Lampiran Surat

Direktur Jenderal Pengendalian Perubahan Iklim

Nomor : S.317/PPI/MS2R/KLN.3/8/2023
Tanggal : 9 Agustus 2023
DAFTAR TUJUAN

Kepada Yth. Bapak /Ibu/Saudara/Saudari:

SEKRETARIAT NEGARA
1. Sekretaris Kementerian

SEKRETARIAT KABINET
2. Deputi Bidang Kemaritiman dan Investasi
3. Deputi Bidang Perekonomian
4. Deputi Bidang Politik, Hukum, dan Keamanan
5. Deputi Bidang Pembangunan Manusia dan Kebudayaan
6. Staf Ahli Bidang Kemaritiman, Investasi dan Hubungan Internasional

KEMENTERIAN KOORDINATOR BIDANG PEREKONOMIAN

7. Deputi Bidang Koordinasi Kerja Sama Ekonomi Internasional
8. Deputi Bidang Koordinasi Pengembangan Usaha BUMN dan Inovasi
9. Deputi Bidang Pangan dan Agribisnis

KEMENTERIAN KOORDINATOR BIDANG PEMBANGUNAN MANUSIA DAN

KEBUDAYAAN
10. Sekretaris Kementerian Koordinator

KEMENTERIAN KOORDINATOR BIDANG KEMARITIMAN DAN INVESTASI

11. Sekretaris Kementerian Koordinator
12. Deputi Bidang Koordinasi Pengelolaan Lingkungan dan Kehutanan
13. Deputi Bidang Koordinasi Sumber Daya Maritim

KEMENTERIAN LUAR NEGERI

14. Direktur Jenderal Hukum dan Perjanjian Internasional
15. Direktur Jenderal Kerjasama Multilateral

KEMENTERIAN KEUANGAN
16. Sekretaris Jenderal
17. Direktur Jenderal Perbendaharaan
18. Direktur Jenderal Anggaran
19. Kepala Badan Kebijakan Fiskal
KEMENTERIAN KESEHATAN
20. Sekretaris Jenderal
21. Direktur Jenderal Pencegahan dan Pengendalian Penyakit
KEMENTERIAN KETENAGAKERJAAN
22. Sekretaris Jenderal
23. Direktur Jenderal Pembinaan Hubungan Industrial dan Jaminan Sosial
Ketenagakerjaan
24. Direktur Jenderal Pembinaan Pelatihan Vokasi dan Produktivitas
25. Kepala Badan Perencanaan dan Pengembangan Ketenagakerjaan
KEMENTERIAN PERINDUSTRIAN
26. Direktur Jenderal Ketahanan, Perwilayahan dan Akses Industri Internasional
27. Kepala Badan Standardisasi dan Kebijakan Jasa Industri
28. Direktur Jenderal Industri Kimia, Farmasi dan Tekstil

KEMENTERIAN PERDAGANGAN
29. Sekretaris Jenderal
30. Direktur Jenderal Perundingan Perdagangan Internasional

KEMENTERIAN ENERGI DAN SUMBER DAYA MINERAL

31. Sekretaris Jenderal
32. Staf Ahli Menteri Bidang Perencanaan Strategi
33. Direktur Jenderal Energi Baru, Terbarukan dan Konservasi Energi
34. Direktur Jenderal Ketenagalistrikan
35. Direktur Jenderal Minyak Energi dan Gas Bumi
36. Direktur Jenderal Mineral dan Batubara

KEMENTERIAN PEKERJAAN UMUM DAN PERUMAHAN RAKYAT

37. Sekretaris Jenderal
38. Staf Ahli Menteri Bidang Teknologi, Industri, dan Lingkungan

KEMENTERIAN PERHUBUNGAN
39. Sekretaris Jenderal
40. Direktur Jenderal Perhubungan Darat
41. Direktur Jenderal Perhubungan Laut
42. Direktur Jenderal Perhubungan Udara

KEMENTERIAN PERTANIAN
43. Sekretaris Jenderal
44. Kepala Badan Standardisasi Instrumen Pertanian

KEMENTERIAN KELAUTAN DAN PERIKANAN

45. Sekretaris Jenderal
46. Direktur Jenderal Pengelolaan Ruang Laut

KEMENTERIAN AGRARIA DAN TATA RUANG/BPN

47. Sekretaris Jenderal
48. Direktur Jenderal Tata Ruang

KEMENTERIAN PERENCANAAN DAN PEMBANGUNAN NASIONAL/BAPPENAS

49. Deputi Bidang Kemaritiman dan Sumber Daya Alam

KEMENTERIAN PEMBERDAYAAN PEREMPUAN DAN PERLINDUNGAN ANAK

50. Sekretaris Kementerian
51. Deputi Perlindungan Hak Perempuan
52. Deputi Kesetaraan Gender
53. Deputi Partisipasi Masyarakat
54. Deputi Bidang Pemenuhan Hak Anak
KEMENTERIAN INVESTASI / BADAN KOORDINASI PENANAMAN MODAL
55. Sekretaris Kementerian
56. Deputi Bidang Perencanaan Penanaman Modal
57. Deputi Bidang Hilirisasi Investasi Strategis
58. Deputi Bidang Kerja Sama Penanaman Modal

