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20260522_ITIC_Pemanggilan RUPS_32093754_lamp4.pdf
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Surat Kuasa
Menghadiri Rapat Umum Pemegang Saham Tahunan
PT Indonesian Tobacco Tbk.
Power Of Attorney To Attend Annual General Meeting Of Shareholders
PT Indonesian Tobacco Tbk.
Yang bertanda tangan di bawah ini:
The undersigned
Nama : .................................................................................................
Name
Jabatan : .................................................................................................
Position
*(untuk diisi jika mewakili badan hukum/ to be filled if Authorizer represents a legal entity)
Alamat : .................................................................................................
Address
Nomor KTP/ Paspor : .................................................................................................
ID Card/ Passport No
Alamat E-mail : .................................................................................................
E-mail Address
Nomor Telepon : .................................................................................................
Phone Number
Dalam hal ini sebagai Pemegang Saham dan pemilik sah atas ........................................
saham yang terdaftar dalam daftar pemegang saham PT Indonesian Tobacco Tbk. pada
tanggal 21 Mei 2026, yang selanjutnya disebut sebagai Pemberi Kuasa;
In this matter as a shareholder and the legal owner of the ........................................ that registered in
the PT Indonesian Tobacco Tbk. shareholder register, as of May 21st, 2026 hereinafter referred to as
Authorizer.
Dengan ini memberikan kuasa (dengan/tanpa)* hak substitusi kepada: *coret salah satu
Herewith confer a power of attorney (with/without)* substitution right to *scratch one
Nama : .................................................................................................
Name
Alamat : .................................................................................................
Address
Nomor KTP/ Paspor : .................................................................................................
ID Card/ Passport No
Alamat E-mail : .................................................................................................
E-mail Address
(“Penerima Kuasa”/ the “Attorney”)
-----------------------------------------------------KHUSUS-----------------------------------------------------
SPECIFICALLY
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Untuk menghadiri dan menyampaikan tanggapan, pertanyaan dan memberikan suara dalam
Rapat Umum Pemegang Saham Tahunan PT Indonesian Tobacco Tbk. yang selanjutnya
disebut (“Rapat”) yang diadakan di Jakarta pada tanggal 15 Juni 2026 (atau tanggal lainnya
sesuai dengan peraturan yang berlaku) dan memberikan suara atas mata acara Rapat
sebagai berikut:
To attend and to convey response, question and vote in the Annual General Meeting of Shareholder of
PT Indonesian Tobacco Tbk. hereinafter referred to as the (“Meeting”) to be held in Jakarta, May 15th,
2025 (or other date of replacement in accordance with the applicable laws and regulation), and to vote
with respect to the following agendas:
Mohon Diisi Dengan Tanda (√)
sesuai pilihan
Mata Acara Rapat Please fill with (√) as you choose
No
Meeting Agendas Setuju Tidak Abstain
Setuju
For Against Abstain
1 Persetujuan atas Laporan Tahunan Direksi,
Laporan Tugas Pengawasan Dewan Komisaris
dan pengesahan Laporan Posisi Keuangan serta
Laporan Laba Rugi dan Penghasilan
Komprehensif Lain Perseroan untuk tahun buku
yang berakhir pada tanggal 31 Desember 2025
Approval of the Board of Directors' Annual Report,
Board of Commissioners Supervisory Report and
ratification of the Financial Position Report and the
Company's Statement of Profit and Loss and Other
Comprehensive Income for the financial year ending
December 31st, 2025
2 Persetujuan penggunaan Laba Bersih
Perseroan untuk tahun buku yang berakhir pada
tanggal 31 Desember 2025
Approval to determine the use of the Company's Net
Profit for the financial year ending on December 31st,
2025
3 Persetujuan penetapan besaran gaji dan
tunjangan lain bagi anggota Direksi serta
honorarium dan tunjangan lainnya bagi anggota
Dewan Komisaris Perseroan
Approval of the determination of the amount of salary
and other allowances for members of the Board of
Directors and honorarium and other allowances for
members of the Company's Board of Commissioners
4 Persetujuan penunjukan Kantor Akuntan Publik
yang akan melakukan audit terhadap Laporan
Keuangan Perseroan yang berakhir pada
tanggal 31 Desember 2026
Approval of the appointment of a Public Accounting
Firm that will conduct an audit of the Company's
Financial Statements ending on December 31st, 2026
5 Perubahan susunan Direksi Perseroan
Changes to the composition of the Company's Board
of Directors
6 Persetujuan Perubahan Pasal 3 Anggaran Dasar
Perseroan disesuaikan dengan Peraturan Badan
Pusat Statistik (BPS) Nomor 7 Tahun 2025
Page 3
tentang Klasifikasi Baku Lapangan Usaha (KBLI
2025)
Approval of Amendments to Article 3 of the
Company's Articles of Association in accordance with
the Regulation of the Central Statistics Agency (BPS)
Number 7 of 2025 concerning the Standard
Classification of Business Fields (KBLI 2025)
Penerima Kuasa wajib memberikan suara sebagaimana tersebut di atas sesuai dengan
pilihan Pemberi Kuasa selaku Pemegang Saham, pada setiap mata acara Rapat.
The Attorney is obliged to vote as mentioned above in accordance with the choice of the Authorizer as
the Shareholder, at each Meeting Agenda.
Pemberi Kuasa dengan ini menyatakan bahwa suara dalam setiap mata acara Rapat yang
disampaikan berdasarkan Surat Kuasa ini adalah sah dan benar dan surat kuasa ini dapat
digunakan sebagai bukti bilamana diperlukan.
The Authorizer hereby confirm that the votes in the each agenda of the Meeting casted based on this
Power of Attorney are valid and true and this Power of Attorney can be used as evidence if necessary.
Demikian Surat Kuasa ini dibuat agar dipergunakan sebagaimana mestinya.
Thus this Power of Attorney was made to be used as it should.
Pemberi Kuasa, Penerima Kuasa,
The Authorizer The Attorney
Materai Rp
10.000,-
Stamp Duty
____________________ ____________________
Nama/ Name Nama/ Name
Names mentioned 3 people and organisations named in the text · linked when the evidence is strong
unresolved
—
ini memberikan kuasa (dengan/tanpa)* hak substitusi
p.1
unresolved
org
Pusat Statistik
p.2
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