Z-test-Designation Application Designated Financial Services Advisor (DFSA™)

PERSONAL INFORMATION

Student ID *

Identity Verification Birthdate *

Please indicate your name (including any initials used) exactly as it appears on your government-issued photo ID. *

First

Middle

Last

Gender *

Female
Male
Non-Binary

Language preference for communication *

English
French

Preferred Email Address *

Alternate Email Address

Phone number to reach you *

Personal
Business
Both

Address *

Home Address
Business Address
Both

Home Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Business Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

To which address would you like us to send your Certificate *

Business Address
Home Address

Which address would you like listed in our DFSA™ directory? *

Business Address
Home Address
I do not wish to have my address listed

DFSA™ DECLARATION AND SIGNATURE OF APPLICANT

Declare *

I declare that I have completed this application as completely as I am able and I hereby apply for the DFSA™ Designation.

DFSA™ REQUIREMENTS *

I declare that I have completed the Investment Funds in Canada or the Canadian Securities Course or the Canadian Investment Funds Course,

Financial Services Regulatory Authority (FSRA) Title Protection Act

CSI has been approved as a Credentialling Body and the DFSA™ has been approved as a Financial Advisor credential.
DFSA™ designation holders who fall under the FSRA Title Protection Act:

Reside in Ontario, or
Reside outside of Ontario but have clients within Ontario, or
Hold out to consumers in Ontario that they have the DFSA™

I fall under the FSRA Title Protection Act *

I fall under the Financial Professionals Title Protection Act, 2019 or I adopt, accept and agree to be bound by all of its requirements.

I fall under the FSRA Title Protection Act agreement *

I agree to disclose to clients that I hold the DFSA™ designation in a clear and timely manner

I fall under the FSRA Title Protection Act understand *

I understand that if CSI terminates my license to use the DFSA™ Trademark (see Certification Mark License Agreement just below) I will be advised to discontinue using the Financial Advisor title as use of this title is regulated under the Financial Services Regulatory Authority of Ontario. Under this regulation, you must hold an accredited financial advisor designation and be in good standing to use the title or similar named title.

DFSA™ Post Requirements

DFSA™ Post Requirements *

If I have not already completed the full DFSA™ post educational path, I am aware that I must meet this education requirement within 2 years (24 months) of being granted the DFSA™ designation. If I do not complete the approved educational path within that time period, the DFSA™ designation will be revoked. For more information see: https://www.csi.ca/en/credentials/dfsa/

Fit and Proper Requirement

Have you ever been accused of professional misconduct, disciplined or reprimanded by, or had a licence suspended or revoked by, an employer, professional association, regulatory authority (i.e. securities commission, IIROC, MFDA, Insurance Regulator, or consumer protection legislation?

Are you currently bankrupt or have you at any time in the past 5 years been adjudged bankrupt?

Have you ever been convicted of a criminal offence* in any jurisdiction for which a record suspension or a pardon has not been granted?

Have you ever been convicted of an offense under any financial services or consumer protection legislation in any jurisdiction (i.e., laws regulating the sale of securities, insurance, real estate, mortgages, etc.)?

If you have answered “Yes” to any of the questions above, please attach all relevant paperwork, including details of any punishment or disciplinary action taken. Any information you provide will collected, stored and used in accordance with applicable law and our privacy policy and will be shared with the Designation Ethics Committee to determine your suitability for the designation.

Continuing Education Requirements

Continuing Education Requirements *

I understand and agree to comply with the DFSA™ Continuing Education (CE) requirements as described on the website. This includes maintaining records of completion and agreement that you may be audited for compliance. Click to view more details regarding Continuing Education Requirements.

You are not required to submit your CE documentation on an annual basis, however a percentage of DFSA holders will be audited for compliance annually.

Code of Ethics

As a DFSA™ designation holder and throughout my annual designation period, I agree that: *

I will continue to uphold the DFSA™ Code of Ethics and abide by the Ethical Misconduct Process.

Certification Mark License Agreement

Certification Mark License Agreement *

I understand that CSI grants me license to use the DFSA™ Certification Mark for a one-year term and that if I do not renew my DFSA™ designation, CSI will terminate my license to use the DFSATM Certification Mark. I also agree to notify CSI, without delay, of any circumstances that may affect my ability to continue to fulfill the certification requirements. Click to view the DFSA™ Certification Mark License Agreement.

Signature *

Clear Signature

EMPLOYMENT VERIFICATION

Name of Authorized Representative *

Email of Authorized Representative *