Mine Acquisition

1. Company Information Company Name: Business Registration Number: Country of Incorporation: Year of Establishment: Business Type: Website (if any):

2. Authorized Representative Full Name: Designation/Position: Email Address: Mobile Number (with country code): ID Proof / Passport No. (optional):

3. Company Address Head Office Address: City: State/Province: Country: Postal Code:

4. Interest in Concession Type of Commodity Interested In: Preferred GAR Range / Grade (if applicable): Target Location: Expected Production Capacity (MT/month): Investment Mode: Budget Range (USD):

5. Technical Capability Does your company have mining experience in Indonesia? Do you have a local partner or PMA entity in Indonesia? Brief summary of past mining/concession acquisitions (optional):

6. Legal & Financial Readiness Is your company ready to sign an NDA? Are you prepared to show proof of funds when required? Preferred Payment Terms:

7. Supporting Documents (Optional at Registration) Company Profile (PDF): Proof of Funds or Letter of Intent (LOI): Mining License or Trading License (if applicable): Passport copy of Authorized Representative:

8. Declaration & Consent I confirm that the information provided above is true and correct to the best of my knowledge, and I authorize MineConnect to contact me for further discussion. Signature or Digital Acknowledgement: Date of Submission: