Form 5434 - Application For Enrollment - Joint Board For The Enrollment Of Actuaries - 2004 Page 3

Download a blank fillable Form 5434 - Application For Enrollment - Joint Board For The Enrollment Of Actuaries - 2004 in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 5434 - Application For Enrollment - Joint Board For The Enrollment Of Actuaries - 2004 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Employment Record-Schedule A (Cont.)

Continue to account for the entire period of your employment since your completion of full time studies and within the last 10 years.

NUMBER each continuation sheet, working backward, in the space marked 'BLOCK.'

1. Dates of Employment (Month, Year)

2. Exact Title of Position

3. Kind of Business or Organization

From

4. Final Annual Salary or Earnings

5. Avg. Hrs. 6. Location of Office

7. Name and title of individual to whom you

per Week

reported and who can verify and evaluate

City:

Over $25,000

your experience.

State:

Other (specify) $

8. Name of Employer (Firm, Organization, etc.) and Full Mailing Address

9. Area Code and Telephone

Number (If Known)

In your own words, describe IN DETAIL your actual duties and responsibilities in the above employment. When more than one type of work

is included, estimate the proportion of the total period devoted to each type.

(a) How many months of this employment constitute "responsible actuarial experience" as defined in section 901.1(c) of the regulations?

months

(b) How many months of ''responsible pension actuarial experience'' as defined in section 901.1(e) of the regulations are included in (a) above?

months

(c) Did the experience in (b) above involve performance or supervision of actuarial valuations for defined benefit pension plans (other than valuation

of contractual liabilities of an insurance company)?

Yes

If yes, estimate how many such plans.

If yes, did you participate in the determination that the methods and assumptions adopted and the procedures followed were appropriate?

Yes

5434

Department of the Treasury - Internal Revenue Service

Form

(Rev. 10-2004)