KEMENTERIAN LINGKUNGAN HIDUP DAN KEHUTANAN

59. Sekretaris Jenderal
60. Direktur Jenderal Planologi Kehutanan dan Tata Lingkungan
61. Direktur Jenderal Konservasi Sumber Daya Alam dan Ekosistem
62. DirekturJenderal Pengelolaan Daerah Aliran Sungai dan Rehabilitasi Hutan
63. Direktur Jenderal Pengelolaan Hutan Lestari
64. Direktur Jenderal Pengendalian Pencemaran dan Kerusakan Lingkungan
65. Direktur Jenderal Pengelolaan Sampah, Limbah, dan Bahan Berbahaya dan
Beracun
66. Direktur Jenderal Perhutanan Sosial dan Kemitraan Lingkungan
67. Direktur Jenderal Penegakan Hukum LHK
68. Kepala Badan Penyuluhan dan Pengembangan SDM
69. Kepala Badan Standarisasi Instrumen LHK

BADAN RISET DAN INOVASI NASIONAL (BRIN)

70. Sekretaris Utama
71. Deputi Kebijakan Pembangunan
72. Kepala Organisasi Riset Hayati dan Lingkungan

BADAN RESTORASI GAMBUT DAN MANGROVE (BRGM)

73. Sekretaris Utama
74. Deputi Bidang Edukasi, Sosialisasi, Partisipasi dan Kemitraan
75. Deputi Perencanaan dan Evaluasi

BADAN METEOROLOGI, KLIMATOLOGI, DAN GEOFISIKA (BMKG)

76. Sekretaris Utama
77. Deputi Bidang Klimatologi

BADAN NASIONAL PENANGGULANGAN BENCANA (BNPB)

78. Sekretaris Utama
79. Deputi Bidang Sistem dan Strategi
80. Deputi Bidang Pencegahan

BADAN INFORMASI GEOSPASIAL (BIG)

81. Sekretaris Utama
82. Deputi Bidang Informasi Geospatial Tematik

BADAN STANDARDISASI NASIONAL (BSN)

83. Sekretaris Utama
84. Deputi Bidang Pengembangan Standar
FORMULIR PENDAFTARAN DELEGASI REPUBLIK INDONESIA
United Nations Climate Change Conference 2023
COP28/CMP18/CMA5, SBSTA59 & SBI59
Dubai, Persatuan Emirat Arab, 30 November – 12 Desember 2023
PAGE – 1

Salutation (pilih) Mr. Ms.

First/Given name (sesuai paspor)
Last/Family name (sesuai paspor)

Catatan:
Sesuai informasi KJRI Dubai, nama dalam lembar
pertama (bukan di lembar amandamen) paspor
sangat direkomendasikan minimal dua kata untuk
dapat diterima di UAE
Relationship to nominator (pilih) 1. Paid relationship/contract with the nominating entity
(Hubungan dengan National Focal Point to the (Hubungan/kontrak berbayar dengan entitas yang
UNFCCC / Direktur Jenderal Pengendalian mencalonkan)
Perubahan Iklim KLHK) 2. Paid relationship/contract with an affiliate/member of
the nominating entity
(Hubungan/kontrak berbayar dengan afiliasi/anggota dari
entitas yang mencalonkan)
3. Unpaid advisory capacity
(Kapasitas penasihat yang tidak dibayar)
4. Partner/sponsorship of the nominating entity
(Mitra/sponsor dari entitas yang mencalonkan)
5. Guest of the nominating entity
(Tamu dari entitas yang mencalonkan)
6. Other (please specify)
………………………..
(Lainnya – tolong disebut secara spesifik)
7. Choose not to disclose
(Memilih untuk tidak mengungkapkan)
Functional title (English)
(Bahasa Indonesia)
Department (English)
(Bahasa Indonesia)
Home Organisation (English)
(Bahasa Indonesia)
Date of birth (DD/MM/YYYY) (Tanggal, contoh: 01) (Bulan, contoh: 01) (Tahun, contoh: 1981)
….. …. ……
Passport number (paspor yang masih
berlaku)
Catatan:
Bagi yang sedang proses, dapat mencantumkan
nomor paspor lama (jika ada). Selanjutnya, nomor
paspor baru dapat dikomunikasikan

