Form No ICC/06/INT/ICF/2011

Revision 03
Form Title Internship Agreement

INTERNSHIP AGREEMENT

A. Student Personal Details

Full Name : Rustam Efendi Batu Bara
Study Program : Mechanical Engineering
Student ID : 003201900015
Concentration : Automotive and Manufacture
Mobile Phone Number : 082311342490
Current Address : Jl. Swadaya Kp. Rw. Badung No.3, RT.6/RW.13,
Pegangsaan Dua, Kec. Cakung, Kota Jakarta Timur,
Daerah Khusus Ibukota Jakarta 13930 (domisili sekarang)
Email Address : rustam.presuniv.ac.id@gmail.com,
rustam.bara@student.president.ac.id
Home Number : +6282311342490

B. Organization Information

Organization/Company’s Name : PT. YAMAHA MUSIC

MANUFACTURING INDONESIA

Type of Industry : Manufactur and Production

Office Phone Number : (021) -4613234
Fax Number : (021) -4600585
Address : Kawasan Industri Pulogadung, Jl. Pulobuaran Raya No.1,
Jatinegara, Kec. Cakung, Kota Jakarta Timur

Website Address : t-torie@ymmi.post.yamaha.co.jp

Country Representative : Indonesia

C. Internship Coordinator
Please state the contact person who is responsible for coordinating internship program in the
organization/company that hires the intern.
Name : Ratno
Department : Electric Guitar
Position : Wakil Ketua
Office Phone Number : 085711494514
Email :ratno.ymmi@gmail.com
 Form No ICC/06/INT/ICF/2011
Revision 03
Form Title Internship Agreement

D. Internship Placement
Department : Electrical Guitar
Work Hours per day : 5 Hour/Day
Internship Duration : 17 Weeks
Starting Date : 2022-05-23
Finishing Date : 2022-09-14
Name of Immediate Supervisor : RATNO

Supervisor Job Title :Wakil Ketua Pimpinan

Supervisor office number : 085711494514

E. Internship Entitlement
- Uniform
- Certificate
- BPJS

This form is the agreement made among the three parties, which are the institution, intern, and
President University for the internship cooperation during the specified period. By signing this form,
each party agrees on the terms and conditions which may affect the internship as stipulated by the
institution and/or President University. Any information obtained as the result of the internship shall be
regarded as confidential which can only be issue to the public upon the consent and acknowledgement
from the respective institution and/or President University.

On-Site Supervisor Intern

Signed and duly stamped

Name : RATNO Name : Rustam Efendi Batu Bara
Date : May 23, 2022 Date : May 23, 2022