Management Documentation

Compliance Office

BUSINESS PARTNER QUESTIONNAIRE

You/your company and a G+D subsidiary are currently engaged in a business relationship, or are assessing the possibility
of entering into a business relationship. Accordingly, G+D is required to gather the information requested below in order
to fulfill its statutory obligations. To this end, please complete all the questions below in full and with as much detail as
possible, as permitted by the relevant local laws. If you require additional space to answer individual questions, please
provide your statements on a separate sheet of paper, initial it, and attach it this to the questionnaire.

Thank you for your cooperation!

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1. CONTACT DETAILS

Name of the company or natural person:

PT. OSCA CONSULTANT INDONESIA__________________________________________

Company address:

Citylofts Sudirman Lt 9 Unit 927, Jl. K.H. Mas Mansyur No 121, Sub-District
Karet Tengsin, District Tanah Abang, Kota Jakarta Pusat, Postal code 10220
Homepage:
https://www.osca.asia/________________________________________________________

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2. COMPANY DETAILS

Date the company was founded:

02 February 2022____________________________________________________________

Registered office address:

Citylofts Sudirman Lt 9 Unit 927, Jl. K.H. Mas Mansyur No 121, Sub-District
Karet Tengsin, District Tanah Abang, Kota Jakarta Pusat, Postal code 10220
_______________________________________________________________________________

Please attach an up-to-date extract of your company’s registration details from the commercial register (no older
than 12 months).
If no up-to-date extract is available, please state why under Section 12. If your company is not registered on a
commercial register, please provide other forms detailing an equivalent registration. If these documents are not
available in English or German, please attach certified translations.
If you are completing this form as a natural person, please provide a copy of your
passport.

D-U-N-S number:

_______________________________________________________________________________

Object of the company:

_______________________________________________________________________________

Previous company names:

______________________________________________________________________________

Date of (most recent) change to the company name:

______________________________________________________________________________

States or regions in which your company is or will be performing work for G+D:

______________________________________________________________________________

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3. SHAREHOLDERS IN THE COMPANY

Names of shareholders (including companies) with a Holding in percent Nationality or registered office
share exceeding 10%

Chin Kim Koon 1%

OSCA INDO PTE. LTD 99%

4. REPRESENTATIVES OF THE COMPANY

Names of current Managing Directors/Executive Title/position Joined the company (date)

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5. LEGAL PROCEEDINGS/KNOWLEDGE

Have criminal or other legal measures due to material legal breaches, in particular due to corruption or
breaches of antitrust law, been imposed on you yourself, or your company, or an individual specified
in Sections 3 and 4 (hereinafter, the term “relevant group of individuals” will be used to mean
yourself, your company, and the individuals specified in Sections 3 and 4), and/or are investigations in
this respect ongoing?
Yes (please provide details) No

Has an individual in the relevant group of individuals ever been excluded from the placement of an
order by a public authority?
Yes (please provide details) No

Has an individual in the relevant group of individuals ever directly or indirectly offered, or given, financial rewards
or incentives in return for business decisions?

Yes (please provide details) No

6. INTENDED SERVICES
Please describe the services that you or your company intend to provide.

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7. SUBCONTRACTORS
Will a subcontractor be commissioned as part of service provision for G+D?

Yes No

If “yes”, please provide the contact/company details for the subcontractor, and explain which services the
subcontractor will provide and why subcontracting is necessary:

8. BUSINESS ACCOUNT

Bank name:

OCBC NISP _________________________________________________________________

OCBC NISP Tower, Jl. Prof.Dr. Satrio Kav. 25, Jakarta Selatan, Postal code 12940

Bank country:
INDONESIA_________________________________________________________________
Account holder:

PT. OSCA CONSULTANT INDONESIA________________________________________

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9. PERSONAL RELATIONSHIPS

In the following, the term “official” primarily refers to the following individuals:
(i) A civil servant or public sector worker
(ii) An individual entrusted with tasks of public administration (e.g. in a company that performs public
administration tasks)
(iii) A candidate for public office
____________________________________________________________________________________

Is any person in the relevant group of persons (cf. No. 5) an official, or is there any familial or friendship-based
relationship with an official, whose decision (such as the awarding of a contract or issuance of a permit) is relevant to
your activity for G+D?

Yes (please describe the relationship) No

____________________________________________________________________________________

Is the decision of an official (such as the awarding of a contract or issuance of a permit) relevant to the service
intended to be performed by you or your company?

Yes (please describe the relationship) No

___________________________________________________________________________________

Has an individual in the relevant group of individuals previously been employed at G+D Group?
Yes (please provide details) No

Is an individual in the relevant group of individuals simultaneously performing work for G+D, or in
a familial or friendship-based relationship with a shareholder, representative, or employee of the
customer?
Yes (please provide details) No

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10. REFERENCES

Insofar as you are contractually or legally authorized to so, please state at least two companies or natural persons
with which you or your company have a similar business relationship to the intended relationship with G+D.
_________________________________________________________________________________

Name:

Contacts:

Address:

E-mail:
_________________________________________________________________________________

Name:

Contacts:

Address:

E-mail:

11. OTHER INFORMATION

Please state any additional information that you think is relevant or important.

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12. COMPLIANCE STATEMENT

I hereby confirm that the information provided above is accurate to the best of my knowledge and belief.

Similarly, I also confirm that no individuals in the relevant group of individuals pursuant to Section 5, nor any
employees of the company, have directly or indirectly offered or granted cash or non-cash benefits to any third parties
(e.g. an official or another business partner) in order to illegally influence the recipient’s decision to gain a direct or
indirect benefit for G+D (e.g. an approval or an order), and also that they will not do so in future.

Furthermore, I confirm that all individuals in the relevant group of individuals fulfill all the relevant laws, particularly
with respect to anti-corruption and anti-competitive behavior.

I declare or my company declares that the above statement will also be fulfilled by any third party commissioned as
a subcontractor within the framework of business transactions with G+D.

Furthermore, I confirm that I have read and understood the G+D Code of Conduct, which can be viewed online at
https://www.gi-de.com/en/us/g-d-group/values/compliance/ and that all individuals in the relevant group of individuals
and their colleagues who perform work in the framework of the business relationship with G+D shall observe this code.

Name:

Company:

Title/position:

Signature:

Date:

Important note:
G+D complies with the strict national and European provisions of data privacy law. Further information is available
online at https://www.gi-de.com/en/us/data-privacy/.

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