Canadian Securities Institute Inc. recognizes the importance of protecting your personal information. The information collected will not be shared with anyone other than those selecting the members of the PFP Advisory Council. For further questions, please see our privacy policies at www.csi.ca

10/02/2015

PFP Advisory Council Application Form

Thank you for your interest in being part of the PFP Advisory Council. To ensure we have a good cross-section of PFP’s that best represent the industry and PFP’s new wider scope, please make sure to fill out the form below with as much detail as possible. Deadline for submission is April 1, 2015. All fields are required to be answered.

First Name: ________________________________ Last Name: _____________________________________

Company Name: _____________________________________________________________________________

Work Email Address: __________________________________________________________________________

Home Email Address: __________________________________________________________________________

Cell Phone: __________________________________________________________________________________

Work Phone: ________________________________________________________________________________

Company Address

Street Address: _______________________________________________________________________________

Apartment/Suite #:____________________________________________________________________________

City: __________________________ Province: ________________________ Postal Code: __________________

Home Address

Street Address: _______________________________________________________________________________

Apartment/Suite #:____________________________________________________________________________

City: __________________________ Province: ________________________ Postal Code: __________________

What sector do you work in? (Please check one)

Securities (retail) Securities (institutional) Banking Insurance

How big is your firm in Canada? (Please check one)

0 - 100 employees 101 - 500 employees 500 + employees

Canadian Securities Institute Inc. recognizes the importance of protecting your personal information. The information collected will not be shared with anyone other than those selecting the members of the PFP Advisory Council. For further questions, please see our privacy policies at www.csi.ca

10/02/2015

What is your main interest in being a member of the PFP Advisory Council? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What do you feel will make you a strong member of the Council? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What designations do you currently hold? (List all) ___________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please attach your resume or a detailed bio to this application (include LinkedIn profile link if applicable):

___________________________________________________________________________________________

Thank you for your application for the PFP Advisory Council. New Advisory Council members will be notified in May of their involvement and next steps. For questions please email designations@csi.ca.

Mail to: Canadian Securities Institute, Inc. Attn: Credentialing Department 200 Wellington Street West, 15th Floor Toronto, ON M5V 3C7

To submit your application by Fax or Email:

Email: designations@csi.ca Subject line: “PFP Advisory Council application”

Fax: 1-866-866-2660