License Renewal for Designated Financial Services Advisor (DFSA™) Please enable JavaScript in your browser to complete this form.Please select a DFSA™ license renewal application: *—- Select Application —-DFSA™ Designated Financial Services AdvisorDFSA™ Designated Financial Services Advisor – including late feeDFSA™ Designated Financial Services Advisor – including late and reinstatement feesPERSONAL INFORMATIONStudent ID *Please indicate your name (including any initials used) exactly as it appears on your government-issued photo ID. *FirstMiddleLastIdentity Verification Birthdate 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FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryHome Address *Address Line 1Address Line 2CityState / Province / RegionPostal Code— Select country —AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryDFSA™ DECLARATION AND SIGNATURE OF APPLICANTDeclare *I declare that I have completed this application as completely as I am able and I hereby apply for the DFSA™ Designation.Continuing Education RequirementsContinuing 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.You are required to submit your documentation confirming completion of your CE requirements for all the cycles of non-renewal.Upload Documents * Click or drag files to this area to upload. You can upload up to 20 files. Fit and Proper RequirementHave 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, CIRO, Insurance Regulator, or consumer protection legislation)?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, CIRO, Insurance Regulator, or consumer protection legislation?YesNoAre you currently bankrupt or have you at any time in the past 5 years been adjudged bankrupt? Are you currently bankrupt or have you at any time in the past 5 years been adjudged bankrupt? YesNoHave 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 a criminal offence* in any jurisdiction for which a record suspension or a pardon has not been granted?YesNoHave 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.)?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.)?YesNoIf 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 be 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. Please attach all relevant paperwork * Click or drag files to this area to upload. You can upload up to 20 files. Code of EthicsAs 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 AgreementCertification 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 DFSA™ 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 Checkboxes *Please check to verify all information you have provided is true and accurate.Submit