KPMG ASEAN SCHOLARSHIP APPLICATION

* This application is open to Indonesian citizens only

* Kindly fill ALL mandatory fields marked with "*"

A. PERSONAL DETAILS

Full Name* Eva Khofifah

ID Number 6371044101000024

Age* 18

Gender* Female

Pemanent Mailing Address* Jl. HKSN Komplek AMD Permai Blok B.5 No. 130 RT
21 RW 02
North Alalak village
North Banjarmasin district
Banjarmasin City

Home Phone No.* 087716208408

Mobile Phone No.* 087716208408

Email Address* evakhofifah110@gmail.com

B. EDUCATION

1. SENIOR HIGH SCHOOL / EQUIVALENT

Name of School* SMK NEGERI 1 BANJARMASIN

Total UN Score* 294,2

English UN Score* 78

2. UNIVERSITY / EQUIVALENT

Name of School/College* UNIVERSITAS LAMBUNG MANGKURAT

Year Started* 2017

Major* ACCOUNTING

GPA / Grade* 3,94

© 2017 Siddharta Widjaja & Rekan – Registered Public Accountants, an Indonesian partnership and a member firm of the KPMG network of independent
member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.
The KPMG name and logo are registered trademarks or trademarks of KPMG International.
C. CO-CURRICULAR ACTIVITIES

1. ORGANIZATION /CLUB /SOCIETY EXPERIENCES

Name of Institution Year From Year To Position Responsibilities

ENGLISH DEBATE CLUB 2015 2017 MEMBER Improve

Improve Debate
Debate Skill
Skill and
and Join
Join competition
competition

ACCOUNTING CLUB 2015 2017 MEMBER Master

Master in
in financial
financial statement
statement making
making

MATH CLUB 2015 2017 MEMBER Running a work program and learning math

Korean Study Center 2017 Now Student Able to Speak Korean and Writing

2. SPORTS / ARTS / MUSIC

Name of Institution Year From Year To Activity Presenting Level

3. OTHER QUALIFICATIONS / AWARDS

Name of Award Year Given Name of Institution

1st on English Debate Competiton 2018 Economic and Business Faculty Lambung Mangkurat University

1st on English Debate Competiton 2016 Head of Education Department of Banjarmasin City

1st on English Debate Contest 2015 Antasari State Institute For Islami Studies Banjarmasin

2nd on Individual Accounting Competition 2016 Student Association of Economics & Business Faculty ULM

2nd on Economic Debate Competition 2016 Student Association of Management STIE Indonesia

D. INTERNSHIP AND PART TIME EXPERIENCES

Name of Company From To Salary Position Responsibilities

BANK KALSEL KANTOR PUSAT 28/12/15 31/03/16 Rp 600.000,- Human Resources Department Handle incoming and outgoing mail
PT. MARITIM BARITO PERKASA 01/07/16 30/9/16 Rp 400.000,- Human Resources Department Handle incoming and outgoing mail

E. FAMILY BACKGROUND*

Name Relationship Occupation Employer

Syamsiah Mother Housewife

Maria Ulfah Sister PDAM Employees PDAM BANDARMASIH
Fitriani Sister Teacher
Syarifah Mellyannur Sister PLN Employees PT. PLN PERSERO

© 2017 Siddharta Widjaja & Rekan – Registered Public Accountants, an Indonesian partnership and a member firm of the KPMG network of independent
member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.
The KPMG name and logo are registered trademarks or trademarks of KPMG International.
F. OTHER INFORMATION*
1. Have you ever had or are you suffering from any physical impairment, Yes No
disease or mental illness? e.g stammering, hypertension, diabetes, asthmetics

If yes, please give details

Yes No
2. Have you ever been convicted for a criminal offence in a Court of Law in any country?

If yes, please give details

Yes No
3. Have you ever been convicted for bankruptcy?

If yes, please give details

4. How did you hear about this scholarship? University Information Center

If other, please specify:

By submitting the details in the KPMG ASEAN Scholarship application form with KPMG, you undertake to give consent for use of your personal data by KPMG
and its related entities (hereinafter “KPMG”) for the processing of scholarship application including but not limited to verification of information provided in the
application form, conducting background checks in relation to criminal records & credit reporting, conducting reference checks, obtaining health records,
academic certificates & examination transcripts, copy of identity card & photo, etc. The processing of your personal data shall include but not limited to
collection, recording, storage, clarification (updating, modification), extraction, use, transfer (distribution, access), deletion and destruction. KPMG shall be
entitled to process your personal data by entering them into electronic databases, including them in lists (registers) and other reporting forms. Such personal
data shall be stored in KPMG’s electronic databases up to two (2) years after the date of application for the purpose of short-listing of the KPMG ASEAN
Scholarship and streamlining future applications from you before KPMG or its appointed 3rd party service provider who shall act on its behalf proceeds with the
destruction of such data. The consent for use of personal data shall be valid at all times and it may be withdrawn by you by sending a written request to the
People, Performance & Culture Department via careers@kpmg.co.id.

Application Date 13 April 2018 I Agree ✔

The information contained herein is of a general nature and is not intended to address the circumstances of any particular individual or entity. Although we
endeavor to provide accurate and timely information, there can be no guarantee that such information is accurate as of the date it is received or that it will
continue to be accurate in the future. No one should act on such information without appropriate professional advice after a thorough examination of the
particular situation.

© 2017 Siddharta Widjaja & Rekan – Registered Public Accountants, an Indonesian partnership and a member firm of the KPMG network of independent
member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.
The KPMG name and logo are registered trademarks or trademarks of KPMG International.