PTDI DUE DILIGENCE

QUESTIONNAIRE

Introduction
This Questionnaire is to complete your business engagement with PTDI, to support our
company policy for having adequate processes and controls to manage risks – in particular
anti-corruption compliance risks.
Therefore, we kindly ask you to complete this Questionnaire.
If a question is not applicable to your circumstances and/or engagement, simply respond
“N/A” or “not applicable.”
Please note that PTDI has an obligation to monitor each company with whom it has an
ongoing relationship. Should an agreement be concluded, PTDI may require that this
Questionnaire be updated when necessary. We appreciate your time and effort in
participating in this process and thank you for your cooperation.
PRELIMINARY INFORMATION
1 Is this an update of a previously completed YES NO
Questionnaire?
2 Territory(ies) INDONESIA
BASIC DATA
3 Name (whether an individual or an entity, including PT PUTRA ELANG
trade names and name of Supplier in local ANGKASARAYA
language)
4 Legal Form PERSEROAN TERBATAS
For example:
-Perseroan Terbatas
-Corporation (Inc., Ltd., GmbH, SARL, etc.)
-Partnership
-Individual wishing to contract as individual
5 Place of incorporation/registration PONDOK CABE TANGERANG
SELATAN
a Date of incorporation/registration 27/7/1995
b Registration number/Nomor Induk Berusahan 8120105991399
c Term of validity of the registration -
6 VAT number, including valid European VAT number -
if Supplier registered in the European Union
7 Tax registration number/NPWP 01.735.016.6-415.000
8 Registered office address
a Operational address (if different) HANGAR LANUDAL
JAKARTA
b Main Office telephone number 02174710982
c Main Office fax number 0217411484
d Main Office email address [email protected]

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e Website
9 Name of legal representative of the Supplier Mohammad Amin Usman
a Function DIRECTOR
b Date and place of birth November 12, 1955
Banda Aceh
c
Nationality WNI
d
Direct Telephone number 02174710982
e
Cell phone number 081314829329
f
Fax number 0217411484
g
Email [email protected]
10 Name of the representative empowered to bind the Alamsyah Hasan
supplier signing this Questionnaire and related
documentation (if different from the legal
representative)
a Function Marketing
b Date and place of birth March 21, 1969 Jakarta
c Nationality WNI
d Phone number 08128680323
GENERAL DESCRIPTION OF THE SUPPLIER’S BUSINESS

11 Primary business activities Maintenance, Repair,

Overhaul
12 Primary industries supported Aviation
13 Approximate number of years active 28
14 Approximate number of employees globally and in 56
Territory specifically
15 Approximate global revenues

DUE DILIGENCE QUESTIONNAIRE

1. OWNERSHIP & MANAGEMENT OF THE COMPANY
Please provide as Appendix 1
a. A list of each individual or entity having an ownership and/or financial interest in the
Company, (indicating as applicable: name, nationality(ies), date and place of birth,
place of residence, date and place of incorporation/registration, and percentage of
ownership), and any changes over the last five (5) years.
b. A list of the Company’s directors or executives, managers, or any other individual or
entity that exercises management control over the Company (indicating as applicable:
name, nationality(ies), date and place of birth, place of residence, date and place of
incorporation/registration and title) and any changes over the last five (5) years.
c. Detailed and dated résumés (“curriculum vitae”) of directors or executives, managers or

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any other individual who exercise management control of the Company.

d. For each person listed in Section 1, please provide information about any other
companies/entities for which they are officers, directors or in which they exercise
managerial control or are shareholders or partners.
Does the Appendix 1 (a):
(i) List the ultimate beneficiary owners of the Company?
YES NO

(ii) Reflect 100% of the Company’s ownership?

YES NO

2. LINKS WITH PUBLIC OFFICIALS

2.1 Current employment: Do any of the individuals or individuals representing the
entities listed in Section 1 above fall into one of the following categories of Public
Officials?
YES NO

 any elected or appointed government official or representative or a member of a

ruling family;
YES NO

 an employee, official, contractor, consultant or representative of a government

or any department, agency or instrumentality.
YES NO

 any employee or person acting for or on behalf of a Public Official, government

agency, or any enterprise that performs a governmental function (e.g., a
licensing official or a tax agent);
YES NO

 any political party, officer, employee or person acting for or on behalf of a

political party or candidate for public office;
YES NO

 a person in the service of a government, including members of the military, coast

guard, space agency, police, or civil service;
YES NO

 other type of Public Official which shall include any person working at a
government body, “government” including all branches, levels and subdivisions
of any government (e.g., local, regional or national and administrative, legislative
or executive)
YES NO

2.2 Past employment: Have any of the individuals or entities listed in Section 1

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previously qualified as Public Official?

YES NO
2.3 Business Relations: Do any of the individuals listed in Section 1 have a business
relationship (including joint ownership or a company) with a Public Official?
YES NO

please provide as Appendix 2

Lists of individuals within the scope of the company’s owners, managers and directors and
operational entities and individuals (as listed in Section 1):

a. Lists and descriptions of any current or past employment, business relations with Public
Officials as disclosed in Sections 2.1, 2.2, 2.3. These lists should include: name(s),
nationality(ies), dates and places of birth, places of residence for each concerned
individual

Glossary

“Public Official” (also often referred to as a “Government Official”) is broadly interpreted

and includes any person (or family member or close relative of any person) working at any
branches, levels or subdivisions of any government (e.g., local, regional or national and
administrative, legislative or executive). Public Officials include:

 Employees of state-owned airlines;

 an employee or person acting for or on behalf of a public international organization
(e.g., United Nations, International Monetary Fund, World Bank, etc.);
 family members and close relatives of any of the above (e.g., a parent, spouse, child,
or sibling, including any of these through marriage).

