TENDER REGISTRATION FORM

TENDER No. : ..
SUBJECT : ..

Please register our company to be considered as a participant for the above

mentioned tender of TOTAL E&P INDONSIE

COMPANY NAME

PT/CV..... Consortium with SKTPM Number

PT/CV.....

FULL ADDRESS

TELEPHONE Number FAX/TELEX No.

Contact Person Name Contact Person Phone Number

BUSINESS CATEGORY (to be filled by Procurement Committee) Tender Requirement:

CLASSIFICATION QUALIFICATION
Qualified Unqualified Check By

LOCAL CONTENT for this Tender

Group 1: _________ % Group 3: _________ %*

Group 2: _________ %* Group 4: _________ %*
To be supported by certificate (Material) or Letter of Commitment (Service)
* for quoting more than 1 group (if any), please state the Local Content for each group
** for HIGH risk job, valid HSE PQF II with score >= 60 must be available upon tender registration

Balikpapan, ..
NAME, SIGNATURE & STAMP

(Name of Authorized Person)

Enclosed with this CFT Registration - MANDATORY Available Not Available
- Latest Year Audited Financial Report
- Copy of Highest PO/CONTRACT which related with tender scope
- Statement/certificate of local content
- Copy of SKTPM Certificate

FAILURE TO SUBMIT THE ABOVE MANDATORY DOCUMENT ON ____ / ____ / 201_ (before 16.30 WITA)
SHALL LEAD TO EXCLUDE IN THE BIDDER LIST FOR THIS CFT
Revision: 14 May 2014