{"id":1194,"date":"2022-06-22T10:47:00","date_gmt":"2022-06-22T14:47:00","guid":{"rendered":"https:\/\/forms.csi.ca\/?page_id=1194"},"modified":"2022-06-22T10:47:00","modified_gmt":"2022-06-22T14:47:00","slug":"license-renewal-form","status":"publish","type":"page","link":"https:\/\/forms.csi.ca\/?page_id=1194","title":{"rendered":"License Renewal Form"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full wpforms-container-save-resume wpforms-block fields-to-confirmation\" id=\"wpforms-1155\"><form id=\"wpforms-form-1155\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1155\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F1194&#038;wpforms_form_id=1155\" data-token=\"946299705c9565d466cff175aa1f656c\" data-token-time=\"1785834370\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-1155-field_112-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"112\"><label class=\"wpforms-field-label\" for=\"wpforms-1155-field_112\">Please select the Designation License you want to renew: <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-1155-field_112\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][112]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>&#8212;- Select Designation &#8212;-<\/option><option value=\"FCSI\u00ae\"  class=\"choice-1 depth-1\"  >FCSI\u00ae<\/option><option value=\"CIM\u00ae\"  class=\"choice-2 depth-1\"  >CIM\u00ae<\/option><option value=\"CIWM\"  class=\"choice-4 depth-1\"  >CIWM<\/option><option value=\"DFSA\u2122\"  class=\"choice-12 depth-1\"  >DFSA\u2122<\/option><option value=\"PFP\u00ae\"  class=\"choice-5 depth-1\"  >PFP\u00ae<\/option><option value=\"MTI\u00ae\"  class=\"choice-11 depth-1\"  >MTI\u00ae<\/option><\/select><\/div><div id=\"wpforms-1155-field_114-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"114\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1155-field_114\">Please select a FCSI\u00ae license renewal application: <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-1155-field_114\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][114]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>&#8212;- Select Application &#8212;-<\/option><option value=\"FCSI\u00ae Fellow of CSI\"  class=\"choice-1 depth-1\"  >FCSI\u00ae Fellow of CSI<\/option><option value=\"FCSI\u00ae Fellow of CSI - including late fee\"  class=\"choice-2 depth-1\"  >FCSI\u00ae Fellow of CSI &#8211; including late fee<\/option><option value=\"FCSI\u00ae Fellow of CSI - including late and reinstatement fees\"  class=\"choice-4 depth-1\"  >FCSI\u00ae Fellow of CSI &#8211; including late and reinstatement fees<\/option><\/select><\/div><div id=\"wpforms-1155-field_117-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"117\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1155-field_117\">Please select a CIM\u00ae license renewal application: <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-1155-field_117\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][117]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>&#8212;- Select Application &#8212;-<\/option><option value=\"CIM\u00ae Chartered Investment Manager \"  class=\"choice-1 depth-1\"  >CIM\u00ae Chartered Investment Manager<\/option><option value=\"CIM\u00ae Chartered Investment Manager - including late fee\"  class=\"choice-2 depth-1\"  >CIM\u00ae Chartered Investment Manager &#8211; including late fee<\/option><option value=\"CIM\u00ae Chartered Investment Manager - including late and reinstatement fees\"  class=\"choice-4 depth-1\"  >CIM\u00ae Chartered Investment Manager &#8211; including late and reinstatement fees<\/option><\/select><\/div><div id=\"wpforms-1155-field_115-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"115\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1155-field_115\">Please select a CIWM license renewal application: <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-1155-field_115\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][115]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>&#8212;- Select Application &#8212;-<\/option><option value=\"CIWM Certified International Wealth Manager\"  class=\"choice-5 depth-1\"  >CIWM Certified International Wealth Manager<\/option><option value=\"CIWM Certified International Wealth Manager - including late fee\"  class=\"choice-6 depth-1\"  >CIWM Certified International Wealth Manager &#8211; including late fee<\/option><option value=\"CIWM Certified International Wealth Manager - including late and reinstatement fees\"  class=\"choice-7 depth-1\"  >CIWM Certified International Wealth Manager &#8211; including late and reinstatement fees<\/option><\/select><\/div><div id=\"wpforms-1155-field_118-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"118\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1155-field_118\">Please select a PFP\u00ae license renewal application: <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-1155-field_118\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][118]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>&#8212;- Select Application &#8212;-<\/option><option value=\"PFP\u00ae Personal Financial Planner\"  class=\"choice-1 depth-1\"  >PFP\u00ae Personal Financial Planner<\/option><option value=\"PFP\u00ae Personal Financial Planner - including late fee\"  class=\"choice-2 depth-1\"  >PFP\u00ae Personal Financial Planner &#8211; including late fee<\/option><option value=\"PFP\u00ae Personal Financial Planner - including late and reinstatement fees\"  class=\"choice-4 depth-1\"  >PFP\u00ae Personal Financial Planner &#8211; including late and reinstatement fees<\/option><\/select><\/div><div id=\"wpforms-1155-field_116-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"116\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1155-field_116\">Please select a MTI\u00ae license renewal application: <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-1155-field_116\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][116]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>&#8212;- Select Application &#8212;-<\/option><option value=\"MTI\u00ae Estate and Trust Professional\"  class=\"choice-8 depth-1\"  >MTI\u00ae Estate and Trust Professional<\/option><option value=\"MTI\u00ae Estate and Trust Professional - including late fee\"  class=\"choice-9 depth-1\"  >MTI\u00ae Estate and Trust Professional &#8211; including late fee<\/option><option value=\"MTI\u00ae Estate and Trust Professional - including late and reinstatement fees\"  class=\"choice-10 depth-1\"  >MTI\u00ae Estate and Trust Professional &#8211; including late and reinstatement fees<\/option><\/select><\/div><div id=\"wpforms-1155-field_176-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"176\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1155-field_176\">Please select a DFSA\u2122 license renewal application:  <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-1155-field_176\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][176]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>&#8212;- Select Application &#8212;-<\/option><option value=\"DFSA\u2122 Designated Financial Services Advisor\"  class=\"choice-8 depth-1\"  >DFSA\u2122 Designated Financial Services Advisor<\/option><option value=\"DFSA\u2122 Designated Financial Services Advisor - including late fee\"  class=\"choice-9 depth-1\"  >DFSA\u2122 Designated Financial Services Advisor &#8211; including late fee<\/option><option value=\"DFSA\u2122 Designated Financial Services Advisor - including late and reinstatement fees\"  class=\"choice-10 depth-1\"  >DFSA\u2122 Designated Financial Services Advisor &#8211; including late and reinstatement fees<\/option><\/select><\/div><div id=\"wpforms-1155-field_41-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"41\"><h3 id=\"wpforms-1155-field_41\">PERSONAL INFORMATION<\/h3><\/div><div id=\"wpforms-1155-field_1-container\" class=\"wpforms-field wpforms-field-number wpforms-one-half wpforms-first\" data-field-type=\"number\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-1155-field_1\">Student ID <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-1155-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" step=\"any\" required><\/div><div id=\"wpforms-1155-field_32-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-half\" data-field-type=\"date-time\" data-field-id=\"32\"><label class=\"wpforms-field-label\">Identity Verification Birthdate <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-small\"><select name=\"wpforms[fields][32][date][d]\" id=\"wpforms-1155-field_32-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][32][date][m]\" id=\"wpforms-1155-field_32-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][32][date][y]\" id=\"wpforms-1155-field_32-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/div><div id=\"wpforms-1155-field_3-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"3\"><label class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-two-fifths\"><input type=\"text\" id=\"wpforms-1155-field_3\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][3][first]\" required><label for=\"wpforms-1155-field_3\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-fifth\"><input type=\"text\" id=\"wpforms-1155-field_3-middle\" class=\"wpforms-field-name-middle\" name=\"wpforms[fields][3][middle]\" ><label for=\"wpforms-1155-field_3-middle\" class=\"wpforms-field-sublabel after\">Middle<\/label><\/div><div class=\"wpforms-field-row-block wpforms-two-fifths\"><input type=\"text\" id=\"wpforms-1155-field_3-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][3][last]\" required><label for=\"wpforms-1155-field_3-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-1155-field_4-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-half wpforms-first wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"4\"><label class=\"wpforms-field-label\">Gender <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_4\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1155-field_4_1\" name=\"wpforms[fields][4]\" value=\"Female\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_4_1\">Female<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1155-field_4_2\" name=\"wpforms[fields][4]\" value=\"Male\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_4_2\">Male<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1155-field_4_3\" name=\"wpforms[fields][4]\" value=\"Non-Binary\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_4_3\">Non-Binary<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_28-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-half wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"28\"><label class=\"wpforms-field-label\">Language preference for communication <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_28\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1155-field_28_1\" name=\"wpforms[fields][28]\" value=\"English\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_28_1\">English<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1155-field_28_2\" name=\"wpforms[fields][28]\" value=\"French\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_28_2\">French<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_7-container\" class=\"wpforms-field wpforms-field-email wpforms-one-half wpforms-first\" data-field-type=\"email\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-1155-field_7\">Preferred Email Address <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1155-field_7\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][7]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-1155-field_8-container\" class=\"wpforms-field wpforms-field-email wpforms-one-half\" data-field-type=\"email\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-1155-field_8\">Alternate Email Address<\/label><input type=\"email\" id=\"wpforms-1155-field_8\" class=\"wpforms-field-medium\" name=\"wpforms[fields][8]\" spellcheck=\"false\" ><\/div><div id=\"wpforms-1155-field_165-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"165\"><label class=\"wpforms-field-label\">Phone number to reach you <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_165\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1155-field_165_1\" name=\"wpforms[fields][165]\" value=\"Personal\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_165_1\">Personal<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1155-field_165_2\" name=\"wpforms[fields][165]\" value=\"Business\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_165_2\">Business<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1155-field_165_3\" name=\"wpforms[fields][165]\" value=\"Both\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_165_3\">Both<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_21-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"phone\" data-field-id=\"21\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1155-field_21\">Personal Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1155-field_21\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][21]\" aria-label=\"Personal Phone\" required><\/div><div id=\"wpforms-1155-field_10-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"phone\" data-field-id=\"10\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1155-field_10\">Business Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1155-field_10\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][10]\" aria-label=\"Business Phone\" required><\/div><div id=\"wpforms-1155-field_166-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-field wpforms-conditional-hide wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"166\"><label class=\"wpforms-field-label\">Address <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_166\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1155-field_166_1\" name=\"wpforms[fields][166]\" value=\"Home Address\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_166_1\">Home Address<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1155-field_166_2\" name=\"wpforms[fields][166]\" value=\"Business Address\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_166_2\">Business Address<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1155-field_166_3\" name=\"wpforms[fields][166]\" value=\"Both\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_166_3\">Both<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_174-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"174\" style=\"display:none;\"><label class=\"wpforms-field-label\">Address <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_174\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1155-field_174_1\" name=\"wpforms[fields][174]\" value=\"Business Address\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_174_1\">Business Address<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1155-field_174_2\" name=\"wpforms[fields][174]\" value=\"I am currently unemployed; I don&#039;t have a business address\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_174_2\">I am currently unemployed; I don&#8217;t have a business address<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_43-container\" class=\"wpforms-field wpforms-field-number wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"number\" data-field-id=\"43\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1155-field_43\">Business Branch Transit Number (if applicable)<\/label><input type=\"number\" id=\"wpforms-1155-field_43\" class=\"wpforms-field-medium\" name=\"wpforms[fields][43]\" step=\"any\" ><\/div><div id=\"wpforms-1155-field_44-container\" class=\"wpforms-field wpforms-field-number wpforms-one-half wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"number\" data-field-id=\"44\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1155-field_44\">Employee Number<\/label><input type=\"number\" id=\"wpforms-1155-field_44\" class=\"wpforms-field-medium\" name=\"wpforms[fields][44]\" step=\"any\" ><\/div><div id=\"wpforms-1155-field_128-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"128\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1155-field_128\">Employer <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1155-field_128\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][128]\" required><\/div><div id=\"wpforms-1155-field_127-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"127\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1155-field_127\">Job Title<\/label><input type=\"text\" id=\"wpforms-1155-field_127\" class=\"wpforms-field-medium\" name=\"wpforms[fields][127]\" ><\/div><div id=\"wpforms-1155-field_11-container\" class=\"wpforms-field wpforms-field-address wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"address\" data-field-id=\"11\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1155-field_11\">Business Address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-1155-field_11\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][11][address1]\" placeholder=\"Street Address, P.O. box\" required><label for=\"wpforms-1155-field_11\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-1155-field_11-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][11][address2]\" placeholder=\"Apartment, suite, unit, floor, etc.\" ><label for=\"wpforms-1155-field_11-address2\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1155-field_11-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][11][city]\" placeholder=\"City\" required><label for=\"wpforms-1155-field_11-city\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1155-field_11-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][11][state]\" placeholder=\"State \/ Province\" required><label for=\"wpforms-1155-field_11-state\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1155-field_11-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][11][postal]\" placeholder=\"ZIP \/ Postal\" required><label for=\"wpforms-1155-field_11-postal\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Postal Code<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-1155-field_11-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][11][country]\" required><option class=\"placeholder\" value=\"\" selected disabled>&#8212; Select country &#8212;<\/option><option value=\"AF\" >Afghanistan<\/option><option value=\"AL\" >Albania<\/option><option value=\"DZ\" >Algeria<\/option><option value=\"AS\" >American Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua and Barbuda<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\" >Belgium<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia (Plurinational State of)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouvet Island<\/option><option value=\"BR\" >Brazil<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\" >Canada<\/option><option value=\"KY\" >Cayman Islands<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocos (Keeling) Islands<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoros<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Democratic Republic of the)<\/option><option value=\"CK\" >Cook Islands<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"CZ\" >Czech Republic<\/option><option value=\"CI\" >C\u00f4te d&#039;Ivoire<\/option><option value=\"DK\" >Denmark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypt<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estonia<\/option><option value=\"SZ\" >Eswatini (Kingdom of)<\/option><option value=\"ET\" >Ethiopia<\/option><option value=\"FK\" >Falkland Islands (Malvinas)<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >France<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"DE\" >Germany<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GR\" >Greece<\/option><option value=\"GL\" >Greenland<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungary<\/option><option value=\"IS\" >Iceland<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IR\" >Iran (Islamic Republic of)<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Ireland (Republic of)<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italy<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordan<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"KP\" >Korea (Democratic People&#039;s Republic of)<\/option><option value=\"KR\" >Korea (Republic of)<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Lao People&#039;s Democratic Republic<\/option><option value=\"LV\" >Latvia<\/option><option value=\"LB\" >Lebanon<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libya<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithuania<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia (Federated States of)<\/option><option value=\"MD\" >Moldova (Republic of)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MA\" >Morocco<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NZ\" >New Zealand<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MK\" >North Macedonia (Republic of)<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"NO\" >Norway<\/option><option value=\"OM\" >Oman<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (State of)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Poland<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Romania<\/option><option value=\"RU\" >Russian Federation<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"SH\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >Sao Tome and Principe<\/option><option value=\"SA\" >Saudi Arabia<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SX\" >Sint Maarten (Dutch part)<\/option><option value=\"SK\" >Slovakia<\/option><option value=\"SI\" >Slovenia<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"ZA\" >South Africa<\/option><option value=\"GS\" >South Georgia and the South Sandwich Islands<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spain<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SD\" >Sudan<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard and Jan Mayen<\/option><option value=\"SE\" >Sweden<\/option><option value=\"CH\" >Switzerland<\/option><option value=\"SY\" >Syrian Arab Republic<\/option><option value=\"TW\" >Taiwan, Republic of China<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania (United Republic of)<\/option><option value=\"TH\" >Thailand<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad and Tobago<\/option><option value=\"TN\" >Tunisia<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TR\" >T\u00fcrkiye<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"UM\" >United States Minor Outlying Islands<\/option><option value=\"US\" >United States of America<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vatican City State<\/option><option value=\"VE\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"VG\" >Virgin Islands (British)<\/option><option value=\"VI\" >Virgin Islands (U.S.)