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20241206_LABS_Laporan Bulanan Registrasi Pemegang Efek//Perubahan Struktur Pemegang Saham_31806350.pdf
Shareholder register Parsed LABSSource file signed link, expires in 15 minutes
Extracted text 10
Page 1
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Nomor Surat 006/BIMA/LABS/XII/2024
Nama Perusahaan PT UBC Medical Indonesia Tbk
Kode Emiten LABS
Papan Pencatatan Pengembangan
Lampiran 0
Perihal Laporan Bulanan Registrasi Pemegang Efek
Perseroan menyampaikan Laporan Bulanan Registrasi Pemegang Efek yang berakhir pada 30 November 2024
Sebagai Berikut :
Biro Administrasi Efek: PT. Bima Registra
Persen
Jumlah Persen
Jumlah Saham Saham
Nama Alamat Jabatan Saham Bulan Saham Bulan Pengendali Afiliasi
Sebelumnya Sebelumny
Ini Ini
a
PT Optel Ruko De 2.859.428.400 72,3906% 2.859.428.40 72,3906%
Investama Mansion Blok E 0 X
no.7 Alam
Sutera, 15143
Kota Tangerang
Banten
PT Inodia Perkantoran 571.600 0,0145% 571.600 0,0145%
Kedoya Elok X
Plaza Blok Db
Pemegang
24, Jl. Panjang
Saham > 5% 11520 Jakarta
Jakarta
Budi Hariadi Kond. Taman 130.000.000 3,2911% 130.000.000 3,2911%
Anggrek TWR X
8-43 H
RT008/RW007
Tanjung Duren
Selatan, Grogol
Petamburan,
Jakarta Barat
Page 2
Persen
Jumlah Persen
Jumlah Saham Saham
Nama Alamat Jabatan Saham Bulan Saham Bulan Pengendali Afiliasi
Sebelumnya Sebelumny
Ini Ini
a
Nathan Tirtana Kond. Taman Komisaris 0 0% 0 0%
Anggrek TWR
8-43 H
RT008/RW007
Tanjung Duren
Selatan, Grogol
Petamburan,
Jakarta Barat
Suyanto Primere Estate Komisaris 0 0% 0 0%
Blok F.II
RT003/RW005
Setu Cipayung
Jakarta Timur
Pemegang FX Yoshua Kawasan Direksi 0 0% 0 0%
Raintjung Industri
Saham > 5%
Pulogadung, Jl.
Rawa Gelam V,
Blok L, No Kav
11-13, Kel.
Jatinegara, Kec.
Cakung, Jakarta
Timur, Jakarta,
13930
Marcella Kawasan Direksi 0 0% 0 0%
Angelin Industri
Pulogadung, Jl.
Rawa Gelam V,
Blok L, No Kav
11-13, Kel.
Jatinegara, Kec.
Cakung, Jakarta
Timur, Jakarta,
13930
130.000.000 3,2911% 130.000.00 3,2911%
Masyarakat - Warkat - Scrip 0
830.000.000 21,0127% 830.000.00 21,0127%
Masyarakat - Non Warkat - Scripless 0
0 0% 0 0%
Saham Treasury
Page 3
3.950.000.00 100% 3.950.000.00 100%
Total 0 0
Persentase Jumlah Saham (Bulan Persentase(Bulan
Nama Jumlah Saham (Sebelumnya)
(Sebelumnya) Ini) Ini)
2,859,428,400 72.3906% 2,859,428,400 72.3906%
Total Pengendali
1,090,571,600 27.6094% 1,090,571,600 27.6094%
Total Non Pengendali
Informasi Saham Free Float
Keterangan Bulan Sebelumnya Bulan Ini
Jumlah saham scripless dimiliki oleh pemegang saham kurang
830.000.000 830.000.000
dari 5%
Jumlah saham scripless dimiliki oleh Direksi dan Dewan
0 0
Komisaris kurang dari 5%
Jumlah saham scripless dimiliki oleh Pengendali kurang dari 5% 0 0
Jumlah saham scripless dimiliki oleh Afiliasi dari Pengendali 0 0
kurang dari 5%
Jumlah treasury stock scripless kurang dari 5% 0 0
Jumlah saham portofolio investasi dengan penerima manfaat
0 0
investor publik yang telah disetujui Bursa untuk diperhitungkan
sebagai Free Float
Jumlah saham Free Float 830.000.000 830.000.000
Jumlah saham tercatat di Bursa per akhir bulan 3.950.000.000 3.950.000.000
% Saham Free Float 21,01 21,01
Page 4
Jumlah Pemegang Saham
Bulan Sebelumnya Bulan Sekarang Perubahan
3.405 3.100 305
Penerima Manfaat Akhir dari Kepemilikan Saham
Demikian untuk diketahui.
Hormat Kami,
PT UBC Medical Indonesia Tbk
Franciscus Xaverius Yoshua Raintjung
Direktur Utama
PT UBC Medical Indonesia Tbk
Kawasan Industri Pulogadung, Jl. Rawa Gelam V, Blok L, No Kav 11-13, Kel.
