NON-DISCLOSURE AND ATTESTATION OF NO CONFLICT OF

INTEREST FORM
ON THE JOB TRAINING / KERJA PRAKTEK
With respect to do on the job training/ kerja praktek (OJT/KP), i agree to hold all information revealed
during OJT in strict confidence. I will not reveal or discuss such information with anyone other than
participants in OJT as necessary to evaluate / precentation in campus. I will report to the company
Representative of any approach by any outside party attempting to gain such information. In addition,
i attest that (i) I am aware of the Company’s Conflicts of Interest Guidelines; and (ii) I am not aware of
any conflicts or affilations that would prevent me rom participating in this OJT and (iii) i will
immediately notify the Company Representative of any potential conflict or interest associated with my
involvement with this OJT.

Further, I will not disclose information that i am not appointed to unless specificall authorized in writing
by the Company Representative.

The information to be held in strict confidence includes, but is not limited to :

 Company Documents (AMDAL, PROCEDURS,ETC)

 Pictures/photos of Company’s Activities
 Business terms and conditions and other information (if any)

I am aware that the Company considers all information, but not limited to procedural and
administrative information, stictly confidential and that such information is being provided to me on a
“need t-know” basis due to my involvement in OJT.

During OJT, i will :

 Conduct OJT in compliance adhere to all Safety,Health,Environmental and Security protocols

advised by the Company Representative.
 Avoid unauthorized contacts / discussionns, paricularly social contacts, without the supervision
of the Company Representative.

After OJT, I understand that the information will continue to be confidential and that disclosure of any
information to any persons, including but nt limited to non-company personnel, and any third parties
sho have not signed ths confidentially statement would require management approval.

I understand that breach of the terms and conditions here under may result in displinar action and may
result in lawsult.

___________________________________________________
(Signature)

___________________________________________________ ____________________
Name (Typed or Printed) Date

___________________________________________________ ____________________
Name of Company (if not PEPC)