Nomor : ${nomor_naskah} ${tanggal_naskah}

Hal : ${hal}

Yang terhormat :

……………
di-
TEMPAT

Dalam Rangka mewujudkan transformasi SDM kesehatan dalam upaya

meningkatkan kerjasama pendidikan dengan institusi di luar negeri, bersama surat ini
kami ingin melaporkan rencana inisiasi kegiatan kerjasama antara Poltekkes
Pontianak dan Universitas Malaysia Sarawak (UNIMAS). Sebagai bahan
pertimbangan, berikut kami lampirkan template MoU kerjasama yang dikirim pihak
UNIMAS untuk dapat digunakan, kami mohon masukan dan arahan terkait tindak
lanjut dan mekanisme kerjasama selanjutnya.
Atas perhatiannya kami ucapkan terima kasih

Direktur,
${ttd_pengirim}
${nama_pengirim}

1
 Lampiran 1
Tanggal : ${tanggal_naskah}
Nomor : ${nomor_naskah}

This Memorandum of Understanding (hereinafter referred to as “MoU”) is

made on......................................(please leave this blank);

BETWEEN

UNIVERSITI MALAYSIA SARAWAK (hereinafter referred to as “UNIMAS”), an

institution of higher learning established under the Universities and
University Colleges Act 1971 whose address is at UNIVERSITI MALAYSIA
SARAWAK, 94300 KOTA SAMARAHAN,
SARAWAK, MALAYSIA and shall include its legal representatives
and permitted assigns, of the first part;;

AND

Politeknik Kesehatan Kementerian Kesehatan Pontianak (hereinafter

referred to as "POLKESPON"), is an established research institute set up by
the Indonesian government whose address is at Jalan 28 Oktober Siantan
Hulu Pontianak, WEST KALIMANTAN , INDONESIA including its legal
representative and permitted transfer;

UNIMAS and POLKESPON hereinafter referred to singularly as “the Party”

and collectively as “Parties”

2
WHEREAS: -
A. UNIMAS is an established University which strives to enhance and
strengthen its research capabilities and has taken various initiatives to
complement its educational excellence. UNIMAS has entered into
various collaborative arrangements with other parties to enhance
research, consultancy and academia. For the purpose of this MoU,
UNIMAS is represented by Faculty of Medicine and Health Sciences.

B. Poltekkes Pontianak previously known as Institute of POLKESPON, is

an institution which focused on vocational health education.

C. The Parties are desirous of entering into MoU to declare their respective
intentions and to establish a basis of co-operation and collaboration
between the Parties upon the terms as contained herein.

NOW THEREFORE the Parties hereby have reached an understanding

as follows: -

CLAUSE 1
OBJECTIVE
The Parties, subject to the terms of this MoU and the laws, rules,
regulations and national policies from time to time in force in each Party’s
country, will endeavor to strengthen, promote and develop academic staff
and researchers to exchange research collaboration and co-operation
between the Parties on the basis of equality and mutual benefits.

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 CLAUSE 2
GENERAL AREAS OF CO-OPERATION
2.1 Engagements shall be carried out, between UNIMAS and POLKESPON
through such activities or programmes which include but not limited
to:
a. Exchange program for students, lecturers, researchers to conduct
joint research, teaching and support continuing education;
b. Collaborate in organizing joint research, traineeships, inspection
and communication programme for students and graduates;
c. Co-operate in international, seminars, conferences, and local
organization survey;
d. Curriculum development; Credit Transfer for students in Short
Course concept; International Speakers Exchange; Lecturers
Internship; Master and Doctoral Program for Lectures

2.2 The terms of such mutual assistance and the resources required for
each programme and activity that is implemented under the terms of
this MoU shall be mutually discussed and agreed upon in writing by both
Parties prior to the initiation of the particular programme or activity.

2.3 The implementation of specific proposals shall be negotiated on a

case-by-case basis and be dependent upon the availability of
resources.

CLAUSE 3
SCHEDULES
All schedules, if any, referred to herein shall form part of this MoU
and shall be taken, read, construed as an essential part of this MoU.

4
 CLAUSE 4
DURATION OF THE MoU
4.1 This MoU will come into effect on the date of last signature and will
remain in effect for a period of five (5) years or until terminated by either
Party with six (6) months written notice.

4.2 This MoU may be extended for a further period as agreed to in writing
by the Parties by issuance to the other Party of a written notice signifying
its intention to renew the MoU not less than six
(6) months prior to the Expiry Date.

CLAUSE 5
FINANCIAL ARRANGEMENTS
5.1 This MoU shall not give rise to any financial obligation by one Party to
the other.

5.2 Each Party shall bear its own cost and expenses in the implementation
of this MoU.

CLAUSE 6
CONFIDENTIALITY
6.1 The Parties undertake to observe confidentiality towards other Parties
not concerned or connected with this MoU. Any confidential information
disclosed to either Party pursuant to this MoU shall not without prior
written consent of the other Party be disclosed to a third party or be
used for any purpose not expressly permitted in writing by the other
Party.