<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"AX\" >\u00c5land Islands<\/option><\/select><label for=\"wpforms-1155-field_11-country\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Country<\/label><\/div><\/div><\/div><div id=\"wpforms-1155-field_14-container\" class=\"wpforms-field wpforms-field-address wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"address\" data-field-id=\"14\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1155-field_14\">Home Address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-1155-field_14\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][14][address1]\" placeholder=\"Street Address, P.O. box\" required><label for=\"wpforms-1155-field_14\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-1155-field_14-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][14][address2]\" placeholder=\"Apartment, suite, unit, floor, etc.\" ><label for=\"wpforms-1155-field_14-address2\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1155-field_14-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][14][city]\" placeholder=\"City\" required><label for=\"wpforms-1155-field_14-city\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1155-field_14-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][14][state]\" placeholder=\"State \/ Province\" required><label for=\"wpforms-1155-field_14-state\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1155-field_14-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][14][postal]\" placeholder=\"ZIP \/ Postal\" required><label for=\"wpforms-1155-field_14-postal\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Postal Code<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-1155-field_14-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][14][country]\" required><option class=\"placeholder\" value=\"\" selected disabled>&#8212; Select country &#8212;<\/option><option value=\"AF\" >Afghanistan<\/option><option value=\"AL\" >Albania<\/option><option value=\"DZ\" >Algeria<\/option><option value=\"AS\" >American Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua and Barbuda<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\" >Belgium<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia (Plurinational State of)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouvet Island<\/option><option value=\"BR\" >Brazil<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\" >Canada<\/option><option value=\"KY\" >Cayman Islands<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocos (Keeling) Islands<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoros<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Democratic Republic of the)<\/option><option value=\"CK\" >Cook Islands<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"CZ\" >Czech Republic<\/option><option value=\"CI\" >C\u00f4te d&#039;Ivoire<\/option><option value=\"DK\" >Denmark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypt<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estonia<\/option><option value=\"SZ\" >Eswatini (Kingdom of)<\/option><option value=\"ET\" >Ethiopia<\/option><option value=\"FK\" >Falkland Islands (Malvinas)<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >France<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"DE\" >Germany<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GR\" >Greece<\/option><option value=\"GL\" >Greenland<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungary<\/option><option value=\"IS\" >Iceland<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IR\" >Iran (Islamic Republic of)<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Ireland (Republic of)<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italy<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordan<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"KP\" >Korea (Democratic People&#039;s Republic of)<\/option><option value=\"KR\" >Korea (Republic of)<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Lao People&#039;s Democratic Republic<\/option><option value=\"LV\" >Latvia<\/option><option value=\"LB\" >Lebanon<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libya<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithuania<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia (Federated States of)<\/option><option value=\"MD\" >Moldova (Republic of)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MA\" >Morocco<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NZ\" >New Zealand<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MK\" >North Macedonia (Republic of)<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"NO\" >Norway<\/option><option value=\"OM\" >Oman<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (State of)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Poland<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Romania<\/option><option value=\"RU\" >Russian Federation<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"SH\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >Sao Tome and Principe<\/option><option value=\"SA\" >Saudi Arabia<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SX\" >Sint Maarten (Dutch part)<\/option><option value=\"SK\" >Slovakia<\/option><option value=\"SI\" >Slovenia<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"ZA\" >South Africa<\/option><option value=\"GS\" >South Georgia and the South Sandwich Islands<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spain<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SD\" >Sudan<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard and Jan Mayen<\/option><option value=\"SE\" >Sweden<\/option><option value=\"CH\" >Switzerland<\/option><option value=\"SY\" >Syrian Arab Republic<\/option><option value=\"TW\" >Taiwan, Republic of China<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania (United Republic of)<\/option><option value=\"TH\" >Thailand<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad and Tobago<\/option><option value=\"TN\" >Tunisia<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TR\" >T\u00fcrkiye<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"UM\" >United States Minor Outlying Islands<\/option><option value=\"US\" >United States of America<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vatican City State<\/option><option value=\"VE\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"VG\" >Virgin Islands (British)<\/option><option value=\"VI\" >Virgin Islands (U.S.)<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"AX\" >\u00c5land Islands<\/option><\/select><label for=\"wpforms-1155-field_14-country\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Country<\/label><\/div><\/div><\/div><div id=\"wpforms-1155-field_19-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"19\"><h3 id=\"wpforms-1155-field_19\">DECLARATION AND SIGNATURE OF APPLICANT<\/h3><\/div><div id=\"wpforms-1155-field_70-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"70\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\">FCSI Declaration <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_70\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_70_1\" name=\"wpforms[fields][70][]\" value=\"I declare that I have completed this application as completely as I am able and I hereby apply for the renewal of Fellow of CSI (FCSI\u00ae).\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_70_1\">I declare that I have completed this application as completely as I am able and I hereby apply for the renewal of Fellow of CSI (FCSI\u00ae).<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_119-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"119\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\">CIM Declaration <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_119\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_119_1\" name=\"wpforms[fields][119][]\" value=\"I declare that I have completed this application as completely as I am able and I hereby apply for the renewal of the CIM\u00ae Designation.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_119_1\">I declare that I have completed this application as completely as I am able and I hereby apply for the renewal of the CIM\u00ae Designation.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_120-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"120\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\">CIWM Declaration <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_120\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_120_1\" name=\"wpforms[fields][120][]\" value=\"I declare that I have completed this application as completely as I am able and I hereby apply for renewal of the Certified International Wealth Manager License.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_120_1\">I declare that I have completed this application as completely as I am able and I hereby apply for renewal of the Certified International Wealth Manager License.