SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
MP WEST CANADA S.A.S.

(Last) (First) (Middle)
51, RUE D'ANJOU

(Street)
PARIS I0 75008

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
02/01/2017
3. Issuer Name and Ticker or Trading Symbol
DEEP WELL OIL & GAS INC [ DWOG ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 45,111,778 D(1)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
1. Name and Address of Reporting Person*
MP WEST CANADA S.A.S.

(Last) (First) (Middle)
51, RUE D'ANJOU

(Street)
PARIS I0 75008

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
ETABLISSEMENTS MAUREL & PROM S.A.

(Last) (First) (Middle)
51, RUE D'ANJOU

(Street)
PARIS I0 75008

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
PT Pertamina Internasional Eksplorasi dan Produksi

(Last) (First) (Middle)
PATRA JASA OFFICE TOWER 3A FL.
JALAN GATOT SUBROTO KAV. 32-34

(Street)
SOUTH JAKARTA K8 12950

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
PT Pertamina (Persero)

(Last) (First) (Middle)
JALAN MEDAN MERDEKA TIMUR, NO. 1A

(Street)
JAKARTA K8 10110

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
Explanation of Responses:
1. The shares of the Issuer's common stock reported herein are held directly by MP West Canada S.A.S. ("MP West Canada"). Etablissements Maurel & Prom S.A. ("M&P") is the direct beneficial owner of 100% of the share capital of MP West Canada. PT Pertamina Internasional Eksplorasi dan Produksi ("Pertamina Internasional") is the direct beneficial owner of a majority of the share capital of M&P. PT Pertamina (Persero) is the direct beneficial owner of substantially all of the share capital of Pertamina Internasional. Accordingly, each of PT Pertamina (Persero), Pertamina Internasional and M&P may be deemed to share with MP West Canada the power to (i) vote or direct the vote of and (ii) dispose or direct the disposition of the shares held directly by MP West Canada.
Remarks:
MP WEST CANADA S.A.S. By: /s/ Alain Torre Name: Alain Torre Title: President 02/28/2017
ETABLISSEMENTS MAUREL & PROM By: /s/ Michel Hochard Name: Michel Hochard Title: Chief Executive Officer 02/28/2017
PT PERTAMINA INTERNASIONAL EKSPLORASI DAN PRODUKSI By: /s/ Slamet Riadhy Name: : Slamet Riadhy Title: President Director 02/28/2017
PT PERTAMINA (PERSERO) By: /s/ Syamsu Alam Name: Syamsu Alam Title: Upstream Director 02/28/2017
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.