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20250509_MIKA_Pemanggilan RUPS_31884599_lamp5.pdf
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POWER OF ATTORNEY
ANNUAL GENERAL MEETING OF SHAREHOLDERS
PT Mitra Keluarga Karyasehat Tbk
Wednesday, June 4, 2025
I/We 1), undersigned below:
1. Name : _______________________________________________________
Position : _______________________________________________________
2. Name : _______________________________________________________
Position : _______________________________________________________
in his/her own capacity as [*] and [*] stated above in PT [*], therefore acts for and on behalf of PT [*], a company
established under the laws of the Republic of Indonesia, having its address at [*].
hereinafter referred to as Shareholders registered in the Company’s Securities Administration Bureau (“BAE”) of PT
Mitra Keluarga Karyasehat Tbk (“Principal”), hereby authorizes the officer of BAE, PT Adimitra Jasa Korpora, Kirana
Boutique Office, domiciled in Jl. Kirana Avenue III Blok F3 No. 5, Kelapa Gading – Jakarta Utara 14250.
Name2) : _______________________________________________________
Domicile2) : _______________________________________________________
Identity Number2) : _______________________________________________________
(herinafter referred to as the “Attorney”), to represent and to act for and on behalf of the Principal in his capacity as
Shareholder, in attending the Annual General Meeting of Shareholders of PT Mitra Keluarga Karyasehat Tbk (“the
Company”), which will be held on Wednesday, June 4, 2025 at 10.00 Western Indonesia Time (“the Meeting”) or
other substitutional date with regards to the prevailing regulations, to join in discussing the agenda and matters
related in the Meeting, to vote3) and participate in adopting resolutions relating to the agenda as follow :
AGMS
No Meeting Agenda Resolution
1 Approval of the Annual Report and Ratification of the Company's Consolidated
Financial Statements for the Financial Year Ending December 31, 2024. Agree
Meeting Agenda Description
The first Agenda is the routine Agenda held in the Meeting of the Company. This
is in accordance with the provision in the Articles of Association of the Company, Abstain
Law No. 40 of 2007 regarding Limited Liability Companies, and regulations related
to holding general meetings of shareholders of public companies issued by the
Financial Services Authority.
Disagree
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No Meeting Agenda Resolution
2 Approval on the appropriation of the Company’s Net Profits for the financial year
ended December 31, 2024. Agree
Meeting Agenda Description
The second Agenda is the routine Agenda held in the Meeting of the Company. This
Abstain
is in accordance with the provision in the Articles of Association of the Company,
Law No. 40 of 2007 regarding Limited Liability Companies, and regulations related
to holding general meetings of shareholders of public companies issued by the
Financial Services Authority. Disagree
3 Approval of Changes to the Composition of the Company's Board of Directors.
Agree
Meeting Agenda Description
The Company will propose to the Meeting to obtain approval for changes to the
composition of the Company's Board of Directors and the profiles of the proposed Abstain
candidates for the Company's Directors who will be appointed are available on the
Company's website.
(investor.mitrakeluarga.com) Disagree
4 Determination of salary for the Company’s Board of Directors and Board of
Commissioners for the year 2025 and to determine the honorarium of the
Agree
Company’s Board of Directors and Board of Commissioners for the financial year
2024.
Meeting Agenda Description
Abstain
The fourth Agenda is the routine Agenda held in the Meeting of the Company. This
is in accordance with the provision in the Articles of Association of the Company,
Law No. 40 of 2007 regarding Limited Liability Companies, and regulations related
to holding general meetings of shareholders of public companies issued by the
Disagree
Financial Services Authority.
5 Appointment of a Public Accountant and Public Accounting Firm for the 2025
Financial Year and Determination of Honorarium and Other Requirements relating
to such Appointment. Agree
Meeting Agenda Description
The Company will propose to the Meeting to obtain approval for the
reappointment of Public Accountant Eishennoraz and Public Accounting Firm
Abstain
Amir Abadi Jusuf, Aryanto, Mawar and Rekan, as a Public Accounting Firm
registered with the Financial Services Authority to audit the Company's books for
the year book ending on December 31, 2025, as well as granting authority to the
Company's Board of Commissioners to determine the amount of honorarium for
the Public Accountant and/or Public Accounting Firm as well as other requirements Disagree
for their appointment.
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This Power of Attorney (‘POA”) will continue to be valid and therefore give the right to the Attorney to attend and vote
at each Meeting agenda, as long as I/We are still registered in the Company. This POA is granted with substition rights.
I/We hereby declare that I/We have read the Announcement of Meeting which was announced in the eASY.KSEI
platform and corporate website on April 24, 2025 and the Invitation which was announced in eASY.KSEI platform and
corporate website on May 9, 2025.
Number of shares owned: ______________________ shares. 4)
Date: ______________________ 2025
Principal Signature Attorney Signature
(Stamp Duty)
Rp10.000,-
(__________________________________) (__________________________________)
Acknowledge by
PT Adimitra Jasa Korpora (BAE)
Name : (__________________________________)
Position : (__________________________________)
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Instructions
1) Write your name and address if your name is recorded in the Company’s Register of Shareholders on May 8, 2025
until at 16.00 Western Indonesian Time.
2) Write the name and address of the Attorney in capital letters in the space provided. Directors, Board of
Commissioners or member of the Company can act asthe Attorney for the Meeting, but the votes they cast will not
counted.
3) Give an (X) remarks in the box for every vote. If no sign is given by the Principal, the Attorney must be deemed to
have been authorized to vote in favor of every proposal arise the Meeting and at any postponement Meetings.
Each vote cast is legal, binding and enforceable against the Principal.