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_121-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"121\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\">PFP Declaration <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_121\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_121_1\" name=\"wpforms[fields][121][]\" value=\"I declare that I have completed this application as completely as I am able and I hereby apply for the renewal of the PFP\u00ae Designation.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_121_1\">I declare that I have completed this application as completely as I am able and I hereby apply for the renewal of the PFP\u00ae Designation.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_122-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"122\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\">MTI Declaration <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_122\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_122_1\" name=\"wpforms[fields][122][]\" value=\"I declare that I have completed this application as completely as I am able and I hereby apply for the renewal of the MTI\u00ae Designation.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_122_1\">I declare that I have completed this application as completely as I am able and I hereby apply for the renewal of the MTI\u00ae Designation.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_177-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"177\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\">DFSA Declaration <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_177\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_177_1\" name=\"wpforms[fields][177][]\" value=\"I declare that I have completed this application as completely as I am able and I hereby apply for the DFSA\u2122 Designation.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_177_1\">I declare that I have completed this application as completely as I am able and I hereby apply for the DFSA\u2122 Designation.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_45-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"45\"><div id=\"wpforms-1155-field_45\"><p>I confirm that:<\/p><\/div><\/div><div id=\"wpforms-1155-field_46-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"46\" style=\"display:none;\"><label class=\"wpforms-field-label\">FCSI\u00ae INDUSTRY CONTRIBUTION REQUIREMENTS <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_46\" class=\"wpforms-field-required\"><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_46_3\" name=\"wpforms[fields][46][]\" value=\"I understand, and agree to comply with the FCSI\u00ae Industry Contribution Requirements to complete a minimum of 12 hours per calendar year as set out in Maintaining your FCSI\u00ae on &lt;a href=&quot;https:\/\/www.csi.ca\/en\/credentials\/fcsi\/&quot; target=&quot;_blank&quot;&gt;www.fcsi.ca&lt;\/a&gt;.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_46_3\">I understand, and agree to comply with the FCSI\u00ae Industry Contribution Requirements to complete a minimum of 12 hours per calendar year as set out in Maintaining your FCSI\u00ae on <a href=\"https:\/\/www.csi.ca\/en\/credentials\/fcsi\/\" target=\"_blank\">www.fcsi.ca<\/a>.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_156-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"html\" data-field-id=\"156\" style=\"display:none;\"><div id=\"wpforms-1155-field_156\"><p><em>You are not required to submit your documentation on an annual basis, however from time to time some members may be subject to random audits.<\/em><\/p><\/div><\/div><div id=\"wpforms-1155-field_155-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"html\" data-field-id=\"155\" style=\"display:none;\"><div id=\"wpforms-1155-field_155\"><p><em>You are required to submit your documentation confirming completion of your 12 industry contribution hours for each calendar year of non-renewal.<\/em><\/p><\/div><\/div><div id=\"wpforms-1155-field_124-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"124\" style=\"display:none;\"><label class=\"wpforms-field-label\">CIM\u00ae CONTINUING EDUCATION REQUIREMENTS <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_124\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_124_1\" name=\"wpforms[fields][124][]\" value=\"I understand, and agree to comply with the CIM\u00ae Continuing Education (CE) requirements as described on the website and that I may be subject to the random audit to assess compliance with CE requirements.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_124_1\">I understand, and agree to comply with the CIM\u00ae Continuing Education (CE) requirements as described on the website and that I may be subject to the random audit to assess compliance with CE requirements.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_159-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"159\" style=\"display:none;\"><label class=\"wpforms-field-label\">CIWM CONTINUING EDUCATION REQUIREMENTS <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_159\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_159_1\" name=\"wpforms[fields][159][]\" value=\"I understand, and agree to comply with the CIWM Continuing Education (CE) requirements as described on the website and that I may be subject to the random audit to assess compliance with CE requirements.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_159_1\">I understand, and agree to comply with the CIWM Continuing Education (CE) requirements as described on the website and that I may be subject to the random audit to assess compliance with CE requirements.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_160-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"160\" style=\"display:none;\"><label class=\"wpforms-field-label\">PFP\u00ae CONTINUING EDUCATION REQUIREMENTS <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_160\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_160_1\" name=\"wpforms[fields][160][]\" value=\"I understand, and agree to comply with the PFP\u00ae Continuing Education (CE) requirements as described on the website and that I may be subject to the random audit to assess compliance with CE requirements.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_160_1\">I understand, and agree to comply with the PFP\u00ae Continuing Education (CE) requirements as described on the website and that I may be subject to the random audit to assess compliance with CE requirements.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_161-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"161\" style=\"display:none;\"><label class=\"wpforms-field-label\">MTI\u00ae CONTINUING EDUCATION REQUIREMENTS <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_161\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_161_1\" name=\"wpforms[fields][161][]\" value=\"I understand, and agree to comply with the MTI\u00ae Continuing Education (CE) requirements as described on the website and that I may be subject to the random audit to assess compliance with CE requirements.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_161_1\">I understand, and agree to comply with the MTI\u00ae Continuing Education (CE) requirements as described on the website and that I may be subject to the random audit to assess compliance with CE requirements.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_178-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"178\" style=\"display:none;\"><label class=\"wpforms-field-label\">DFSA\u2122 CONTINUING EDUCATION REQUIREMENTS <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_178\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_178_1\" name=\"wpforms[fields][178][]\" value=\"I understand and agree to comply with the DFSA\u2122 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.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_178_1\">I understand and agree to comply with the DFSA\u2122 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.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_157-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"html\" data-field-id=\"157\" style=\"display:none;\"><div id=\"wpforms-1155-field_157\"><p><em>You are not required to submit your CE documentation on an annual basis, however from time to time some members may be subject to random audits.<\/em><\/p><\/div><\/div><div id=\"wpforms-1155-field_158-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"html\" data-field-id=\"158\"><div id=\"wpforms-1155-field_158\"><p><em>You are required to submit your documentation confirming completion of your CE requirements for all the cycles of non-renewal.<\/em><\/p><\/div><\/div><div id=\"wpforms-1155-field_145-container\" class=\"wpforms-field wpforms-field-file-upload wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"file-upload\" data-field-id=\"145\"><label class=\"wpforms-field-label\" for=\"wpforms-1155-field_145\">Upload Documents<\/label><div\n\t\tclass=\"wpforms-uploader \"\n\t\tdata-field-id=\"145\"\n\t\tdata-form-id=\"1155\"\n\t\tdata-input-name=\"wpforms_1155_145\"\n\t\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,heif,heics,heifs,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,vtt,mp3,m4a,m4b,aac,ra,ram,wav,x-wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages\"\n\t\tdata-max-size=\"52428800\"\n\t\tdata-max-file-number=\"20\"\n\t\tdata-post-max-size=\"52428800\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg  viewBox=\"0 0 640 640\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M352 173.3L352 384C352 401.7 337.7 416 320 416C302.3 416 288 401.7 288 384L288 173.3L246.6 214.7C234.1 227.2 213.8 227.2 201.3 214.7C188.8 202.2 188.8 181.9 201.3 169.4L297.3 73.4C309.8 60.9 330.1 60.9 342.6 73.4L438.6 169.4C451.1 181.9 451.1 202.2 438.6 214.7C426.1 227.2 405.8 227.2 393.3 214.7L352 173.3zM320 464C364.2 464 400 428.2 400 384L480 384C515.3 384 544 412.7 544 448L544 480C544 515.3 515.3 544 480 544L160 544C124.7 544 96 515.3 96 480L96 448C96 412.7 124.7 384 160 384L240 384C240 428.2 275.8 464 320 464zM464 488C477.3 488 488 477.3 488 464C488 450.7 477.3 440 464 440C450.7 440 440 450.7 440 464C440 477.3 450.7 488 464 488z\"\/>\n\t\t<\/svg>\n\n\t\t<span class=\"modern-title\">\n\t\t\t\t\t\t\tDrag &amp; Drop Files, \t\t\t\t<span>Choose Files to Upload<\/span>\n\t\t\t\t\t<\/span>\n\n\t\t\t\t\t<span class=\"modern-hint\">You can upload up to 20 files.