Telepon : 021-38865110, Fax : , www.ubcindonesia.com
Nama Pengirim Franciscus Xaverius Yoshua Raintjung
Jabatan Direktur Utama
Tanggal dan Waktu 09-12-2024 17:42
Page 5
Dokumen ini merupakan dokumen resmi PT UBC Medical Indonesia Tbk yang tidak memerlukan tanda tangan
karena dihasilkan secara elektronik oleh sistem pelaporan elektronik. PT UBC Medical Indonesia Tbk bertanggung
jawab penuh atas informasi yang tertera didalam dokumen ini.
Page 6
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Letter / Announcement No. 006/BIMA/LABS/XII/2024
Issuer Name PT UBC Medical Indonesia Tbk
Issuer Code LABS
Listing Board Development
Attachment 0
Subject Monthly Report of Securities Holders Registration
The Company hereby announce Monthly Report of Securities Holders Registration which ends in 30 November
2024 as follows:
Security Administration Bureau: PT. Bima Registra
Number of Percent of Number of Percent of
Name Address Position Shares in Shares in Shares in Shares in Controller Affiliation
Previous Previous Current Current
PT Optel Ruko De 2,859,428,400 72.3906% 2,859,428,40 72.3906%
Investama Mansion Blok E 0 X
no.7 Alam
Sutera, 15143
Kota Tangerang
Banten
PT Inodia Perkantoran 571,600 0.0145% 571,600 0.0145%
Kedoya Elok X
Plaza Blok Db
Share 24, Jl. Panjang
Ownership > 11520 Jakarta
5% Jakarta
Budi Hariadi Kond. Taman 130,000,000 3.2911% 130,000,000 3.2911%
Anggrek TWR X
8-43 H
RT008/RW007
Tanjung Duren
Selatan, Grogol
Petamburan,
Jakarta Barat
Page 7
Number of Percent of Number of Percent of
Name Address Position Shares in Shares in Shares in Shares in Controller Affiliation
Previous Previous Current Current
Nathan Tirtana Kond. Taman Komisaris 0 0% 0 0%
Anggrek TWR
8-43 H
RT008/RW007
Tanjung Duren
Selatan, Grogol
Petamburan,
Jakarta Barat
Suyanto Primere Estate Komisaris 0 0% 0 0%
Blok F.II
RT003/RW005
Setu Cipayung
Jakarta Timur
Share FX Yoshua Kawasan Direksi 0 0% 0 0%
Ownership > Raintjung Industri
5% Pulogadung, Jl.
Rawa Gelam V,
Blok L, No Kav
11-13, Kel.
Jatinegara, Kec.
Cakung, Jakarta
Timur, Jakarta,
13930
Marcella Kawasan Direksi 0 0% 0 0%
Angelin Industri
Pulogadung, Jl.
Rawa Gelam V,
Blok L, No Kav
11-13, Kel.
Jatinegara, Kec.
Cakung, Jakarta
Timur, Jakarta,
13930
130.000.000 3,2911% 130.000.00 3,2911%
Masyarakat - Warkat - Scrip 0
830.000.000 21,0127% 830.000.00 21,0127%
Masyarakat - Non Warkat - Scripless 0
0 0% 0 0%
Saham Treasury
3.950.000.00 100% 3.950.000.00 100%
Total 0 0
Page 8
Percentage Number of Shares (This Percentage (This
Name Number of Shares (Previously)
(Previous) Month) Month)
2,859,428,400 72.3906% 2,859,428,400 72.3906%
Total Controller
1,090,571,600 27.6094% 1,090,571,600 27.6094%
Total Non-Controllers
Free Float Share Information
Information Previous Month This Month
The number of scripless shares owned by shareholders is less
830.000.000 830.000.000
than 5%
The number of scripless shares owned by the Board of Directors
0 0
and Board of Commissioners is less than 5%
The number of scripless shares owned by the Controller is less
0 0
than 5%
The number of scripless shares owned by Affiliates of the 0 0
Controller is less than 5%
The amount of scripless treasury stock is less than 5% 0 0
Number of investment portfolio shares with public investor
0 0
beneficiaries that have been approved by the Exchange to be
counted as Free Float
The amount of Free Float Share 830.000.000 830.000.000
The number of shares listed on the Exchange at the end of the
3.950.000.000 3.950.000.000
month
% Free Float Share 21,01 21,01
Page 9
Number of Shareholders
Previous Month This Month Change
3.405 3.100 305
Final Beneficiaries of Share Ownership
Thus to be informed accordingly.
Respectfully,
PT UBC Medical Indonesia Tbk
Franciscus Xaverius Yoshua Raintjung
Direktur Utama
PT UBC Medical Indonesia Tbk
Kawasan Industri Pulogadung, Jl. Rawa Gelam V, Blok L, No Kav 11-13, Kel.