SEKRETARIAT NATIONAL FOCAL POINT TO THE UNFCCC

DIREKTORAT JENDERAL PENGENDALIAN PERUBAHAN IKLIM
KEMENTERIAN LINGKUNGAN HIDUP DAN KEHUTANAN 2023
 FORMULIR PENDAFTARAN DELEGASI REPUBLIK INDONESIA
United Nations Climate Change Conference 2023
COP28/CMP18/CMA5, SBSTA59 & SBI59
Dubai, Persatuan Emirat Arab, 30 November – 12 Desember 2023
PAGE – 2

Passport expiry date (DD/MM/YYYY) (Tanggal, contoh: 01) (Bulan, contoh: 01) (Tahun, contoh: 1981)
….. …. ……
Scanned passport available Process to be available
Residence Country (Negara kediaman)
Residence City (Kota kediaman)
Personal and secure e-mail address (alamat
email tujuan pengiriman Acknowledgement
Letter)
Mohon menggunakan alamat e-mail aktif dan milik
sendiri.
Mobile phone number / WhatsApp number
(preferred)
MANDATORY - Recently taken photo available process to be available
● Taken within the last 6 months
● With no shadows
● With a plain background
● Person must face the camera in the photo
● Have a neutral expression
● Have both eyes open
● Not wear eyeglasses except for medical
reasons
● Image type: jpeg
● Image size: square, min 300 x 300 pixels
Agenda / Events a. Negosiasi (sebutkan agenda)
(diisi dengan judul agenda / sesi pertemuan b. Paviliun Indonesia (sebutkan agenda)
yang akan diikuti) c. Lainnya (misalnya mandated (sebutkan agenda)
events, side events,
exhibition, dll)

Date and Place of Signing: ……………………………. Electronic / Scanned Signature: …………………………………….

Keterangan:
● Persyaratan foto: foto terbaru max 6 bulan terakhir,
● Mohon perkenan Bapak/Ibu/Saudara/Saudari untuk dapat mengirimkan kembali formulir yang telah diisi lengkap
dalam format text PDF disertai dengan Surat Usulan resmi dari Instansi/Unit asal, scan paspor, dan file foto
jpeg.dan disampaikan ke alamat: sekdelripi@menlhk.go.id

SEKRETARIAT NATIONAL FOCAL POINT TO THE UNFCCC

DIREKTORAT JENDERAL PENGENDALIAN PERUBAHAN IKLIM
KEMENTERIAN LINGKUNGAN HIDUP DAN KEHUTANAN 2023
 Possible elements of the provisional agenda for the COP28/CMP18/CMA5
No Kelompok Isu
1 Transparency dan
Global Stocktake
2 Mitigation dan Just
Transition Work
Programme
3 Mitigation dan Just
Transition Work
Programme
4 Transparency dan
Global Stocktake
5 Transparency dan
Global Stocktake
6 Transparency dan
Global Stocktake
7 Transparency dan
Global Stocktake
8 Article 6 of the Paris
Agreement
9 Article 6 of the Paris
Agreement
10 Climate Finance,
Article 6 of the Paris
Agreement
1 As defined in Article 1, para. 7, of the Kyoto Protocol.
Agenda Sesi
Conclusion of the first global stocktake.
CMA5
Sharm el-Sheikh mitigation ambition and implementation work programme.
CMA5
Work programme on just transition.
CMA5
Reporting from and review of Parties included in Annex I to the Convention.
COP28
Reporting from and review of Parties included in Annex I: 1
• National communications;
• Annual compilation and accounting report for the second commitment period for Annex
CMP18
B Parties under the Kyoto Protocol;
• Date of completion of the expert review process under Article 8 of the Kyoto Protocol
for the second commitment period.
Reporting from Parties not included in Annex I to the Convention.
COP28
Reporting and review pursuant to Article 13 of the Paris Agreement: provision of financial
CMA5
and technical support to developing country Parties for reporting and capacity-building.
Matters relating to the clean development mechanism.
CMP18
Matters relating to joint implementation.
CMP18
Matters relating to the Adaptation Fund.
CMP18
No Kelompok Isu Agenda Sesi
11 Adaptation dan Loss Matters relating to adaptation:
and Damage • Report of the Adaptation Committee;
• Review of the progress, effectiveness and performance of the Adaptation Committee. COP28, CMA5
• Glasgow–Sharm el-Sheikh work programme on the global goal on adaptation referred
to in decision 7/CMA.3.
12 Adaptation dan Loss Warsaw International Mechanism for Loss and Damage associated with Climate Change
COP28, CMA5
and Damage Impacts 2
13 Agriculture Sharm el-Sheikh joint work on implementation of climate action on agriculture and food
SBI59, CMA5
security
14 Climate Finance, Matters relating to finance:
Adaptation dan Loss • Long-term climate finance;
and Damage • Matters relating to the Standing Committee on Finance;
• Report of the Green Climate Fund to the COP and guidance to the Green Climate
Fund;
• Report of the Global Environment Facility to the COP and guidance to the Global
Environment Facility;
COP28
• Seventh review of the Financial Mechanism;
• Compilation and synthesis of, and summary report on the in-session workshop on,
biennial communications of information related to Article 9, paragraph 5, of the Paris
Agreement;
• Matters relating to funding arrangements responding to loss and damage associated
with the adverse effects of climate change, including a focus on addressing loss and
damage.
15 Climate Finance, Matters relating to finance:
Adaptation dan Loss • Matters relating to the Standing Committee on Finance;
and Damage • Guidance to the Green Climate Fund;
CMA5
• Guidance to the Global Environment Facility;
• Matters relating to the Adaptation Fund;
• New collective quantified goal on climate finance;