<\/span>\n\t\t\t<\/div>\n<\/div>\n\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\treadonly\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-1155-field_145\"\n\t\tname=\"wpforms_1155_145\" \t\tvalue=\"\">\n<\/div><div id=\"wpforms-1155-field_109-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"109\" style=\"display:none;\"><label class=\"wpforms-field-label\">FCSI\u00ae CODE OF ETHICS <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_109\" class=\"wpforms-field-required\"><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_109_3\" name=\"wpforms[fields][109][]\" value=\"I understand that this application will be subject to the procedures set out in the FCSI\u00ae Code of Ethics and Ethical Misconduct Process.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_109_3\">I understand that this application will be subject to the procedures set out in the FCSI\u00ae Code of Ethics and Ethical Misconduct Process.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_146-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"146\" style=\"display:none;\"><label class=\"wpforms-field-label\">CIM\u00ae CODE OF ETHICS <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_146\" class=\"wpforms-field-required\"><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_146_3\" name=\"wpforms[fields][146][]\" value=\"As a CIM\u00ae designation holder and throughout my annual designation period, I agree that:  I will continue to uphold the CIM\u00ae Code of Ethics and abide by the Ethical Misconduct Process.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_146_3\">As a CIM\u00ae designation holder and throughout my annual designation period, I agree that:  I will continue to uphold the CIM\u00ae Code of Ethics and abide by the Ethical Misconduct Process.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_147-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"147\" style=\"display:none;\"><label class=\"wpforms-field-label\">MTI\u00ae CODE OF ETHICS <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_147\" class=\"wpforms-field-required\"><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_147_3\" name=\"wpforms[fields][147][]\" value=\"As a MTI\u00ae designation holder and throughout my annual designation period, I agree that:  I will continue to uphold the MTI\u00ae Code of Ethics and abide by the Ethical Misconduct Process.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_147_3\">As a MTI\u00ae designation holder and throughout my annual designation period, I agree that:  I will continue to uphold the MTI\u00ae Code of Ethics and abide by the Ethical Misconduct Process.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_148-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"148\" style=\"display:none;\"><label class=\"wpforms-field-label\">PFP\u00ae CODE OF ETHICS <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_148\" class=\"wpforms-field-required\"><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_148_3\" name=\"wpforms[fields][148][]\" value=\"As a PFP\u00ae designation holder and throughout my annual designation period, I agree that:  I will continue to uphold the PFP\u00ae Code of Ethics and abide by the Ethical Misconduct Process.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_148_3\">As a PFP\u00ae designation holder and throughout my annual designation period, I agree that:  I will continue to uphold the PFP\u00ae Code of Ethics and abide by the Ethical Misconduct Process.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_149-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"149\" style=\"display:none;\"><label class=\"wpforms-field-label\">CIWM CODE OF ETHICS <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_149\" class=\"wpforms-field-required\"><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_149_3\" name=\"wpforms[fields][149][]\" value=\"As a CIWM designation holder and throughout my annual designation period, I agree that:  I will continue to uphold the CIWM Code of Ethics and abide by the Ethical Misconduct Process.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_149_3\">As a CIWM designation holder and throughout my annual designation period, I agree that:  I will continue to uphold the CIWM Code of Ethics and abide by the Ethical Misconduct Process.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_179-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"179\" style=\"display:none;\"><label class=\"wpforms-field-label\">DFSA\u2122 CODE OF ETHICS <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_179\" class=\"wpforms-field-required\"><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_179_3\" name=\"wpforms[fields][179][]\" value=\"As a DFSA\u2122 designation holder and throughout my annual designation period, I agree that: I will continue to uphold the DFSA\u2122 Code of Ethics and abide by the Ethical Misconduct Process.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_179_3\">As a DFSA\u2122 designation holder and throughout my annual designation period, I agree that: I will continue to uphold the DFSA\u2122 Code of Ethics and abide by the Ethical Misconduct Process.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_168-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"divider\" data-field-id=\"168\" style=\"display:none;\"><h3 id=\"wpforms-1155-field_168\">FINANCIAL SERVICES REGULATORY AUTHORITY (FSRA) TITLE PROTECTION ACT<\/h3><\/div><div id=\"wpforms-1155-field_169-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"html\" data-field-id=\"169\" style=\"display:none;\"><div id=\"wpforms-1155-field_169\"><p>CSI has been approved as a Credentialling Body and the PFP\u00ae has been approved as a Financial Planner credential.<br \/><br \/>\r\nPFP\u00ae designation holders who fall under the FSRA Title Protection Act:<br \/><br \/>\r\n\u2022\tReside in Ontario, or<br \/>\r\n\u2022\tReside outside of Ontario but have clients within Ontario, or<br \/>\r\n\u2022\tHold out to consumers in Ontario that they have the PFP\u00ae<br \/>\r\n<\/p>\r\n<\/div><\/div><div id=\"wpforms-1155-field_170-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"170\" style=\"display:none;\"><label class=\"wpforms-field-label\">Do any of the above criteria apply to you? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_170\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1155-field_170_1\" name=\"wpforms[fields][170]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_170_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1155-field_170_2\" name=\"wpforms[fields][170]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_170_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_173-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"html\" data-field-id=\"173\" style=\"display:none;\"><div id=\"wpforms-1155-field_173\">If you have answered &#8220;Yes&#8221;, please enter Business Email Address.<\/div><\/div><div id=\"wpforms-1155-field_175-container\" class=\"wpforms-field wpforms-field-email wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"email\" data-field-id=\"175\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1155-field_175\">Business Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1155-field_175\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][175]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-1155-field_171-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"171\" style=\"display:none;\"><label class=\"wpforms-field-label\">Please attest to the following: <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_171\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_171_1\" name=\"wpforms[fields][171][]\" value=\"I agree to disclose to clients that I hold the PFP\u00ae designation in a clear and timely manner.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_171_1\">I agree to disclose to clients that I hold the PFP\u00ae designation in a clear and timely manner.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_172-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"172\" style=\"display:none;\"><ul id=\"wpforms-1155-field_172\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_172_1\" name=\"wpforms[fields][172][]\" value=\"I understand that if CSI terminates my license to use the PFP\u00ae Certification Mark (see Certification Mark License Agreement just below) I will be advised to discontinue using the Financial Planner 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 Planner designation and be in good standing to use the title or similar named title.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_172_1\">I understand that if CSI terminates my license to use the PFP\u00ae Certification Mark (see Certification Mark License Agreement just below) I will be advised to discontinue using the Financial Planner 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 Planner designation and be in good standing to use the title or similar named title.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_167-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"167\"><h3 id=\"wpforms-1155-field_167\">FIT AND PROPER REQUIREMENT<\/h3><\/div><div id=\"wpforms-1155-field_189-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"189\"><div id=\"wpforms-1155-field_189\"><p>All candidates are required to declare any legal action, allegations or complaints prior to being granted a designation. Designation\/Fellowship holders must notify CSI of any criminal charges, legal actions or complaints initiated against them within 30 calendar days of occurrence or upon renewal of the credential, whichever comes first. This declaration includes a \u201cFit and Proper Requirement\u201d that sets out the following situations for self-declaration:<\/p><\/div><\/div><div id=\"wpforms-1155-field_52-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"52\"><div id=\"wpforms-1155-field_52\"><p>Have you ever been accused of professional misconduct, disciplined or reprimanded by, or had a licence suspended or revoked by, an employer,\r\nprofessional association or administrative or regulatory authority (i.e. securities commission, law society, real estate association, Have you ever been accused of professional misconduct, disciplined or reprimanded by, or had a licence suspended or revoked by, an employer,  professional association or administrative or regulatory authority (i.e. securities commission, law society, real estate association, CIRO, Insurance Regulator, FINRA, etc.)?,\r\nInsurance Regulator, FINRA, etc.)?<\/p><\/div><\/div><div id=\"wpforms-1155-field_96-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"96\"><label class=\"wpforms-field-label wpforms-label-hide\">Have you ever been accused of professional misconduct, disciplined or reprimanded by, or had a licence suspended or revoked by, an employer, professional association or administrative or regulatory authority (i.e. securities commission, law society, real estate association, CIRO, Insurance Regulator, FINRA, etc.)