4) Write down the total number of shares related to this Power of Attorney in accordance with the number of your
shares in the Company’s Register of Shareholders. Any difference between the total number of shares written in
the Power of Attorney and the Company’s Register of Shareholders, the number of votes to be counted is based on
the number of shares listed on the Company’s Register of Shareholders.
Notes
1. Pursuant to Article 21 paragraph (4) of the Company's Articles of Associations, the Company will not send separate
invitations to individual shareholders of the Company, and this announcement shall be deemed as official invitation
to the Meeting.
2. The shareholders who are eligible to attend the Meeting are:
a. For shares that are not yet placed under Collective Custody: shareholders or their proxies whose names are
registered at the Company’s Share Register at 16.00 Western Indonesian Time on Thursday, May 8, 2025.
b. For shares placed under Collective Custody: shareholders or their proxies whose names are registered at the
account holders or custodian banks at PT Kustodian Sentral Efek Indonesia (“KSEI”) on Thursday, May 8, 2025
not later than 16.00 Western Indonesian Time.
c. Holders of KSEI’s securities accounts in the Collective Custody shall provide a List of Shareholders under their
management to KSEI to obtain a Written Confirmation for the Meeting (“KTUR”).
3. Shareholders or their proxies who will attend the Meeting are kindly required to bring copies of their Collective
Share Certificates and valid copies of personal identification (“KTP”) or other valid and acceptable forms of personal
identification to be presented and submitted to the Company’s Officers before entering the meeting room. Holders
of shares in the Collective Custody are required to bring the KTUR from the Exchange Member or Custodian Bank.
4. a. Shareholders who cannot attend the Meeting may be represented by their proxies who shall present a legal
proxy letter in a form as determined by the Board of Directors, provided that any members of the Board of
Directors, the Board of Commissioners and employees of the Company may act as a proxy for any shareholders
in the Meeting, but their votes shall not be counted in the voting process. For shareholders whose registered
addresses are outside of Indonesia, their proxies shall be legalized by a notary or authorized person and local
Embassy of the Republic of Indonesia.
b. The Company asks to all shareholders to use power of attorney facility that provided by Company on website
investor.mitrakeluarga.com or power of attorney from Securities Administration Bureau (“BAE”), which can be
completed and sent along with its supporting document through the BAE Office: PT Adimitra Jasa Korpora, Rukan
Kirana Boutique Office, Jl. Kirana Avenue III Blok F3 No. 5 Jakarta 14250, Phone number +6221 29745222, Fax
+6221 29289961, or Email: opr@adimitra-jk.co.id.
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c. Proxy letters must be received by the Board of Directors in the address as stated in point 4b, not later than 3
(three) business days before the Meeting, not later than 16.00 Western Indonesian Time.
5. Since the date of the Invitation to the Meeting up until the holding of the Meeting, the materials which will be
discussed in the Agenda are available at the Company’s office.
6. Legal entity shareholders such as corporates, cooperatives, foundations, or pension funds are requested to bring
the copies of their Articles of Associations.
7. To facilitate the convention of the Meeting in an orderly manner, the shareholders or their proxies are kindly
requested to be present 30 (thirty) minutes prior to the start of the Meeting.
Additional Information for Shareholders to Attend the Meeting
The Company informs additional information to Shareholders related to the implementation of e-Meeting, as follows:
1. Meeting will be implemented in such a way in order to promote health and safety of all participants and obey valid
rules as enforced by related government authority and institution. As an effort to increase the efficiency and
effectiveness of the implementation of the Meeting, the Company will strive for the implementation of the Meeting
following the e-GMS mechanism as stipulated in the regulation of the Financial Services Authority of the Republic of
Indonesia Number 15/POJK.04/2020 concerning the Plans and Implementation of the Public Company General
Meeting Shareholders, further notification regarding the e-GMS can be accessed via investor.mitrakeluarga.com.
2. Based on the Decree of the KSEI Board of Directors regarding the Application of the KSEI Electronic General Meeting
System Facility (eASY.KSEI) as an Electronic Authorization Mechanism in the Process of GMS for Securities Issuers
which is a Public Company and the Shares Stored in KSEI Collective Custody, the Company provides an alternative
authorization for electronic shareholders, namely by using e-proxy in eASY.KSEI.
3. The Company will provide Meeting materials for each Meeting agenda by Company website
investor.mitrakeluarga.com. Shareholders who are entitled to attend, have the right to ask question about Meeting
agenda and such question will be delivered in Meeting and recorded on deed minutes of Meeting that prepared by
Public Notary.
4. Public Notary assisted by BAE will check and do vote counting on every Meeting agenda on every decision making
during Meeting for related agenda, based on power of attorney which delivered by Shareholder as mentioned on
point 2 (two) above.
5. For health reasons, Company will not provide food/beverage, electronic/as well as gratitude to Shareholder who
attend the Meeting.
Appendix I
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Questionnaire/Opinion Sheet for the Annual General Meeting of Shareholders
Meeting Agenda : 1
Shareholders Name :
No of Shares owned :
Email :
Questions/Opinion :
Meeting Agenda : 2
Shareholders Name :
No of Shares owned :
Email :
Questions/Opinion :
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Meeting Agenda : 3
Shareholders Name :
No of Shares owned :
Email :
Questions/Opinion :
Meeting Agenda : 4
Shareholders Name :
No of Shares owned :
Email :
Questions/Opinion :
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Meeting Agenda : 5
Shareholders Name :
No of Shares owned :
Email :
Questions/Opinion :
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Names mentioned 5 people and organisations named in the text · linked when the evidence is strong
unresolved
org
PT Adimitra Jasa Korpora
p.1 ×3
unresolved
org
Financial Services Authority
p.1 ×5
unresolved
org
PT Kustodian Sentral Efek Indonesia
p.4
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