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Form PROPE-S2

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TOTAL SCHOLARSHIP FOR ITB PROFESSIONNAL MASTERS INPETROLEUM ENGINEERING

In Collaboration with IFP School (French Institute of Petroleum School)

Total E&P Indonesie will grant a substantial number of scholarships for students from the best

Indonesian Universities with good Technical or Scientific majors in support of the ITB Professional

Masters in Petroleum Engineering.

This program is considered as one of TOTAL E&P Indonesies commitment to develop human resources

in their core business by giving a financial support to outstanding Indonesian students and also further

developing the institutes of higher learning by encouraging international cooperation.

The scholarship candidates should:

Be in their 8th semester or have already graduated in the previous semester,

Have good academic records with GPA min. 3.00,

English proficiency of 500 TOEFL or follow the TOEFL test arranged by ITB and obtain the

passing mark of 500.

Pass the Academic Potency Test conducted by OTO BAPPENAS at ITB with a minimum score of

500.

Total E&P Indonesie will conduct the selection process together with ITB. The grantees will be entitled to

have their tuition fees paid. The fee for the Professional Master PE has been fixed at Rp 39.000.000,

payable Rp 13.000.000,/semester.

A certain number of the successful Scholarship holders will be offered pre-employment agreements with

TOTAL E&P INDONESIE where in addition to the Tuition Fees, a competitive living allowance will be

offered to cover lodging, books and other expenses during the period of the course.

An obligation to work with TOTAL E&P INDONESIE will be required for a period of 2n+1 in which n is the

number of years of the pre-employment agreement between the Scholarship holder and TOTAL E&P

INDONESIE.

This form can be returned before 25 April 2013 to TOTALs localuniversity correspondent with the address here below

STUDENT ADVISORY CENTERITS

Contact Person: Ibu RinunPhone: (031) 592 5880/ (031) 709 79292

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APPLICATION FOR SCHOLARSHIP

PERSONAL DATA

Full Name :INDRA PERKASA

Present Address :BHASKARA SARI NO 69. MULYOSARI - SURABAYA

Permanent Address :BLOSSOM VILLE BLOK J/20 NO 5 THE GREEN, BUMI SERPONGDAMAI-SOUTH TANGERANG, BANTEN

Telephone : (62)85697040699

Email Address : Indra_perkasaa@yahoo.co.id

Place & Date ofBirth

: TANJUNG, SOUTH BORNEO, FEBRUARY 12TH 1991

Account Number : 1280005803116

Bank Address : BANK MANDIRI

FAMILY DATA

Name Age Education Occupation

FatherTIASHADI YITMOYONO 61 BACHELOR OF MINING

ENGINEERING IN INSTITUTTEKNOLOGI BANDUNG

RETIRED FROM PT.PERTAMINA

Mother SRI UTARI 57 SENIOR HIGH SCHOOL HOUSE WIFE

Sibling:

1ARYO UTOMO 29 BACHELOR OF

MANAGEMENT IN ATMA JAYAJAKARTA

EMPLOYEE

2TEGUH MAULANA 26 BACHELOR OF PETROLEUM

ENGINEERING IN INSTITUTTEKNOLOGI BANDUNG

EMPLOYEE

3

4

5

EDUCATION BACKGROUND

School From - To Name & Location of School Major CourseGraduated/ Degree

ReceivedGPA

Elementary

1997 2003AL-AZHAR BUMI SERPONG

DAMAI- -

Jr. High 2003 2006AL-AZHAR BUMI SERPONG

DAMAI- -

Sr. High 2006 2009AL-AZHAR BUMI SERPONG

DAMAISCIENCE -

University2009 -

PRESENTINSTITUT TEKNOLOGISEPULUH NOPEMBER

ENVIRONMENTALENGINEERING

- 2.97

UNIVERSITY CONTACT NUMBER

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University :INSTITUT TEKNOLOGI SEPULUH NOPEMBER

Faculty/ Major :FAKULTAS TEKNIK SIPIL DAN PERENCANAAN

University Address(with post code)

:KAMPUS ITS, SUKOLILO, SURABAYA, EAST JAVA, INDONESIA 60111

Telephone & Fax. Number(with area code)

