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20240429_ITIC_Pemanggilan RUPS_31630616_lamp4.pdf

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Page 1
                                                     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 26 April 2024, 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 April 26th, 2024 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
Page 2
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 21 Mei 2024 (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 21st, 2024 (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
                                                                                      For            Setuju          Abstain
                                                                                                     Against
   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 2023.

          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, 2023
   2      Penetapan penggunaan Laba Bersih Perseroan untuk
          tahun buku yang berakhir pada tanggal 31 Desember 2023.

          Approval to determine the use of the Company's Net Profit for the
          financial year ending on December 31st, 2023
   3      Penetapan besaran gaji dan tunjangan lain bagi anggota
          Direksi serta honorarium dan tunjangan lainnya bagi
          anggota Dewan Komisaris Perseroan.

          Determination of the amount of salary and other allowances for
          members of the Board of Directors as well as honorarium and
          other allowances for members of the Board of Commissioners of
          the Company.
   4      Pengangkatan kembali anggota Direksi dan Dewan
          Komisaris Perseroan.

          Reappointment the Company's Board of Directors members and
          Board of Commissioners.
   5      Penunjukan Akuntan Publik yang akan melakukan audit
          terhadap Laporan Keuangan Perseroan yang berakhir pada
          tanggal 31 Desember 2024.

          Appointment of a Public Accountant who will audit the Company's
          Financial Statements ending on December 31st, 2024.
Page 3
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

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Names mentioned 3 people and organisations named in the text · linked when the evidence is strong

linked org Indonesian Tobacco Tbk. p.1 ×17
unresolved — KTP/ Paspor p.1 ×2
unresolved — ini memberikan kuasa (dengan/tanpa)* hak substitusi p.1

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