ACOI MEMBERSHIP APPLICATION

Transcription

1 ACOI MEMBERSHIP APPLICATION YOU MUST BE A MEMBER OF THE ACOI ONLY IN ORDER TO REGISTER FOR THE PROFESSIONAL CERTIFICATE AND PROFESSIONAL DIPLOMA IN COMPLIANCE PERSONAL DETAILS Surname Name before marriage (if applicable) First name Date of birth (dd/mm/yyyy) Mother s maiden name of birth e.g. Dublin (if born outside of Ireland, country of birth) address Mobile phone number ALL FIELDS ARE MANDATORY qq / qq / qqqqq Title Mr q Mrs q Ms q WORK DETAILS Employer name Department Staff number Work phone number Job title Job description (please complete) Note that all postal correspondence is sent to your work address unless requested otherwise. The Institute of Banking does not accept responsibility for correspondence sent to home addresses HOME DETAILS Home phone number

2 INITIAL MEMBERSHIP FEE The ACOI Initial Membership Fee of must be paid by cheque* or credit card. MEMBERSHIP RENEWAL FEES The ACOI membership year is from 1st August to 31st July. The ACOI membership renewal fees of must be paid by cheque/credit card or direct debit. I agree to pay future membership fees by direct debit q Please complete and return the direct debit form overleaf *Cheques for ACOI membership fees if accompanied by module registration fees should be made out to The Institute of Banking. The ACOI membership renewal fee of 150 must be paid by cheque/credit card or direct debit. DATA PROTECTION NOTICE I wish to become a member of the Association of Compliance Officers in Ireland. I have read and understood the terms and conditions of Membership of the Association of Compliance Officers in Ireland (as set out on and I agree to be bound by those terms and conditions. Those who do not qualify for membership of the Association, but who wish to register for the ACOI examinations, will be registered as Affiliates. The information provided by you on this registration form will be retained and processed by the ACOI for the purpose of administering your application and your ongoing membership of ACOI, including your participation in examinations. We will disclose the data to our agents, service providers, other group companies, and contractors including (but not limited to) The Institute of Banking, only as appropriate. ACOI may also disclose information relating to your membership status and examination results to your current or future employer or the Central Bank of Ireland pursuant to a reasonable request to satisfy the Central Bank of Ireland s Fitness and Probity, Minimum Competency or other regulatory requirement. Your information will be processed recorded and retained by ACOI and we may communicate with you electronically in relation to your membership. ACOI may rely on such electronic communication in any dealings with you. You have the right to receive a copy of your personal data held by ACOI following a written request and to have any inaccuracies in your personal data corrected. You may do so by writing to: The Association of Compliance Officers in Ireland, Fitzwilliam Hall, Fitzwilliam Place, Dublin 2. DECLARATION I wish to become a member of the Association of Compliance Officers in Ireland. I have read and understood the terms and conditions of Membership of the Association of Compliance Officers in Ireland (as set out on and I agree to be bound by those terms and conditions. Those who do not qualify for membership of the Association, but who wish to register for the ACOI examinations, will be registered as Affiliates. Signature q Date

3 MEMBERSHIP SEPA DIRECT DEBIT MANDATE Unique Mandate Reference qqq Unique Mandate Reference (UMR) to be completed by Association of Compliance Officers By signing this mandate form, you authorise Association of Compliance Officers (A) to send instructions to your bank to debit your account and (B) your bank to debit your account in accordance with the instructions from Association of Compliance Officers. As part of your rights, you are entitled to a refund from your bank under the terms and conditions of your agreement with your bank. A refund must be claimed within 8 weeks starting from the date on which your account was debited. Your rights are explained in a statement that you can obtain from your bank. Creditor Name: Association of Compliance Officers Creditor : Fitzwilliam Hall, Dublin 2 Creditor ID: IE95SDD PLEASE COMPLETE ALL THE FIELDS MARKED * Membership number* Type of payment:* Debtor name:* Debtor address: City: Post Code: Country: Debtor account number IBAN:* Debtor bank identifier code BIC:* Date of signature:* Please sign here:* Recurrent payment q qqqqqqqq qqqqqqqqqqq qqqqq Signature(s) PLEASE RETURN THIS MANDATE TO THE CREDITOR

