S T A T E M E N T

To complete our application for film / video shooting permit in Indonesia, we hereby declare that we shall :
1.  Obey all regulations of the Government of the Republic of Indonesia (the central as well as the
    provincial Government).
2.  Report on our arrival to the Department of Information c/o Directorate of Film and Video
    Recording Development in Jakarta to get some information of central and local regulations before
    shooting is conducted.
3.  Agree to be accompanied by the liaison Officer who will be appointed by the Department of
    Information during filming of all shooting in Indonesia without exception, and bear all his/her
    expenses namely board, lodging, transportation, and daily allowance from the beginning until the
    end of our activities.
4.   Make shooting only in accordance with the script / synopsis and object / location approved and
    written in shooting permit issued by the Department of Information.
5.   No shooting or filming of any forbidden objects or locations or creating situations which may have
    the impression to harm the image of the Republic of Indonesia.
6.   Bear all expenses occured during filming objects / locations which have specific rules, including
    any expenses of hiring a special Officer required by that rules.
7.   Re-export all our shooting equipment on our own expenses upon completion of our activities.
8.   Submit one copy of the released film/video to the Department of Information through the
    Embassy of the Republic of Indonesia and agree that the Government of the Republic of Indonesia
    has the right to use it for non- commercial purposes based on its national interest at any time
    within its territory or abroad.

                                                                        Date   : ____________________




                                                                        Signature : _________________

For more information, please contact us (+62 81 338 450000) or email: info@balisatriafilm.com