2 The inclusion of this element does not prejudge outcomes on matters related to the governance of the Warsaw International Mechanism.
No Kelompok Isu Agenda Sesi
• Compilation and synthesis of, and summary report on the in-session workshop on,
biennial communications of information related to Article 9, paragraph 5, of the Paris
Agreement.
• Matters relating to Article 2, paragraph 1(c), of the Paris Agreement.
• Matters relating to funding arrangements for responding to loss and damage
associated with the adverse effects of climate change, including a focus on addressing
loss and damage.
16 Development and Development and transfer of technologies and implementation of the Technology
Transfer of Mechanism:
Technology • Joint annual report of the Technology Executive Committee and the Climate
COP28, CMA5
Technology Centre and Network;
• Linkages between the Technology Mechanism and the Financial Mechanism of the
Convention.
17 Capacity Building Capacity-building under the Convention. COP28
dan Action for Capacity-building under the Kyoto Protocol. CMP18
Climate Capacity-building under the Paris Agreement.
Empowerement CMA5
(ACE)
18 Response Measure Report of the forum on the impact of the implementation of response measures. COP28, CMP18, CMA5
19 Article 6 of the Paris Matters relating to cooperative approaches referred to in Article 6, paragraph 2, of the
CMA5
Agreement Paris Agreement.
20 Article 6 of the Paris Mechanism established by Article 6, paragraph 4, of the Paris Agreement.
CMA5
Agreement
21 Article 6 of the Paris Work programme under the framework for non-market approaches referred to in Article 6,
CMA5
Agreement paragraph 8, of the Paris Agreement.
22 Gender and Climate Gender and climate change.
COP28
Change
23 Compliance, Report of the committee to facilitate implementation and promote compliance referred to in
International Article 15, paragraph 2, of the Paris Agreement.
Organization and CMA5
Intergovernmental
Meetings
No Kelompok Isu Agenda Sesi
24 Compliance, Consideration of proposals by Parties for amendments to the Convention under Article 15:
International • Proposal from the Russian Federation to amend Article 4, paragraph 2(f), of the
Organization and Convention; COP28
Intergovernmental • Proposal from Papua New Guinea and Mexico to amend Articles 7 and 18 of the
Meetings Convention.
25 Compliance, Second review of the adequacy of Article 4, paragraph 2(a–b), of the Convention.
International
Organization and
Intergovernmental
COP28
Meetings;
Mitigation dan Just
Transition Work
Programme
26 Adaptation dan Loss Mountains and climate change: highlighting the need for the protection of vulnerable
and Damage mountain ecosystems while building the resilience of mountain peoples and economies to COP28
reduce loss and damage. 3
27 Transparency dan Report of the Compliance Committee.
CMP18
Global Stocktake
28 International Report on the high-level ministerial round table on increased ambition of Kyoto Protocol
Organization and commitments.
Intergovernmental
Meetings; CMP18
Mitigation dan Just
Transition Work
Programme
29 International Special needs and special circumstances of Africa 4
Organization and
CMA5
Intergovernmental
Meetings

3 On 23 March 2023, the secretariat received a request from Andorra to include the item in the provisional agenda for COP 28.
4 On 3 April 2023, the secretariat received a request from Zambia on behalf of the African Group to include this item in the provisional agenda for CMA 5.
No Kelompok Isu Agenda Sesi
30 Research and Research and systematic observation.
systematic
COP28, CMA5
observation.

31 Kesekretariatan Administrative, financial and institutional matters. COP28, CMP18, CMA5

****