24 Driver D. Truk Spare

8'l c2190 WAHYU HIDAYAT 06-Mav-24 Driver D. Truk Spare

82 c2191 RENDY 0B-Mav-24 Driver D. Truk Spare

83 c2193 ^FEBRI^RITON 25-Mav-24 Driver D. Truk Spare 84 c2194 NUGRAH ANDIKA 26-Mav-24 Driver D. Truk Spare

85 c2195 RIVALDO 01-Jun-24 Driver D. Truk Spare

86 c2196 YOSUA RIKUMAHU 01-Jun-24 Driver JOKER

87 c2197 GIA WIRANDA 03-Jun-24 Driver D. Truk Spare

BB c2199 AFSI 01-Jul-24 Driver D. Truk Spare

89 c2203 ROBET SAPUTRA 05-Auq-24 Driver Dumotruck Soare 90 c2244 TEGUH WIDODO ^'18-Nov-24 Driver Dumokuck Soare

91 c2205 ^{AL AHYAGRI} 18-Nov-24 Driver Dumptruck Spare

92 c2206 ^JONNALDI ^'19-Nov-24 Driver Dumptruck Spare

93 c2247 YAUMIL FAUZAN 20-Nov-24 Driver Dumptruck Spare 94 cv1044 JULIANSYAH PUTRA 18-Oct21 Driver FuelTruck FT 01 95 c2053 SETIYONO BUDI RAHARJO 12-Apr-22 Driver Fuel Truck FT 01 96 cv1045 RAMLI SETIAWAN 14-Mar-22 Driver MH & LV

97 c2048 MASJONI 19-Ocl21 Driver Manhaul 01

9B c2097 ARMAN 13-Nov-22 Driver Manhaul 01

99 v3104 RUDI HARTONO 01-Aor-22 Driver Manhaul MH 05

100 v3'115 PEDRI RANDA PUTRA 1S-ltlav-22 Fuel Truck Driver FT 02 101 c2122 VERI ENDRA CIPTA 02-Apr-23 Driver LV& MH

102 v3295 ARIEF RAHMAN 29-Aor-23 Driver Fuel Tank 02

103 c2013 HARIADI 1B-Ocl21 Operator Exca. KOB 508

104 c2020 EKA PUTRA BANJAR. S 30-Oct-21 Operator Exca, KOB 308 105 c2041 AZMI RAMADAN 06-Jan-22 Operator Exca, SANY 310

106 c2052 MASMERI 11-Aor-22 Operator Exca. HIT EP 311

107 c2073 MISWANDI 05-Sep-22 Operator Exca. KOB EP 507

108 c2474 AZMI 16-Sep-22 Operator Exca. KOB EP 508

109 c2081 RITO ARIANSYAH 21-Seo-22 Operator Exca. Hit EP 312 110 c2083 NAHARUDDIN 02-Ocl-22 Operator Exca.

Hit

Eo 302

111 c2087 ISWANTO A2-Ocl-22 Operator Exca. KOB 12

112 c2096 SANJAYA 06-Nov-22 Operator Exca KOB EP 308

113 c2098 JHONVERI GULTOM 14-Nov-22 Operator Excavator Spare 114 c2126 JERIKSON MARBUN 3-Aor-23 Operator Exca. KOB EP 307 115 c2141 RIDHO RAHMANUDDIN 29-Aar-23 Operator Exca. SANY 309 116 c2146 IMAN BUDIMAN -l.llav-23 Operator Exca. SANY ³⁰⁹

117 c2151 ALI IMRAN 7-\Aav-23 Operator Exca202

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118 v3008 SAIDI 13-Oct-21 Cperator Exca. CAT 303

c2153 JAMRON MANALU 7-May-23 Operator Dozer

120 c2156 KOSIEM MHD FAHRIDZI 13-May-23 Operator Excavator Spare 121 c2165 BAMBANG ADYANTO SIANIPAR 02-Sep-23 Operator Exca Spare

122 c2169 IWALDI 06-Nov-23 Ooerator Exca Spare

123 c2172 HANDES FERYANDES 18-Dec-23 Ooerator Dozer 124 c2179 MAHMUD RITONGA 20-Apr-24 00. Dozer Spare

125 c2202 ROBI SYAPUTRA 04-Auq-24 Ooerator Bulldozer Spare

126 v3355 ATER SIMARMATA 31-Aus-23 0oeartor Exca

127 v3254 M, FADLI 21-Nov-22 Ooerator B. Dozer DP 05

128 v3255 EDI SAPUTRA 30-Nov-22 Ooerator B. Dozer DP 0B

129 v 3074 KALIWAN 03-Auq-24 Cperator Bulldozer

130

v

³⁰⁷⁷ RUDOLF PANDIANGAN 03-Auq-24 Operator Bulldozer

131 v3377 FERI TAMARA 11-Jan-24 Op. Excavator

132 v3342 LAMHOT GULTOM 20-Aor-24 Operator Excavator 133 V 3OB3 DEDI HERI YANTO 10-0ct24 0perator Bulldozer 134 v 3084 YOGI PRASETIYO 03-Nov-24 Operator Excvator 135 V 3OB5 IRFAN JUNAIDI S HUTAGALUNG 03-Nov-24 Ooerator Excavator

136 v 3088 BUDI RIANDI 16-Nov-24 Operator Excavator

137 V 3OB9 HERMAWAN 16-Nov-24 Ooerator Excavator

138

v

3090 MANONDANG SILABAN 16-Nov-24 Ooerator Excavator 139 v 3091 SAHAT SIREGAR 16-Nov-24 0perator Excavator

140 JPL01 0723 ELGI 12-Jul23 Penqawas

141 JP1020623 ASNADI NURMASARI 26-Jun-23 Cperator Dozer

142 JP1040723 IBRAHIM POHAN 12-Jul23 Cperator Dozer

143 lPL14A824 KRISTIAN HERIANTO PARHUSIP 18-Auq-24 Cperator Bulldozer 144 JPLl 50924 SARIHOT GANDA SIAGIAN 23-Sep-24 0perator Excavator

145 ZULKIFLI 0B-Des-24 Operator Bulldozer

146 MAG011124 RIDWAN SITUMORANG 14-Nov-24 Operator Excavator

Demikian surat rekomendasi permohonan pengesahan KTMPER ini dibuat sebagal persyaratan wajib untuk karyawan di areal tambang kami sampaikan, atas perhatian dan kerjasamanya disampaikan terimakasih.

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