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 SKTPM Number FULL ADDRESS

TELEPHONE Number

FAX/TELEX No.
Tender Requirement :

BUSINESS CATEGORY (to be filled by Procurement Committee)

CLASSIFICATION
Qualified Unqualified

QUALIFICATION
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), state Local Content for each group ** Bidder quoting Local Content in Bid Submission less than Local Content in registration will be disqualified *** for HIGH risk job, HSE PQF II score < 60 before commercial opening will be disqualified

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 domestic content - Copy of SKTPM or LOE (letter of evidence) - For tenderer having No SKTPM nor LOE should enclose : 1. SIUP/SIUJK/SIUPAL 2. Notarial deed of Company Establishment 3. NPWP & Latest year of SPT-PPH Ps. 29

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: 13 May 2011