Simplified - KYC v.

2/2021

KNOW YOUR COUNTERPARTY QUESTIONNAIRE

The PETRONAS Code of Conduct and Business Ethics (“CoBE”) sets out PETRONAS’ core principles with respect to ethics and integrity,
competition, sanction and export control, and data privacy.

As part of our commitment, PETRONAS expects its contractors, subcontractors, consultants, agents, representatives and others performing
work or services for or on behalf of the Group to comply with all applicable laws and the relevant parts of the CoBE and any other relevant
guidelines or manual when performing such work or services.

Therefore, before PETRONAS engages a third party, we are obligated to conduct appropriate third party due diligence to understand the
business and background of our prospective business counter parties to ensure that we are dealing with parties that subscribe to the same
values and ethical standards of integrity as PETRONAS in the conduct of their business.

Please complete the following questionnaire, using additional pages where necessary, and return a scanned, signed copy to the PETRONAS
focal person in charge. If you subsequently learn that any of the information provided below is incorrect or incomplete, please correct or
complete it (as applicable) and notify us as soon as possible.

SECTION A: COMPANY INFORMATION

NO QUESTIONS RESPONSE
1 Full legal name (and any previous legal names and/or trading names). Universitas Syiah Kuala

2 Country of incorporation.
Indonesia
3 Date of incorporation and registration number. 24 April 1962

Presidential Decree No
161/1962
4 Registered address. Jalan T. Nyak Arief,
Darussalam, Banda Aceh,
Special Region of Aceh,
Indonesia
5 Telephone number.
+62-651-7553205
6 Nature of the Company’s business.
University
7 Please provide a copy of the Company’s annual report or other publications describing the Company’s Univesitas Syiah Kuala (USK)
activities. is a public university in
Indonesia under Presidential
Decree No 162/1962. USK
contains 12 faculties range
from Natural Science,
Medicine, Engineering to Law

Open
 Simplified - KYC v.2/2021

and Social Science. Civil

Engineering Department the
organiser of AISCE2021 is
under Faculty of Engineering.

https://unsyiah.ac.id/
http://sipil.unsyiah.ac.id/
8 Please provide the following details: a. Republic of Indonesia
under Ministry of
a. Shareholder(s); Culture, Education
b. Ultimate beneficial owner(s); and Higher Education
c. Percentages held and jurisdiction/nationality of each shareholder; and b. Republic of Indonesia
d. Jurisdiction(s) of residence of each ultimate beneficial owner(s). under Ministry of
Culture, Education
and Higher Education
c. 100%, Indonesian
d. Banda Aceh,
Indonesia

Open
 Simplified - KYC v.2/2021

SECTION A: COMPANY INFORMATION

NO QUESTIONS RESPONSE

9 Please provide the following details of each current director:

a. Assoc. Prof. Dr. Renni
a. Full Name Anggraeni, ST., M.Eng
b. Nationality b. Indonesia
c. Date of Birth c. September 23rd, 1971

10 List of “key” employees, contractors and consultants of the Company who will be involved with or has Assoc. Prof. Dr. Renni
an existing commercial relationship with PETRONAS. Anggraeni
Assoc. Prof. Dr. Teuku Budi
Aulia
Dr. Halida Yunita
11 Does the Company outsource or intend to outsource any of its services in relation to the proposed
arrangement with PETRONAS?
No
If yes, please set out details of the third party contractors. Please note that any outsource
arrangement in relation to the transaction requires PETRONAS prior consent.

SECTION B: ETHICS
NO QUESTIONS RESPONSE

1. Are any of the current directors or current key employees of the Company also a Public Official?

If so, please provide details.

DESCRIPTIONS

For ease of reference, “Public Official” shall include the following:

No
(i) a person employed by a public authority holding a legislative, executive, administrative or
judicial office, whether appointed or elected, whether permanent or temporary, whether
paid or unpaid, irrespective of that person’s seniority;
(ii) any other person who performs a public function, including for a public agency or public
enterprise, or provides a public service; or
(iii) any other person defined as a “public official” in the domestic law of a country.

2. Please disclose any relationship which the Company, its affiliates, its directors and/or key employees
has or have with any Public Official related to the transaction. NA

Open
 Simplified - KYC v.2/2021

SECTION B: ETHICS
NO QUESTIONS RESPONSE

3. Have any payments been made by or on behalf of the Company during the past five years to any Public
Official?
No
If so, please provide details.

