Form Pelaporan Hadiah bilingual

FORMULIR PELAPORAN HADIAH
GIFT REPORTING DISCLOSURE FORM
Kepada/To :
Corporate Secretary
Cc: .............................................................. selaku Atasan Langsung (as Direct Supervisor/Manager)
Dalam rangka menegakkan prinsip-prinsip Good Corporate Governance serta menerapkan budaya dan
nilai-nilai pokok Perseroan: Clean-Respectful-Synergy, maka saya yang bertandatangan di bawah ini:
In order to uphold the principles of Good Corporate Governance and implement culture and core values of the
Company: Clean-Respectful-Synergy, then I am the undersigned:

Nama Penerima:
Recipient’s Name:
No. Pegawai:
Employee Number:
Divisi:
Division:
Menyampaikan Laporan Penerimaan Hadiah sebagai berikut:
Reporting the Receipt of Gif as Follows:
Jenis Hadiah:
Type of Gratification:
Perkiraan Nilai Rp.:

Est. Value (Rp)
Tanggal dan Tempat Penerimaan:
Date & Place of Receipt:
Nama Pemberi:
Giver’s Name:
Alamat Pemberi:
Address:
Hubungan Pemberi dengan PT Elnusa Tbk
Relationship with PT Elnusa Tbk:
Bukti (lampiran):
Evidence (Attachment):
Demikian disampaikan atas perhatiannya diucapkan terima kasih.
Thus we conveyed, thank you for your attention.
Hormat kami,
Sincerely yours

(....................................)