?<\/label><ul id=\"wpforms-1155-field_96\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1155-field_96_1\" name=\"wpforms[fields][96]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_96_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1155-field_96_2\" name=\"wpforms[fields][96]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_96_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_97-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"97\"><div id=\"wpforms-1155-field_97\"><p>Are you currently bankrupt or have you at any time in the past 5 years been adjudged bankrupt?<\/p><\/div><\/div><div id=\"wpforms-1155-field_98-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"98\"><label class=\"wpforms-field-label wpforms-label-hide\">Are you currently bankrupt or have you at any time in the past 5 years been adjudged bankrupt?<\/label><ul id=\"wpforms-1155-field_98\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1155-field_98_1\" name=\"wpforms[fields][98]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_98_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1155-field_98_2\" name=\"wpforms[fields][98]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_98_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_99-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"99\"><div id=\"wpforms-1155-field_99\"><p>Have you ever been convicted of a criminal offence* in any jurisdiction for which a record suspension or a pardon has not been granted?<\/p><\/div><\/div><div id=\"wpforms-1155-field_101-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"101\"><label class=\"wpforms-field-label wpforms-label-hide\">Have you ever been convicted of a criminal offence* in any jurisdiction for which a record suspension or a pardon has not been granted?<\/label><ul id=\"wpforms-1155-field_101\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1155-field_101_1\" name=\"wpforms[fields][101]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_101_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1155-field_101_2\" name=\"wpforms[fields][101]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_101_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_100-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"100\"><div id=\"wpforms-1155-field_100\"><p>Have you ever been convicted of an offense under any financial services or consumer protection legislation in any jurisdiction (i.e., laws regulating\r\nthe sale of securities, insurance, real estate, mortgages, etc.)?<\/p><\/div><\/div><div id=\"wpforms-1155-field_102-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"102\"><label class=\"wpforms-field-label wpforms-label-hide\">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.)?<\/label><ul id=\"wpforms-1155-field_102\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1155-field_102_1\" name=\"wpforms[fields][102]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_102_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1155-field_102_2\" name=\"wpforms[fields][102]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_102_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_106-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"106\"><div id=\"wpforms-1155-field_106\"><p>If you have answered \u201cYes\u201d to any of the questions above, please attach all relevant paperwork, including details of any punishment or disciplinary action\r\ntaken. 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\r\nDesignation Ethics Committee to determine your suitability for the designation.\r\n<br \/><br \/>\r\n* \u201cCriminal offence\u201d excludes an offence (i) under a provincial regulatory statute, such as the Highway Traffic Act, unless the provincial statute is\r\nspecifically listed above and unless the provincial conviction involved an offence of dishonesty or theft, such as perjury or subornation of perjury, false\r\nstatement, fraud, embezzlement, or false pretense, or any other offense the commission of which involves some element of deceit or untruthfulness,\r\nand (ii) an offence punishable by summary conviction only that is not an offence of dishonesty or theft. \r\n<\/p><p><\/p><\/div><\/div><div id=\"wpforms-1155-field_107-container\" class=\"wpforms-field wpforms-field-file-upload wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"file-upload\" data-field-id=\"107\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1155-field_107\">Please attach all relevant paperwork <span class=\"wpforms-required-label\">*<\/span><\/label><div\n\t\tclass=\"wpforms-uploader wpforms-field-required\"\n\t\tdata-field-id=\"107\"\n\t\tdata-form-id=\"1155\"\n\t\tdata-input-name=\"wpforms_1155_107\"\n\t\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,heif,heics,heifs,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,vtt,mp3,m4a,m4b,aac,ra,ram,wav,x-wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages\"\n\t\tdata-max-size=\"52428800\"\n\t\tdata-max-file-number=\"20\"\n\t\tdata-post-max-size=\"52428800\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg  viewBox=\"0 0 640 640\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M352 173.3L352 384C352 401.7 337.7 416 320 416C302.3 416 288 401.7 288 384L288 173.3L246.6 214.7C234.1 227.2 213.8 227.2 201.3 214.7C188.8 202.2 188.8 181.9 201.3 169.4L297.3 73.4C309.8 60.9 330.1 60.9 342.6 73.4L438.6 169.4C451.1 181.9 451.1 202.2 438.6 214.7C426.1 227.2 405.8 227.2 393.3 214.7L352 173.3zM320 464C364.2 464 400 428.2 400 384L480 384C515.3 384 544 412.7 544 448L544 480C544 515.3 515.3 544 480 544L160 544C124.7 544 96 515.3 96 480L96 448C96 412.7 124.7 384 160 384L240 384C240 428.2 275.8 464 320 464zM464 488C477.3 488 488 477.3 488 464C488 450.7 477.3 440 464 440C450.7 440 440 450.7 440 464C440 477.3 450.7 488 464 488z\"\/>\n\t\t<\/svg>\n\n\t\t<span class=\"modern-title\">\n\t\t\t\t\t\t\tDrag &amp; Drop Files, \t\t\t\t<span>Choose Files to Upload<\/span>\n\t\t\t\t\t<\/span>\n\n\t\t\t\t\t<span class=\"modern-hint\">You can upload up to 20 files.<\/span>\n\t\t\t<\/div>\n<\/div>\n\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\treadonly\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-1155-field_107\"\n\t\tname=\"wpforms_1155_107\" required\t\tvalue=\"\">\n<\/div><div id=\"wpforms-1155-field_53-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"53\" style=\"display:none;\"><label class=\"wpforms-field-label\">TRADEMARK LICENSE AGREEMENT <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_53\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_53_1\" name=\"wpforms[fields][53][]\" value=\"I understand that CSI grants me license to use the FCSI\u00ae Trademark for a one-year term and that if I do not renew my FCSI\u00ae license, CSI will terminate my license to use the FCSI\u00ae Trademarks.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_53_1\">I understand that CSI grants me license to use the FCSI\u00ae Trademark for a one-year term and that if I do not renew my FCSI\u00ae license, CSI will terminate my license to use the FCSI\u00ae Trademarks.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_150-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"150\" style=\"display:none;\"><label class=\"wpforms-field-label\">CIM\u00ae CERTIFICATION MARK LICENSE AGREEMENT <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_150\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_150_1\" name=\"wpforms[fields][150][]\" value=\"I understand that by renewing my CIM\u00ae designation, CSI continues my license to use the CIM\u00ae Certification Mark for a one-year term and that if I do not renew my CIM\u00ae designation, CSI will terminate my license to use the CIM\u00ae Certification Mark. I also agreee to notify CSI, without delay, of any circumstances that may affect my ability to continue to fulfill the certification requirements.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_150_1\">I understand that by renewing my CIM\u00ae designation, CSI continues my license to use the CIM\u00ae Certification Mark for a one-year term and that if I do not renew my CIM\u00ae designation, CSI will terminate my license to use the CIM\u00ae Certification Mark. I also agreee to notify CSI, without delay, of any circumstances that may affect my ability to continue to fulfill the certification requirements.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_152-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"152\" style=\"display:none;\"><label class=\"wpforms-field-label\">PFP\u00ae CERTIFICATION MARK LICENSE AGREEMENT <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_152\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_152_1\" name=\"wpforms[fields][152][]\" value=\"I understand that by renewing my PFP\u00ae designation, CSI continues my license to use the PFP\u00ae Certification Mark for a one-year term and that if I do not renew my PFP\u00ae designation, CSI will terminate my license to use the PFP\u00ae Certification Mark. I also agreee to notify CSI, without delay, of any circumstances that may affect my ability to continue to fulfill the certification requirements.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_152_1\">I understand that by renewing my PFP\u00ae designation, CSI continues my license to use the PFP\u00ae Certification Mark for a one-year term and that if I do not renew my PFP\u00ae designation, CSI will terminate my license to use the PFP\u00ae Certification Mark. I also agreee to notify CSI, without delay, of any circumstances that may affect my ability to continue to fulfill the certification requirements.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_153-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"153\" style=\"display:none;\"><label class=\"wpforms-field-label\">MTI\u00ae CERTIFICATION MARK LICENSE AGREEMENT <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_153\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_153_1\" name=\"wpforms[fields][153][]\" value=\"I understand that by renewing my MTI\u00ae designation, CSI continues my license to use the MTI\u00ae Certification Mark for a one-year term and that if I do not renew my MTI\u00ae designation, CSI will terminate my license to use the MTI\u00ae Certification Mark. I also agreee to notify CSI, without delay, of any circumstances that may affect my ability to continue to fulfill the certification requirements.