GGL Point of Origin - Declaration

Name of Point of Origin PT Persada Nusa Nabati indonesia

Address of Point of Origin : Desa Minas Timur Kec. Minas Kab. Siak Prov. Riau (mohon diisikan alamat PKS)

Country Indonesia
Suryadi (mohon diisikan nama perwakilan PKS bisa
Nama: :
manajemen/marketing/sustain/manager mill/KTU)
Contact details (name, email, phone): Email: : …………………………….
Phone Number : +62 812-7685-562
Type of feedstock Palm Kernel Shell
Any feedstock specification (when applicable) NA
Name of First Collector PT JPJ – First Collector Dumai, Tanjung Buton & Maredan
- Jalan Soekarno Hatta Km. 17, Kel. Bagan Besar, Kec. Bukit Kapur, Kota Dumai, Prov. Riau
Address of Recipient - Jalan BOB RT. 08, RW. 03, Dusun 2, Kampung Mengkapan, Kec. Suangai Apit, Kab. Siak,Prov. Riau
- Kawasan Pelabuhan PT Bandar Teguh Abadi, Desa Tualang, Kec. Tualang, Kab. Siak, Prov. Riau

Certificate Number:
GGL Endorse (RSPO P&C)
Validity:

In compliance with GGL instruction document 1d under

GGL Non-endorsed PT Jatim Propertindo Jaya’s Point of Origin Group
Management

Compliance with GGL instruction document 1d

The material mentioned on this declaration covered by a GGL endorsed (controlled) scheme complies with the following principles of
instruction document 1d.
Principle 3. All volumes origination from the producer shall be traceable
Principle 4. The producer does not deliberately produce any waste or residues or expand the operation in order to produce
more waste or residues.
Principle 5. A management system is in place for all operations at the processing site.
Principle 6. Relevant international, national, regional and local laws and regulations are complied with in all operations and
transactions.
Principle 7. Labour rights of workers and staff are safeguarded.
Principle 8. Health and Safety of workers and staff are protected.
Principle 9. Transparency and a grievance mechanism are established.
Principle 10. Relevant documents and yearly summaries are stored for at least 5 years.

I agree that by signing this statement an auditor from PT Jatim Propertindo Jaya can verify this claim and compliance with GGL
requirements according to PT Jatim Propertindo Jaya Internal GGL Manual.

I agree that by signing this statement an independent accredited GGL Certification Body and GGL Participant, can verify this claim
and compliance with the identified GGL standards and normative document. I will do everything within my power to assist the
Certification Body and GGL Participant in retrieving the information and documentation necessary to meet the certification
requirements relevant to this statement.

I herewith confirm that my operations comply with the above requirements.

Place : PT Persada Nusa Nabati indonesia, Tanggal : 18-10-2023 Signature: Suryadi

PT Jatim Propertindo Jaya – Point of Origin Declaration V1.0