APP 01

APPLICATION FOR A PROFESSIONAL ENGINEER TO BE

REGISTERED AS ASEAN CHARTERED PROFESSIONAL ENGINEER
(ACPE)

(To be completed by Applicant in BLOCK LETTERS)

Name : Garwono Winardi Surarso

Address : Jalan Mawar No.7-b, RT.01, RW.03, Komplek PU
Padang Terubuk, Senapelan, Pekanbaru, Riau
Tel. No.: 6276135002 Fax No.: 62811753550
Email : garwono_winardi@yahoo.co.id
Identity Card No.: 14.71.05.1006.i.29722.03 Date of Birth: December 01st,1949

Graduate Engineer Registration No.: 881615 Date of Registrations: November 24th,

1990

Professional Engineer Registration No.: 027560 Date of Registrations: Januari 31st,2007

Branch of Engineering : Civil

Academic Qualifications : Master of Engineer in Water Resources Development

I have had 15 (fifteen) years of practical experience in engineering and have complied with
Article 3 of ASEAN Mutual Recognition Arrangement (MRA)

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

for the amount of Rp. … … … … … … being the fee.

Date of previous application: NIL

(Write NIL if not applicable)

Date: Februay 3rd,2009 (Garwono Winardi Surarso)

*delete whichever is not applicable
 APP 02(alternative)

PORTOFOLIO FOR THE APPLICATION AS ASEAN CHARTERED PROFESSIONAL ENGINEER

Name: Garwono Winardi Surarso
Identity Card No.: 14.71.05.1006.i.29722.03
PROFESSIONAL EXPERIENCE
(in responsible charge of significant engineering work refer appendix D of MRA)
A B C E
STATEMENT OF TRAINING & EXPERIENCE EXPERIENCE AREA
(since registration as graduate engineer) (in months)

Total
D1 D2 D3 D4 D5 Signature of any
professional

graduates / study /
engineers who has

research / teaching Masters / post

Date (month State concisely title of position held, name of employer, personal
Name,
& year)

worksOther engineering
knowledge of

managementPlanning /
location and description of each work (make statement position and
relating to brief and concise, designating each work upon which applicants training
address of

Design / office
each or experience in the

Site / field
engaged with or change of position separately: include professional
appointment some indication of magnitude and complexity of work in period mentioned
engineer
which engaged, your duties and degree of responsibility) under whom
Example: April served &
87 to January
(if necessary additional sheets may be attached) contact no.
97

Water Resources Development Division, Public works of

the Riau Province. Construction supervisor of Irrigation
infrastructures i.e. construction of weir, irrigation canal;
1984-1995 88 30 30 18 10
construction supervisor of river improvement works i.e.
construction pumping station, revetment of river bank,
river improvement, drainage canal
 APP 02(alternative)
Planning and Programming Division, Public works of the
Riau Province. Project manager of : 1).Spatial Planning
for infrastructure of Tourism Development Rupat island;
2).Master plan for urban drainage infrastructure of
1996-2005 Pekanbaru city; Survey and inventory of irrigation & 80 16 32 16 16
swap infrastructures 3). Supervision of construction of
water resources infrastructure i.e. swampy rehabilitation
works, small reservoir development ( raw water),
drainage works.
Directorate Jenderal of Water Resources Development,
Irrigation Project of the Riau Province, Inventory of data
base and analyse of water resources management of
Kampar River Basin; Public Works of Riau Province,
2005-2008 18 6 6 6
Team Leader of Supervision of Small reservoir (raw
water); Health and Family Planning of Natuna District,
Team Leader of Construction management and
supervision of Hospital construction
Total
186 52 68 32 26
Months
 APP 03

DECLARATION FOR THE APPLICATION AS ASEAN CHARTERED

PROFESSIONAL ENGINEER

I hereby declare that:

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,

Garwono Winardi Surarso

Name: Garwono Winardi Surarso

Identity Card No.: 14.71.05.1006.i.29722.03

PE Reg. No.: 027560

Date: Januari 31,2007

Note: Please tick (√) in the relevant box.