KPMGASEANSCHOLARSHIPAPPLICATION

*ThisapplicationisopentoIndonesiacitizenonly
*KindlyfillALLmandatoryfieldsmarkwith"*"

A.PERSONALDETAILS
FullName
IDNumber

(KTPno.)

Age
Gender

MaleFemale

PemanentMailingAddress

HomePhoneNo

(i.e.:+6221xxxxxxx)

MobilePhoneNo*

(i.e.:+6281xxxxxxx)

EmailAddress*

B.EDUCATION
1.SENIORHIGHSCHOOL/EQUIVALENT*
NameofSchool
TotalUNScore
EnglishUNScore
2.UNIVERSITY/EQUIVALENT*
NameofUniversity
YearStarted
Major
GPA/Grade
C.COCURRICULARACTIVITIES
1.LEADERSHIPPOSITION(PREFECT,CLASSREP,etc
NameofInstitution

YearFrom

YearTo

Responsibilities

YearFrom

YearTo

Responsibilities

YearFrom

YearTo

2.CLUB/SOCIETY
NameofInstitution

3.SPORTS
NameofInstitution

SportActivities

PresentingLevel

4.OTHERQUALIFICATION/AWARD
NameofAward

YearGiven

NameofInstitution

D.INTERNSHIPANDPARTTIMEEXPERIENCES
NameofCompany

From

To

Salary

PostHeld

Responsibilities

D.FAMILYBACKGROUND
Name

IDNumber

Occupation

1.Haveyoubeen,orareyou,sufferingfromanyphysicalimpairment/disease/illness.
E.gstammering,hypertension,diabetes,asthmetics,eyediseaseoransurgeryhistory?

Employer

Yes

No

Yes

No

Yes

No

2.HaveyoubeenconvictedforcriminaloffenceinacourtofLawinanycountry?

3.Haveyoubeenconvictedforbankruptcy?

BysubmittingthedetailsintheKPMGASEANScholarshipapplicationformwithKPMG,youundertaketogiveconsentforuseofyourpersonaldataby
KPMGanditsrelatedentities(hereinafterKPMG)fortheprocessingofscholarshipapplicationincludingbutnotlimitedtoverificationof
informationprovidedintheapplicationform,conductingbackgroundchecksinrelationtocriminalrecords&creditreporting,conductingreference
checks,obtaininghealthrecords,academiccertificates&examinationtranscripts,copyofidentitycard&photo,etc.Theprocessingofyourpersonal
datashallincludebutnotlimitedtocollection,recording,storage,clarification(updating,modification),extraction,use,transfer(distribution,access),
deletionanddestruction.KPMGshallbeentitledtoprocessyourpersonaldatabyenteringthemintoelectronicdatabases,includingtheminlists
(registers)andotherreportingforms.SuchpersonaldatashallbestoredinKPMGselectronicdatabasesuptotwo(2)yearsafterthedateof
applicationforthepurposeofshort
listingoftheKPMGASEANScholarshipandstreamliningfutureapplicationsfromyoubeforeKPMGorits
applicationforthepurposeofshortlistingoftheKPMGASEANScholarshipandstreamliningfutureapplicationsfromyoubeforeKPMGorits
appointed3rdpartyserviceproviderwhoshallactonitsbehalfproceedswiththedestructionofsuchdata.Theconsentforuseofpersonaldatashall
bevalidatalltimesanditmaybewithdrawnbyyoubysendingawrittenrequesttothePeople,Performance&CultureDepartmentvia
careers@kpmg.co.id

IAgree