4 TO REGISTER BY CREDIT/DEBIT CARD GO TO IF YOU ARE BECOMING A MEMBER ALSO COMPLETE THE ACOI MEMBERSHIP APPLICATION FORM PROFESSIONAL CERTIFICATE AND PROFESSIONAL DIPLOMA IN COMPLIANCE PERSONAL DETAILS Membership number Surname First name Date of birth (dd/mm/yyyy) of birth e.g. Dublin (if born outside of Ireland, country of birth) Mobile phone number* address* Mother s maiden name Have you been a UCD student before? If yes, state dates of attendance ALL FIELDS ARE MANDATORY qqqqqqq Staff number qqqqqqqqqq qq / qq / qqqqq Title Mr q Mrs q Ms q E.g. attained a degree, studied a postgraduate programme or attained an award from The Institute of Banking Yes q No q From (mm/yyyy) qq / qqqq To (mm/yyyy) qq / qqqq *We will send you alerts when new correspondence is posted online to My Institute WORK DETAILS Employer name Department Work phone number Note that all postal correspondence is sent to your work address unless requested otherwise. The Institute of Banking does not accept responsibility for correspondence sent to home addresses HOME DETAILS

5 PROFESSIONAL CERTIFICATE AND PROFESSIONAL DIPLOMA IN COMPLIANCE PLEASE NOTE THAT THIS IS FOR FIRST TIME SITTINGS ONLY. TO RE-REGISTER GO TO MODULES Module Exam date and start time Exam duration PDC 1- Compliance and the Regulatory Structure 7 Jan am 2 hours q 6 May am 2 hours q 2 Sep am 2 hours q Fee per module Module Exam date and start time Exam duration PDC 3- Legal and Regulatory Aspects of Compliance 7 Jan pm 2 hours q 6 May pm 2 hours q 2 Sep pm 2 hours q Fee per module PDC 2- Conduct of Business Rules 14 Jan pm 2 hours q 13 May pm 2 hours q PDC 4- Compliance Management 21 Jan pm 2 hours q 20 May pm 2 hours q 9 Sep pm 2 hours q 16 Sep pm 2 hours q To register for PDC 2 you must have enrolled for, passed or be exempted from PDC 1. To register for the Professional Diploma in Compliance you must have enrolled for or passed the Professional Certificate in Compliance. To register for PDC 4 you must have enrolled for, passed or be exempted from PDC 3. RECOGNISED PRIOR LEARNING Credits for recognised prior learning may be available. Go to EXAM VENUES Venues are available subject to demand Athlone q Belfast q Cork q Dublin q Galway q Letterkenny q Limerick q Waterford q CLOSING DATES Leading to January exams: Friday 30 September 2016 : Leading to May exams: Friday 27 January 2017 : Leading to September exams: Friday 26 May 2017 PAYMENT ADVICE For information on late closing dates go to Cheque/Draft Ensure you print your name and membership number (if applicable) clearly (in block capitals) on the back of the cheque or draft Post dated cheques/drafts are not accepted Make cheques/drafts payable to The Institute of Banking Credit card/debit card Register by credit card/debit card online at or by calling Customer Service on DATA PROTECTION NOTICE The information provided by you on this registration form and generated as a result of your participation in programme(s) may be used and disclosed by The Institute of Banking for all purposes which are reasonably incidental to your participation in the programme(s), including the provision of information to your membership organisation. If you are taking part in programmes in the context of your employment, those purposes may include the disclosure of examination results to your employer and such other information as may be necessary to enable your employer to maintain a register of accredited individuals and for other regulatory or compliance purposes. If applicable your information may also be disclosed to the Central Bank of Ireland for Minimum Competency Code and Fitness and Probity requirements. Where you are taking part in the programme(s) in a private capacity (i.e. outside the course of your employment) you may indicate that your information should not be disclosed to your employer by ticking the box below. I confirm that I am participating in this programme outside the course of my employment. q However, if your employer subsequently seeks such information in relation to you and submits evidence to us that you took part within the course of your employment, we reserve the right to disclose your information to your employer. The Institute of Banking may also provide you with information in relation to other services which they offer. If you do not wish to receive information or offers in relation to such other services please tick this box. q You are entitled to ask for a copy of the personal data which The Institute of Banking holds about you and to have any inaccuracies in such personal data amended or erased. You may do so by writing to: The Registrar, The Institute of Banking, IFSC, 1 North Wall Quay, Dublin 1 DECLARATION I wish to register for the programme(s) selected above. By submitting this The Institute of Banking registration form, I acknowledge that I have read in full, understood and agree to be bound by the terms and conditions set out and referred to online at I further confirm that I have read and understood the contents of the data protection notice and consent to the uses and disclosures of my personal data as set out therein. Signature q Date COMPLETED FORMS CAN BE POSTED TO: THE INSTITUTE OF BANKING, IFSC, 1 NORTH WALL QUAY, DUBLIN 1.