Phone : 021-38865110, Fax : , www.ubcindonesia.com
Sender Name Franciscus Xaverius Yoshua Raintjung
Function Direktur Utama
Date and Time 09-12-2024 17:42
Page 10
This is an official document of PT UBC Medical Indonesia Tbk that does not require a signature as it was generated
electronically by the electronic reporting system. PT UBC Medical Indonesia Tbk is fully responsible for the
information contained within this document.
Names mentioned 12 people and organisations named in the text · linked when the evidence is strong
unresolved
org
PT. Bima Registra
· Biro Administrasi Efek
p.1
unresolved
org
PT. Bima Registra Persen
p.1
unresolved
org
PT Optel
· 2.859.428.400
p.1 ×2
unresolved
person
Nathan Tirtana Kond.
· Komisaris
p.2 ×4
unresolved
person
Primere Estate
· Komisaris
p.2 ×2
unresolved
person
Franciscus Xaverius Yoshua Raintjung
· Direktur Utama
p.4 ×6
unresolved
—
Marcella
· Direksi
p.7
unresolved
person
Function
· Direktur Utama
p.9
Extraction attempts how the parser did, and what it refused
Nothing structured was extracted from this document — the attempts below say why.
Rule parser
OK
confidence 0.900
193 ms
12 Sep 2026 22:55
Raw output
{'aggregates': {'total': {'pct': '100', 'shares': '3950000000'},
'treasury': {'pct': '0', 'shares': '0'},
'under5_non_warkat': {'pct': '21.0127', 'shares': '830000000'},
'under5_warkat': {'pct': '3.2911', 'shares': '130000000'}},
'as_of_date': '2024-11-30',
'checksum_ok': True,
'checksum_parts': '3950000000',
'holders': [{'address': 'Ruko De Mansion Blok E no.7 Alam Sutera, 15143',
'category': 'FIVE_PCT',
'is_controller': True,
'is_controller_affiliate': False,
'name': 'PT Optel Investama',
'page_no': 1,
'pct': '72.3906',
'pct_prev': '72.3906',
'position': '',
'seq': 0,
'shares': '2859428400',
'shares_prev': '2859428400'},
{'address': 'Kota Tangerang Banten Perkantoran Kedoya Elok Plaza '
'Blok Db 24, Jl. Panjang',
'category': 'FIVE_PCT',
'is_controller': False,
'is_controller_affiliate': True,
'name': 'PT Inodia',
'page_no': 1,
'pct': '0.0145',
'pct_prev': '0.0145',
'position': '',
'seq': 1,
'shares': '571600',
'shares_prev': '571600'},
{'address': '11520 Jakarta Jakarta Kond. Taman Anggrek TWR',
'category': 'FIVE_PCT',
'is_controller': False,
'is_controller_affiliate': True,
'name': 'Budi Hariadi',
'page_no': 1,
'pct': '3.2911',
'pct_prev': '3.2911',
'position': '',
'seq': 2,
'shares': '130000000',
'shares_prev': '130000000'},
{'address': 'Kond. Taman Anggrek TWR 8-43 H RT008/RW007 Tanjung '
'Duren',
'category': 'BOARD',
'is_controller': False,
'is_controller_affiliate': False,
'name': 'Nathan Tirtana',
'page_no': 2,
'pct': '0',
'pct_prev': '0',
'position': 'Komisaris',
'seq': 3,
'shares': '0',
'shares_prev': '0'},
{'address': 'Selatan, Grogol Petamburan, Jakarta Barat Primere '
'Estate Blok F.II RT003/RW005',
'category': 'BOARD',
'is_controller': False,
'is_controller_affiliate': False,
'name': 'Suyanto',
'page_no': 2,
'pct': '0',
'pct_prev': '0',
'position': 'Komisaris',
'seq': 4,
'shares': '0',
'shares_prev': '0'},
{'address': 'Setu Cipayung Jakarta Timur Kawasan Industri '
'Pulogadung, Jl. Rawa Gelam V, Blok L, No Kav 11-13, '
'Kel.',
'category': 'BOARD',
'is_controller': False,
'is_controller_affiliate': False,
'name': 'FX Yoshua Raintjung',
'page_no': 2,
'pct': '0',
'pct_prev': '0',
'position': 'Direksi',
'seq': 5,
'shares': '0',
'shares_prev': '0'},
{'address': 'Jatinegara, Kec. Cakung, Jakarta Timur, Jakarta, '
'13930 Kawasan Industri',
'category': 'BOARD',
'is_controller': False,
'is_controller_affiliate': False,
'name': 'Marcella Angelin',
'page_no': 2,
'pct': '0',
'pct_prev': '0',
'position': 'Direksi',
'seq': 6,
'shares': '0',
'shares_prev': '0'}],
'issuer_name': 'PT UBC Medical Indonesia Tbk',
'issuer_ticker': 'LABS',
'layout': 'EREP_COVER',
'letter_number': '006/BIMA/LABS/XII/2024',
'listing_board': 'Pengembangan',
'period_label': 'November 2024',
'registrar': 'PT. Bima Registra',
'total_shares': '3950000000'}