4. Does the Company has any affiliation with current PETRONAS employee who is involved in this
transaction?

If yes, please provide details:

 Full Legal Name of the Individual No
 Position Held
 The Duty/Duties of the Position(s)
 Tenure (start & end dates)

5. Does any government, its agencies or controlled organisations, or any other organisation performing a Yes
governmental function own any interest in or exercise any control over the Company’s business? Ministry of Culture, Education
and Higher Education
If Yes, please list the nature and extent of any such interest or control. Universitas Syiah Kuala

6. Does the Company have and disseminate to its employees the following:

i) a written employee code of conduct;

Yes
ii) a written anti-bribery and corruption policy; and
iii) a policy and process for reporting bribery if discovered?

7. Has the Company (or any of its affiliates, shareholders, directors or key employees) ever been the
subject of any convictions or prosecutions, or is the subject of any pending investigations by public
No
authority, in relation to bribery or corruption? Provide details, if any.

8. Does the Company require its contractors, sub-contractors and other third parties to comply with its
ethics and compliance policies (including anti-bribery and corruption)?
No
If Yes, please provide details to what extent does the Company monitor the integrity of its third
parties.
9. Has the Company (or any person or entity listed in this questionnaire) ever been barred from
competing for government contracts in any country?
No
If Yes, please provide details.

Open
 Simplified - KYC v.2/2021

SECTION C: SELF DECLARATION

We understand and acknowledge that PETRONAS observes good business conduct and is committed to adhere to all laws and regulations
wherever it operates including but not limited to economic sanctions, export control, competition or anti-trust, personal data protection
laws, guided by the PETRONAS Code of Conduct and Business Ethics (“COBE”).
Open
 Simplified - KYC v.2/2021

Accordingly, we confirm and declare that, to the best of our knowledge, the Company and/or any of its affiliates, including its and their
directors, officers, employees–

(a) are not the target or subjects of any sanctions;

(b) are not owned or controlled by any person who is the target or subject of any sanctions;
(c) are not acting for the benefit of or on behalf of any person (including but not limited to any natural person, corporation, limited
liability company, trust, joint venture, association, company, partnership, Governmental Authority or other entity) that is the
target or subject of any sanctions;
(d) have not been engaging in any conduct/activity that would result in us being in breach of any sanctions or becoming a target or
subject of sanctions;
(e) have not been the subject of any convictions or prosecutions or is it the subject of any pending investigations by a public
authority, in relation to export control regulations within the last 5 years.

For and on behalf of Universitas Syiah Kuala

Signed by the authorized representative of the Company:

9 December 2021
Signature Date

Name: Assoc. Prof. Dr.

Renni Aggraini
Designation: Chair of Civil
Engineering Department

Open
 Simplified - KYC v.2/2021

SECTION D: NOTICE OF DISCLOSURE

Applicable Laws relating to regulation of the Processing of Personal Data and matters connected thereto (“Data Protection Law”)

Pursuant to the requirement of Data Protection Law we hereby wish to give this notice and seek your consent on the processing of your personal data as well as to give an
assurance of our commitment to ensure that your data is securely processed, kept and not used or disclosed for any other purpose than the commercial dealings we have with you.

The contact to whom written requests for access to personal data or correction and/or deletion of personal data or for information regarding policies and procedures and types of
personal data handled by us can be made to the following:

Name: Dr.Eng Bentang Arif Budiman

Telephone Number: +62-22-250100
Email Address: bentang@ftmd.itb.ac.id

SECTION E: CERTIFICATION

By signing this document, the undersigned, being duly authorized to complete this questionnaire, hereby certify the following:
Open
 Simplified - KYC v.2/2021

o declares that he/she has, or has obtained from the relevant authority, the proper mandate and authority to disclose such information;
o consents to the processing of such information for the purpose described in the Notice of Disclosure;
o acknowledges that the processing of such information may be conducted by a third party on behalf of PETRONAS which may occur in another country than the
country of disclosure; and
o represents that the information provided in this document is, to the best of his/her knowledge is accurate, current and complete as of the date of disclosure.

For and on behalf of Universitas Syiah Kuala

Signed by the authorized representative of the Company:

9 December 2021

Signature Date

Name: Assoc. Prof. Dr.

Renni Aggraini
Designation: Chair of Civil
Engineering Department

Open