: 62-31-5948886 & 62-31-5928387

ORGANIZATIONAL ACTIVITIES

Name of Organization/ Activities From - To Position

HMTL ITS 2010 2011 STAFF OF RESPONSIBILITYDEPARTEMENT

HMTL ITS 2011 2012 STAFF OF ART AND SPORT

LOMBA INOVASI TEKNIKLINGKUNGAN

2011 2012 CHIEF EVENTS

SOCIETY OF PETROLEUMENGINEERING ITS STUDENT

CHAPTER

2012 PRESENT MEMBER

SOCIETY OF PETROLEUMENGINEERING INTERNATIONAL

2013 - PRESENT MEMBER

TRAINING/ COURSE/ APPRENTICESHIP RECORDS

Kind of Training/ Course/Apprenticeship

From - To Organized By Location

GEOTHERMAL SEMINARAND CARRER TALK WITHCHEVRON

2013 SOCIETY OFEXPLORATIONGEOPHYCICS

SURABAYA

COURSE 2013 SCHLUMBERGER SURABAYA

TRAINING OHSAS

18001:2007

2013 PT PHITAGORAS GLOBAL

DUTA

SURABAYA

YOUNG WATERPROFESSIONAL

2013 INTERNATIONAL WATERASSOCIATION

JAKARTA

COURSE 2013 CHEVRON SURABAYA

ON-JOB TRAINING 2012 PERTAMINA EP CIREBON

ACTIVITIES & HOBBIES

Membership ofProfessional Association

MEMBER OF SOCIETY OF PETROLEUM ENGINEERING STUDENT CHAPTER ITS

Hobbies & Sports FUTSAL, CYCLING, MUSIC, AND TRAVELLING

Social Activities -

ADDITIONAL INFORMATION (if any)

- 3rd PLACE ON FESTIVAL MUDA ACCOUSTIC MUDA CREATIVITY 4TH ANNIVERSARY

- PARTICIPANT IN FUTSAL RECTOR CUP 2012

- 2nd PLACE FUTSAL OLIMPIADE FTSP 2012

- 3rd PLACE FUTSAL OLIMPIADE FTSP 2013

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The facts stated in this Scholarship Form are true and complete to the best of my knowledge and belief.I understand and agree to follow all the procedures, regulations, and requirements that related to Total E&P Indonesies ScholarshipProgram.

Date: Applicants Signature:

N.B: Please supply all of this documents, along with this form:

Copy of academic transcripts, from 1st semester until the last semester.

1 photo (3x4 cm).

Copy of the first page of your account book (that stated the Banks name, your name and account number).

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Date : APRIL 24, 2013

Name : INDRA PERKASA

1. Why are you entitled to accept this scholarship?

I deserve this scholarship because I have potential and competent in my academic and I have good time

management, I have experience in how to lead an organization. I have a strong desire to learn about oil from the

process of getting oil to process oil. I have some participant in the sector of petroleum engineering, such as I am

being a member of Society of Petroleum Engineering ITS SC and International SC. Then I have some experience

when I work practies in Pertamina EP, I enjoy working in the field of petroleum engineering, so I want to continue

my studies to the more spesific in petrolium engineering.

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2. Why do you want to continue your study to Master Degree?

I want to continue my study from bachelor degree to master degree because I want to expand my knowledge in

engineering focused to petroleum engineering and I want to be an expert of it, so can I learned much in petroleum

world, then I can working in leading oil and gas company. And also my reason to continue studying to master

degree to improve the standard when we getting a job. Because the salary standard of master degree is higher than

bachelor degree. And also to make it easier to get a job if I have a Master Degree. Another reason why I want to

continue my study to master degree because I want to expand my networking with people especially the experts.

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3. What is your plan after graduated from ITB Professional Masters in Petroleum Engineering?

My plan after I graduated from ITB then get Master degree in petroleum engineering is working in the oil and gas

company like Total E&P. Total E&P is oil and gas company based in French that pays high salaries to its

employees. Then in oil and gas company, I would connect my environmental science in bachelor degree with a

petroleum engineering to solve problems associated with petroleum world environmental also.

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