3. LINKS WITH CUSTOMERS & COMPETITORS

3.1 Current Employment: Are any of the individuals and entities listed in Section 1
currently an employee of
 Customers or end users of PTDI products that obtain PTDI products through you?
YES NO
 A competitor of PTDI?
YES NO
3.2 Past employment: Have any of the individuals and entities listed in Section 1
been, in the past, an employee of
 Customers or end users of PTDI products that obtain PTDI products through you?
YES NO
 A competitor of PTDI?
YES NO

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3.3 Business Relations: Do any of the individuals and entities listed in Section 1 have
a business relationship with
 Customers or end users of PTDI products that obtain PTDI products through you?
YES NO
 A competitor of PTDI?
YES NO

Please provide as Appendix 3

Lists and descriptions (including dates and titles) of any current or past employment,
business relations with customers/end-users and competitors disclosed in Sections 3.1, 3.2,
3.3

4. COMPLIANCE
4.1 Has your company or any shareholder, beneficial owner, officer, director, or
executive or any of your affiliated companies
 been investigated, charged or convicted in relation to violations of Applicable
International Anti-Corruption Laws?
YES NO
4.2 Do you have in place:
 A Code of Conduct?
YES NO
 Anti-corruption policies?
YES NO
 External body certifications of such anti-corruption compliance policies?
YES NO
4.3 Business Relations: Do any of the individuals and entities listed in Section 1 have
a business relationship with
 Customers or end users of PTDI products that obtain PTDI products through you?
YES NO
 A competitor of PTDI?
YES NO

Please provide as Appendix 4

a. List of individuals and/or entities (indicating as applicable: name, nationality(ies), date

and place of birth, place of residence, date and place of incorporation/registration) who
have been implicated in an investigation (indicating type of investigation, including
duration and name and location of court/administrative authority)

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b. A copy of the company anti-corruption compliance policies

c. A copy of external certification and validity of the company’s compliance program

REPRESENTATIONS AND WARRANTIES

I, the undersigned, acting in my capacity as Director of PT Putra Elang Angkasaraya,

duly empowered to legally represent and bind PT Putra Elang Angkasaraya as the
Maintenance, Repair and Overhaul Services of PT Dirgantara Indonesia products in the
territory of Republic of Indonesia for present purposes,
Hereby represent and warrant that the following statements are true, complete and
accurate:
1. PT Putra Elang Angkasaraya is aware of and fully understands the relevant
Applicable International Anti-Corruption Laws in force in the Territory, in its place
of incorporation and/or its principal place of business and any other relevant
location. PT Putra Elang Angkasaraya has been, is and will remain – and its
officers, directors, employees or agents, and any individual or company that will
be involved in performing the Agreement have been, are and will remain – in
compliance with Applicable International Anti-Corruption Laws and with
professional or commercial ethics rules.
2. PT Putra Elang Angkasaraya declares that, other than as disclosed to PT
Dirgantara Indonesia in writing, neither it, nor any of its shareholders, beneficial
owners, officers, directors or executives or any affiliated companies has been or
is under current criminal investigation or it has been subject to any civil or
criminal enforcement actions in the Territory or any other jurisdiction for
improper conduct relating to violation of Applicable International Anti-Corruption
Laws or other laws or regulations.
3. PT Putra Elang Angkasaraya shall notify PT Dirgantara Indonesia immediately if
these Representations and Warranties become untrue, inaccurate or incomplete.
I hereby acknowledge that PT Dirgantara Indonesia relies on the information provided
herein as a material precondition to entering into the Agreement.

Name Mohammad Amin Usman

Title Director

Place Tangerang Selatan

Date 2/11/2023

Signature ………………………………

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NOTICE OF DISCLOSURE

The information herein is collected by PTDI considering its business relationship with you
and/or your company. PTDI will use such information, and may share it with its concerned
affiliates, and/or designated auditor, consultants or experts, in order to identify any possible
exposure under any applicable laws.

PTDI receiving and processing this information is expected to do so for the purpose
described here above and will use and protect such data consistently with applicable policies
and laws. In consideration thereof, any person referred to in such data has the right to
access and/or modify any incorrect information related to her by addressing the request at
PTDI.

By signing this document, the undersigned, being duly authorized to respond to this
Questionnaire:

a) declares that he/she has, or has obtained from the relevant person, the proper
authority and right to disclose such information; and

b) consents to the processing of such information for the purpose described in this notice;
and

c) acknowledges that the processing of such information may be conducted by a third

party on behalf of PTDI or may occur in another country than the country of disclosure;
and

d) represents that the information provided in this document is correct and complete as of
the date of disclosure; and

e) understands that PTDI (as well as its concerned affiliates) will be relying upon
responses to this Questionnaire and therefore will be sharing such information between
and among each other in deciding whether or not to enter into a contractual
arrangement, and consents to such sharing (as well as with designated anti-corruption
consultants or experts).

Name ………………………………

Title ………………………………

Place ………………………………

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Date ………………………………

Signature ………………………………

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