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_153_1\">I understand that by renewing my MTI\u00ae designation, CSI continues my license to use the MTI\u00ae Certification Mark for a one-year term and that if I do not renew my MTI\u00ae designation, CSI will terminate my license to use the MTI\u00ae Certification Mark. I also agreee to notify CSI, without delay, of any circumstances that may affect my ability to continue to fulfill the certification requirements.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_151-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"151\" style=\"display:none;\"><label class=\"wpforms-field-label\">CIWM CERTIFICATION MARK LICENSE AGREEMENT <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_151\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_151_1\" name=\"wpforms[fields][151][]\" value=\"I understand that by renewing my CIWM designation, CSI continues my license to use the CIWM Certification Mark for a one-year term and that if I do not renew my CIWM designation, CSI will terminate my license to use the CIWM Certification Mark. I also agreee to notify CSI, without delay, of any circumstances that may affect my ability to continue to fulfill the certification requirements.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_151_1\">I understand that by renewing my CIWM designation, CSI continues my license to use the CIWM Certification Mark for a one-year term and that if I do not renew my CIWM designation, CSI will terminate my license to use the CIWM Certification Mark. I also agreee to notify CSI, without delay, of any circumstances that may affect my ability to continue to fulfill the certification requirements.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_183-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"183\" style=\"display:none;\"><label class=\"wpforms-field-label\">DFSA\u2122 CERTIFICATION MARK LICENSE AGREEMENT  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_183\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_183_1\" name=\"wpforms[fields][183][]\" value=\"I understand that CSI grants me license to use the DFSA\u2122 Certification Mark for a one-year term and that if I do not renew my DFSA\u2122 designation, CSI will terminate my license to use the DFSA\u2122 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 &lt;a href=&quot;https:\/\/www.csi.ca\/en\/credentials\/dfsa\/&quot; target=&quot;_blank&quot;&gt;DFSA\u2122 Certification Mark License Agreement&lt;\/a&gt;.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1155-field_183_1\">I understand that CSI grants me license to use the DFSA\u2122 Certification Mark for a one-year term and that if I do not renew my DFSA\u2122 designation, CSI will terminate my license to use the DFSA\u2122 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 <a href=\"https:\/\/www.csi.ca\/en\/credentials\/dfsa\/\" target=\"_blank\">DFSA\u2122 Certification Mark License Agreement<\/a>.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1155-field_18-container\" class=\"wpforms-field wpforms-field-signature\" data-field-type=\"signature\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-1155-field_18\">Signature <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1155-field_18\" class=\"wpforms-signature-input wpforms-screen-reader-element wpforms-field-required\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][18]\" autocomplete=\"off\" inputmode=\"none\" required><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\" data-input-method=\"draw\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-1155-field_18-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Clear Signature\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Clear Signature<\/div>\n\t\t\t<\/div><\/div><\/div><div id=\"wpforms-1155-field_125-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"divider\" data-field-id=\"125\" style=\"display:none;\"><h3 id=\"wpforms-1155-field_125\">CERTIFICATION MARK LICENSE AGREEMENT<\/h3><\/div><div id=\"wpforms-1155-field_126-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"html\" data-field-id=\"126\" style=\"display:none;\"><div id=\"wpforms-1155-field_126\"><p>As a holder of the CIM\u00ae designation, you are licensed to use the CIM\u00ae certification mark (the \u201cCertification Mark\u201d).\r\n<ol>\r\n<li>Licensee acknowledges that CSI owns the entire right, title and interest to the Certification Mark.<\/li>\r\n<li>CSI hereby grants the Licensee a non-exclusive license to use the Certification Mark in association with the provision of financial services to the public for a one-year term,\r\ncommencing on the date the Licensee is granted the CIM\u00ae designation. Licensee hereby explicitly acknowledges that Licensee is not entitled, by virtue of having earned\r\nthis designation, to its use other than under the terms of this license. This Agreement and the license granted hereunder will be renewed automatically every year for\r\nanother one-year term upon payment of an annual renewal fee and provided the Licensee is otherwise in compliance with all of the requirements associated with the\r\nCIM\u00ae designation and conveyed to Licensee by CSI.<\/li>\r\n<li>In order to maintain the right to continue to use the Certification Mark, Licensee agrees to maintain any and all standards for the character and quality of the services to\r\nbe provided in association with the Certification Mark. CSI shall convey such standards to Licensee from time to time. Such standards shall include but not be limited to\r\nthe CIM\u00ae Code of Ethics. Licensee also agrees to earn any continuing education credits required by CSI.<\/li>\r\n<li>Licensee agrees that CSI may monitor the provision of services provided by Licensee in association with the Certification Mark and that, in the event CSI determines that\r\nthe quality of those services do not meet the standards set by CSI, CSI may terminate the license upon 60 days notice. Licensee agrees that the final determination with\r\nrespect to the termination of this license shall be made by the Designation Ethics Committee. Upon termination of this license, Licensee shall immediately cease to use or\r\ndisplay the Certification Mark and\/or CIM\u00ae Trademark for any purpose whatsoever.<\/li>\r\n<li>Licensee shall at all times display the Certification Mark in accordance with the Certification Mark guidelines:\r\nAs a Licensee of the Certification Mark:\r\n<ul>\r\n<li>You can use the Certification Mark as a distinctive visual symbol of the CIM\u00ae designation that can be easily recognized by employers, colleagues, and clients.\r\nIn essence, as a designation holder, you can use this mark as a seal of quality and integrity.<\/li>\r\n<li>The Certification Mark may not be altered or modified in any way.<\/li>\r\n<li>To ensure that the Certification Mark appears properly, all reproduction of the Certification Mark must be made from camera-ready artwork provided by CSI.<\/li>\r\n<li>The Certification Mark can be used to identify a group of individuals; however, each individual listed must be current CIM\u00ae designation holders.<\/li>\r\n<li>The Certification Mark must not be used as part of a company name<\/li>\r\n<li> The Certification Mark should be placed in close proximity to the Licensee\u2019s name. However, the Certification Mark should have enough clear space that it is not\r\nconnected or a part of the Licensee\u2019s personalization or degree. The Certification Mark shall not be confused with a company logo or placed in such close proximity\r\nto a company name or logo so as to give the reader the idea that the Certification Mark certifies the company.<\/li>\r\n<\/ul>\r\n<\/li><li>Licensee agrees to notify CSI, without delay, of any circumstances that may affect the licensee\u2019s ability to continue to fulfill the certification requirements.<\/li>\r\n<\/ol><\/p><\/div><\/div><div id=\"wpforms-1155-field_163-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"html\" data-field-id=\"163\" style=\"display:none;\"><div id=\"wpforms-1155-field_163\"><p>As a holder of the PFP\u00ae designation, you are licensed to use the PFP\u00ae certification mark (the \u201cCertification Mark\u201d).\r\n<ol>\r\n<li>Licensee acknowledges that CSI owns the entire right, title and interest to the Certification Mark.<\/li>\r\n<li>CSI hereby grants the Licensee a non-exclusive license to use the Certification Mark in association with the provision of financial services to the public for a one-year term,\r\ncommencing on the date the Licensee is granted the PFP\u00ae designation. Licensee hereby explicitly acknowledges that Licensee is not entitled, by virtue of having earned\r\nthis designation, to its use other than under the terms of this license. This Agreement and the license granted hereunder will be renewed automatically every year for\r\nanother one-year term upon payment of an annual renewal fee and provided the Licensee is otherwise in compliance with all of the requirements associated with the\r\nPFP\u00ae designation and conveyed to Licensee by CSI.<\/li>\r\n<li>In order to maintain the right to continue to use the Certification Mark, Licensee agrees to maintain any and all standards for the character and quality of the services to\r\nbe provided in association with the Certification Mark. CSI shall convey such standards to Licensee from time to time. Such standards shall include but not be limited to\r\nthe PFP\u00ae Code of Ethics. Licensee also agrees to earn any continuing education credits required by CSI.<\/li>\r\n<li>Licensee agrees that CSI may monitor the provision of services provided by Licensee in association with the Certification Mark and that, in the event CSI determines that\r\nthe quality of those services do not meet the standards set by CSI, CSI may terminate the license upon 60 days notice. Licensee agrees that the final determination with\r\nrespect to the termination of this license shall be made by the Designation Ethics Committee. Upon termination of this license, Licensee shall immediately cease to use or\r\ndisplay the Certification Mark and\/or PFP\u00ae Trademark for any purpose whatsoever.<\/li>\r\n<li>Licensee shall at all times display the Certification Mark in accordance with the Certification Mark guidelines:\r\nAs a Licensee of the Certification Mark:\r\n<ul>\r\n<li>You can use the Certification Mark as a distinctive visual symbol of the PFP\u00ae designation that can be easily recognized by employers, colleagues, and clients.\r\nIn essence, as a designation holder, you can use this mark as a seal of quality and integrity.<\/li>\r\n<li>The Certification Mark may not be altered or modified in any way.