FORMULIR APLIKASI

ASEAN CHARTERED PROFESSIONAL ENGINEER

INDONESIA MONITORING COMMITTEE

2013

Dapat diunduh dari situs IMC, http://imc.or.id/

APP 01

APPLICATION FOR A PROFESSIONAL ENGINEER TO BE

REGISTERED AS ASEAN CHARTERED PROFESSIONAL ENGINEER
(ACPE)
(To be completed by Applicant in BLOCK LETTERS with BLUE INK)

Name:
Name to be put in the certificate:
Address:
Tel . No.:

Fax. No.:

E-mail:
Identity Card No.:

Date of Birth:

First Degree / University:

Discipline of Engineering:
Graduate Engineer Registration No.:
Date of Registration:
Professional Engineer Registration No.:
Date of Registration:
Branch of Engineering:
Discipline for ACPE Registration (select 1 discipline only):

Mechanical

Structural

Aeronautical
Petroleum

Electrical

Chemical

Mining

Geotechnical

Water Resources

Marine Tech

Industrial

Physic

Transportation

Environmental

Geodetic

Civil

I enclose herewith * money order / bank draft / cheque no. :

for the amount of Rp.

being the fee.

Date of previous application:

(Write NIL if not applicable)

Date:
(
*delete whichever is not applicable

)
(signature)

Silakan kirimkan salinan aplikasi ACPE melalui e-mail ke secretariat@imc.or.id

rev 02a

Page 1 of 3

APP 02

PORTOFOLIO FOR THE APPLICATION AS ASEAN CHARTERED PROFESSIONAL ENGINEER

Name:
PROFESSIONAL EXPERIENCE IN RESPONSIBLE CHARGE OF SIGNIFICANT ENGINEERING WORK

rev 02b

E
D5
research / teaching Masters / post
graduates / study /

(if necessary additional sheets may be attached)

Name,
position and
address of
professional
engineer
under whom
served &
contact no.

worksOther engineering

Example: April
87 to January
97

State concisely title of position held, name of employer,

location and description of each work (make statement
brief and concise, designating each work upon which
engaged with or change of position separately: include
some indication of magnitude and complexity of work in
which engaged, your duties and degree of responsibility)

managementPlanning /

Date (month
& year)
relating to
each
appointment

EXPERIENCE AREA (in months)

D1
D2
D3
D4

Site / field

officeDesign /

Total

Signature of any
professional engineers
who has personal
knowledge of applicants
training or experience in
the period mentioned

Page 2 of 3

APP 02
PROFESSIONAL EXPERIENCE IN RESPONSIBLE CHARGE OF SIGNIFICANT ENGINEERING WORK
E
D5
research / teaching Masters / post
graduates / study /

(if necessary additional sheets may be attached)

Name,
position and
address of
professional
engineer
under whom
served &
contact no.

worksOther engineering

Example: April
87 to January
97

State concisely title of position held, name of employer,

location and description of each work (make statement
brief and concise, designating each work upon which
engaged with or change of position separately: include
some indication of magnitude and complexity of work in
which engaged, your duties and degree of responsibility)

managementPlanning /

Date (month
& year)
relating to
each
appointment

EXPERIENCE AREA (in months)

D1
D2
D3
D4

Site / field

officeDesign /

Total

Signature of any
professional engineers
who has personal
knowledge of applicants
training or experience in
the period mentioned

Total
Months

rev 02b

Page 3 of 3

APP 03

DECLARATION FOR THE APPLICATION AS ASEAN CHARTERED

PROFESSIONAL ENGINEER
I hereby declare that:
I have had

years of practical experience in engineering.

YES

NO

I am a Professional Engineer
I meet the entire requirement as stated in Article 3 of the
ASEAN Mutual Recognition Arrangement (MRA)
No disciplinary action have been taken against me
I am not a bankrupt

Others:

Yours Sincerely,

(signature)

Name:
PE Reg. No.:
Date:
Note: Please tick () in the relevant box.

rev 02a

Page 4 of 3