6.2 The confidentiality provisions apply to all confidential information

exchanged in preliminary discussion and during negotiations relating to
matters within the scope of this MoU. Both Parties agree

5
 to develop procedures for the disclosure and protection of their
confidential information.

CLAUSE 7
SETTLEMENT OF DISPUTES
Any difference or dispute between the Parties concerning the
interpretation and/or implementation and/or application of any of the
provisions of this MoU shall be settled amicably through mutual
consultation and or/negotiations between the Parties through
diplomatic channels, without references to any third party or
international tribunal.

CLAUSE 8
NON - CONTRACTUAL NATURE OF RELATIONSHIP
8.1 Save for Clause 4, the Parties agree that this MoU represents the
mutual understanding of the Parties and is not intended nor shall be
deemed to be a contract and shall not give rise to any rights and
liabilities under a contract.

8.2 Nothing contained herein shall be construed so as to constitute a joint

venture partnership or formal business organisation of any kind
between the Parties or so to constitute either Party as the agent of the
other.

8.3 The Parties acknowledge that this MoU does not in any way give rise
to any right or permission to use or to be associated with each Party’s
intellectual property.

6
 CLAUSE 7
NOTICES
Every notice, request or any other communication required or
permitted to be given pursuant to this MoU shall be in writing and
delivered personally or sent by registered or certified post or via air
mail or via courier or facsimile or by e-mail (which shall be
acknowledged by the other Party) to the Parties at their address and
facsimile number as stated below:

To : UNIVERSITI MALAYSIA SARAWAK

Addres : Faculty of Medicine and Health Sciences
s Universiti Malaysia Sarawak, 94300 Kota
Samarahan, Malaysia
: Prof Dr Asri Bin Said
Attn to Dean, Faculty of Medicine and Health Sciences
: +082 – 58 7002
Tel : N/A
no. : sasri@unimas.my
Fax
no. E- : POLITEKNIK KESEHATAN PONTIANAK
mail : Jl. 28 Oktober – Siantan Hulu Pontianak

To : Dr. Kelana Kusuma Dharma, S.Kp, M.Kes

Addres Director, Politeknik Kesehatan
s Pontianak
: +62561-882632
Attn to : N/A
: kelana_dharma@yahoo.com

7
 CLAUSE 8
REVISION, VARIATION AND AMENDMENT
10.1 Either Party may request in writing a revision, variation or amendment
of this MoU.
10.2 Any such revision, variation or amendment agreed to by the Parties
shall be in writing and shall form part of this MoU.
10.3 Such revision, variation or amendment shall come into force on such
date as may be determined by the Parties.
10.4 Any revision, variation or amendment shall not prejudice the
implementation of any project, activity or co-operation arising from or
based on this MoU before or up to the date of such revision, variation or
amendment.

CLAUSE 11
SUPERVENING EVENTS
11.1 Each Party reserves the right for reasons of national security, national
interests, public order or public health to suspend temporarily, either in
whole or in part, the implementation of this MoU which suspension shall
take effect immediately after notification has been given to the other
Party.

11.2 Notwithstanding sub-clause 8.1, should any other event occur which
hinders or restricts the implementation of this MoU, the Parties shall
use their best endeavour to agree upon such action, as may be
necessary and equitable, to remove the cause of such event.

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 CLAUSE 12
EFFECT OF MOU
This MoU serves only as a record of the parties’ intentions and does not
constitute or create, and is not intended to constitute or create,
obligations under domestic or international law and will not give rise to
any legal process and will not be deemed to constitute or create any
legally binding or enforceable obligations, express or implied.

CLAUSE 13
PROTECTION OF INTELLECTUAL PROPERTY RIGHTS

13.1 The protection of intellectual property rights shall be enforced in

conformity with the respective national laws, rules and regulations of
Parties and with other international agreements signed by both
Parties.
13.2 The use of the name, logo and/or official emblem of any of the Parties
on any publication, document and/or paper is prohibited without the
prior written approval of either Party.
13.3 Notwithstanding anything in paragraph 1 above, the intellectual
property rights in respect of any technological development, and any
products or services development, carried out-
(i) jointly by the Parties or research results obtained through the
joint activity effort of the Parties, shall be jointly owned by the
Parties in accordance with the terms to be mutually agreed
upon; and
(ii) solely and separately by the Party or the research results
obtained through the sole and separate effort of the Party,
shall be solely owned by the Party concerned.

***** (End of MoU) *****

-----------This empty space is intentionally left blank-----------

9
respective organisations, sign this MoU on the date as above written.

Signed by
Prof. Datuk Dr. Mohamad Kadim Suaidi ]
Vice Chancellor ]

For and on behalf of ]

Universiti Malaysia Sarawak ]

In the presence of ]
Prof Dr. Ahmad Hata Rasit ]

Deputy Vice Chancellor ]

(Academic and International) ]
Universiti Malaysia Sarawak ]

Signed by
Dr. Kelana Kusuma Dharma, S.Kp, M.Kes ]
Director ]
For and on behalf of ]

Politeknik Kesehatan Pontianak ]

In the presence of ]
Hajimi, SKM, M.Kes ]
Vice Director
(Academic Affairs) ]
For and on behalf of ]
Politeknik Kesehatan Pontianak ]