<\/li>\r\n<li>To ensure that the Certification Mark appears properly, all reproduction of the Certification Mark must be made from camera-ready artwork provided by CSI.<\/li>\r\n<li>The Certification Mark can be used to identify a group of individuals; however, each individual listed must be current PFP\u00ae designation holders.<\/li>\r\n<li>The Certification Mark must not be used as part of a company name<\/li>\r\n<li> The Certification Mark should be placed in close proximity to the Licensee\u2019s name. However, the Certification Mark should have enough clear space that it is not\r\nconnected or a part of the Licensee\u2019s personalization or degree. The Certification Mark shall not be confused with a company logo or placed in such close proximity\r\nto a company name or logo so as to give the reader the idea that the Certification Mark certifies the company.<\/li>\r\n<\/ul>\r\n<\/li><li>Licensee agrees to notify CSI, without delay, of any circumstances that may affect the licensee\u2019s ability to continue to fulfill the certification requirements.<\/li>\r\n<\/ol><\/p><\/div><\/div><div id=\"wpforms-1155-field_164-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"html\" data-field-id=\"164\" style=\"display:none;\"><div id=\"wpforms-1155-field_164\"><p>As a holder of the MTI\u00ae designation, you are licensed to use the MTI\u00ae certification mark (the \u201cCertification Mark\u201d).\r\n<ol>\r\n<li>Licensee acknowledges that CSI owns the entire right, title and interest to the Certification Mark.<\/li>\r\n<li>CSI hereby grants the Licensee a non-exclusive license to use the Certification Mark in association with the provision of financial services to the public for a one-year term,\r\ncommencing on the date the Licensee is granted the MTI\u00ae designation. Licensee hereby explicitly acknowledges that Licensee is not entitled, by virtue of having earned\r\nthis designation, to its use other than under the terms of this license. This Agreement and the license granted hereunder will be renewed automatically every year for\r\nanother one-year term upon payment of an annual renewal fee and provided the Licensee is otherwise in compliance with all of the requirements associated with the\r\nMTI\u00ae designation and conveyed to Licensee by CSI.<\/li>\r\n<li>In order to maintain the right to continue to use the Certification Mark, Licensee agrees to maintain any and all standards for the character and quality of the services to\r\nbe provided in association with the Certification Mark. CSI shall convey such standards to Licensee from time to time. Such standards shall include but not be limited to\r\nthe MTI\u00ae Code of Ethics. Licensee also agrees to earn any continuing education credits required by CSI.<\/li>\r\n<li>Licensee agrees that CSI may monitor the provision of services provided by Licensee in association with the Certification Mark and that, in the event CSI determines that\r\nthe quality of those services do not meet the standards set by CSI, CSI may terminate the license upon 60 days notice. Licensee agrees that the final determination with\r\nrespect to the termination of this license shall be made by the Designation Ethics Committee. Upon termination of this license, Licensee shall immediately cease to use or\r\ndisplay the Certification Mark and\/or MTI\u00ae Trademark for any purpose whatsoever.<\/li>\r\n<li>Licensee shall at all times display the Certification Mark in accordance with the Certification Mark guidelines:\r\nAs a Licensee of the Certification Mark:\r\n<ul>\r\n<li>You can use the Certification Mark as a distinctive visual symbol of the MTI\u00ae designation that can be easily recognized by employers, colleagues, and clients.\r\nIn essence, as a designation holder, you can use this mark as a seal of quality and integrity.<\/li>\r\n<li>The Certification Mark may not be altered or modified in any way.<\/li>\r\n<li>To ensure that the Certification Mark appears properly, all reproduction of the Certification Mark must be made from camera-ready artwork provided by CSI.<\/li>\r\n<li>The Certification Mark can be used to identify a group of individuals; however, each individual listed must be current MTI\u00ae designation holders.<\/li>\r\n<li>The Certification Mark must not be used as part of a company name<\/li>\r\n<li> The Certification Mark should be placed in close proximity to the Licensee\u2019s name. However, the Certification Mark should have enough clear space that it is not\r\nconnected or a part of the Licensee\u2019s personalization or degree. The Certification Mark shall not be confused with a company logo or placed in such close proximity\r\nto a company name or logo so as to give the reader the idea that the Certification Mark certifies the company.<\/li>\r\n<\/ul>\r\n<\/li><li>Licensee agrees to notify CSI, without delay, of any circumstances that may affect the licensee\u2019s ability to continue to fulfill the certification requirements.<\/li>\r\n<\/ol><\/p><\/div><\/div><div id=\"wpforms-1155-field_162-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"html\" data-field-id=\"162\" style=\"display:none;\"><div id=\"wpforms-1155-field_162\"><p>\r\n\t\t<ol>\r\n\t\t\t<li>As a holder of Certified International Wealth Manager Professional designation, you are licensed to use the Certified International Wealth Manager certification mark (the \u201cCertification Mark\u201d).<\/li>\r\n\t\t\t<li>As a licensee of the Certification Mark:\r\n\t\t\t\t<ul>\r\n\t\t\t\t\t<li>You can use the Certification Mark as a distinctive visual symbol of the Certified International Wealth Manager designation that can be easily recognized by employers, colleagues, and clients. In essence, as a designation holder, you can use this mark as a seal of quality and integrity.<\/li>\r\n\t\t\t\t\t<li>The certification Mark may not be altered or modified in any way.<\/li>\r\n\t\t\t\t\t<li>To ensure that the Certification Mark appears properly, all reproduction of the Certification Mark must be made from camera-ready artwork provided by CSI.<\/li>\r\n\t\t\t\t\t<li>The Certification Mark can be used to identify a group of individuals; however, each individual listed must be a current Certified International Wealth Manager designation holder.<\/li>\r\n\t\t\t\t\t<li>The Certification Mark must not be used as part of a company name.<\/li>\t\r\n\t\t\t\t\t<li>The Certification Mark should be placed in close proximity to the licensee\u2019s name. However, the Certification Mark should have enough clear space that it is not connected or a part of the licensee\u2019s personalization or degree. The Certification Mark shall not be confused with a company logo or placed in such close proximity to a company name or logo so as to give the reader the idea that the Certification Mark certifies the company.<\/li>\r\n\t\t\t\t<\/ul>\r\n\t\t\t<\/li>\r\n\t\t\t<li>Licensee acknowledges that CSI\u2019s partner, the Association of International Wealth Management (\u201cAIWM\u201d) owns the entire right, title and interest to the Certification Mark and to the trademarks, Certified International Wealth Manager and CIWM, and any logos that include this trademark (Collectively, the \u201c CIWM Trademarks\u201d) and has authorized CSI to grant the license contemplated herein.<\/li>\r\n\t\t\t<li>CSI hereby grants the licensee a non-exclusive license to use the Certification Mark in association with the provision of financial services to the public for a one-year term, commencing on the date the licensee is granted the Certified International Wealth Manager designation. Licensee hereby explicitly acknowledges that licensee is not entitled, by virtue of having earned this designation, to its use other than under the terms of this license. This Agreement and the license granted hereunder will be renewed automatically every year for another one-year term upon payment by the licensee of an annual renewal fee and provided the licensee is otherwise in compliance with all the requirements associated with the Certified International Wealth Manager designation and conveyed to Licensee by CSI, unless otherwise indicated by CSI in its sole discretion.<\/li>\r\n\t\t\t<li>In order to maintain the right to continue to use the Certification Mark, Licensee agrees to maintain any and all standards for the character and quality of the services to be provided in association with the Certification Mark and Trademark. CSI shall convey such standards to Licensee from time to time. Such standards shall include but not be limited to the Certified International Wealth Manager Code of Ethics and continuing education requirements.<\/li>\r\n\t\t\t<li>Licensee agrees that CSI may monitor the provision of services provided by Licensee in association with the Certification Mark and CIWM Trademark and that, in the event CSI determines that the quality of those services does not meet the standards set by CSI, CSI may terminate the license upon sixty (60) days\u2019 notice. Licensee agrees that the final determination with respect to the termination of this license shall be made by the Ethics Committee. Upon termination of this license, Licensee shall immediately cease to use or display the Certification Mark and\/or CIWM Trademark for any purpose whatsoever.<\/li>\r\n\t\t\t<li>Licensee agrees and acknowledges that CSI may revise any of the terms of this license, in its sole discretion, upon providing licensee with thirty (30) days written notice of such revisions. In the event that licensee does not agree to the revised terms, licensee may terminate the license by providing CSI with written notice of licensee\u2019s intention to terminate within ten (10) business days of being sent written notice of the revised license terms by CSI. In the event that licensee terminates this license in accordance with the terms of this Section 7, licensee will not be entitled to any refund of any fees already paid or owing as of the date of termination.<\/li>\r\n\t\t<\/ol>\t\r\n\t<\/p><\/div><\/div><div id=\"wpforms-1155-field_184-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"divider\" data-field-id=\"184\" style=\"display:none;\"><\/div><div id=\"wpforms-1155-field_185-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"185\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\">Checkboxes <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1155-field_185\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1155-field_185_1\" name=\"wpforms[fields][185][]\" value=\"Please check to verify all information you have provided is true and accurate. 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