APPLICATION

FOR EMPLOYMENT

Position applied for : Actuarial Internship

Date : May, 24th 2017 August, 19th 2017

Please Read These Instruction Carefully

This form is to be fully completed.

Do not leave any item blank. If it is not applicable, please indicate N.A.

For those items accompanied by an asterisk (*), please circle the appropriate item.

Personal Particulars
Full name : Muhammad Al Kahfi

Gender : Male

Address : Kidang Pananjung 114/154C, RT 1, RW 10, Bandung

Telephone :-

Mobile phone : 083180539646

Email : muhammad.kahfi@students.itb.ac.id or

muhammadalkahfi96@gmail.com

Office number :-

Birth place & date : Padang Panjang, July, 27th 1996

ID card number : 1374022707960021

Nationality : Indonesia

Religion : Islam

Marital status : Single

Hobbies : Reading
Family
Parents family

Applicant is the 1st of 3 children in the family.

Relationshi Name Gender* Age Occupation, Name of

p Employer/School
Father Frirozano Male 51 Merchant
Mother Imra Dewi Female 43 Housewife
1st Child Muhammad Al Kahfi Male 20 Institut Teknologi Bandung
2nd Child Muhammad Abdi Rahman Male 17 SMAN 3 Padang Panjang
3rd Child Annisa Rahmah Female 15 SMAN 3 Padang Panjang

Applicants family

Relationshi Name Gender* Birth Occupation, Name of

p date Employer/School
Spouse Male/Fema
le
1st Child Male/Fema
le
2nd Child Male/Fema
le
3rd Child Male/Fema
le

Qualification, skill, and competency

Education

Form To Instituion Major GPA

Bachelor of Science 2014 - Present Institut Teknologi 3,94
(B.Sc) Bandung

Courses/Seminars

Form To Instituion Major GPA

Training of Investment 2016 - 2016 Finanmos, ITB -
Management
Society of Actuaries of 2016 - 2017 PAI A10 : 93.3
Indonesia Profession A20 : 93.3
Test A30 : 90
A50 : 93.3

Chubb Marine Cargo Claim Form. Singapore. Published 04/2016.

2016 Chubb. Coverages underwritten by one or more subsidiary companies. Not all coverages available in all jurisdictions. Chubb and its respective
logos, and Chubb. Insured.SM are registered trademarks. 2
 A60 : 80

Others

Awards/Scholarship Skills Software Competency Language

- 1st Prize on - - MS Office 2010 - Indonesia
International (Ms. Excel, Ms. - English
Mathematics Word, Ms. Access,
Competition, Ms. Power Point)
Bulgaria - Matlab, Maple,
- 3rd place on SPSS, R Studio,
Calculus World SAS
Cup (CWC), - C++, Pascal
Taiwan
- Absolute Winner
and Gold Medal of
ONMIPA on
Mathematics
- 1st place on OSN
Pertamina, Jawa
Barat regional
- 1st place on MAG-
DAY (ITB),
Calculus Cup
(UNJ)

Extracurricular activities

State institution, level of participant, office held, etc.

Chubb Marine Cargo Claim Form. Singapore. Published 04/2016.

2016 Chubb. Coverages underwritten by one or more subsidiary companies. Not all coverages available in all jurisdictions. Chubb and its respective
logos, and Chubb. Insured.SM are registered trademarks. 3
Chairman of Mathematical Challenge Festival (MCF) Formatur, Mathematics ITB

Employment

Present employment
Name of
company
Nature of Duties and responsibilities:
business
Time period
Job title
Reason of
leaving

Please draw organization chart showing your position in your present job

Previous employment
Name of
company
Nature of Duties and responsibilities:
business
Time period
Job title
Reason of
leaving

Chubb Marine Cargo Claim Form. Singapore. Published 04/2016.

2016 Chubb. Coverages underwritten by one or more subsidiary companies. Not all coverages available in all jurisdictions. Chubb and its respective
logos, and Chubb. Insured.SM are registered trademarks. 4
Previous employment
Name of
company
Nature of Duties and responsibilities:
business
Time period
Job title
Reason of
leaving

Earliest date available if offered employment

Do you have any objections to us obtaining reference from previous employers? Yes/No

Referees (from your professional relationship)

Referees
Name Relationship
Job title Name of
company
Contact number Period known

Referees
Name Relationship
Job title Name of
company
Contact number Period known

Referees
Name Relationship
Job title Name of
company
Contact number Period known

Others information
How do you see yourself in next three years? Become a junior actuary in multinational company

Describe your strength : Hardworker, discipline, good in manage time, fast learner, high-motivation

Describe your weakness : Panic

Additional information
Do you possess any driving license? No A/C/Others*
Have you ever been charged, convicted in a court of law in any No
country?

Chubb Marine Cargo Claim Form. Singapore. Published 04/2016.

2016 Chubb. Coverages underwritten by one or more subsidiary companies. Not all coverages available in all jurisdictions. Chubb and its respective
logos, and Chubb. Insured.SM are registered trademarks. 5
Have you been dismissed, discharged or suspended from No
employment?
Do you have any physical/ mental disability? No
Have you suffered or are you suffering from any illness or No
disease or been hospitalized?
Have you ever applied for a job in ACE before? No
No
Do you have any relatives/ friends working in this company as
Employee or Agents?
If yes, please give names and relationship.
How did you know about this vacancy? Please state the source. Yes Friends
Any others supporting information for your application? No

Declaration
I declare that the information given above is complete, true, and accurate. Any false particulars or suppression of
material facts will render me liable to disqualification and if appointed, to dismissal without notice from company.

Applicants signature,

Muhammad Al Kahfi

Chubb Marine Cargo Claim Form. Singapore. Published 04/2016.

2016 Chubb. Coverages underwritten by one or more subsidiary companies. Not all coverages available in all jurisdictions. Chubb and its respective
logos, and Chubb. Insured.SM are registered trademarks. 6