All applications must include the following: The admission fee as prescribed on the CIA website (http://www.cia ica.ca/membership/feesforms/structure). Confirmation will be sent via e mail within five business days. If you do not receive an e mail within five days or for questions regarding the application, contact membership@cia ica.ca Fellow applications must include the following: The information specified in the FCIA application guidelines. An official transcript from the examining actuarial body, listing all exams passed. A photocopy of your Fellowship certificatee from the examining actuarial body. Practical and Canadian actuarial work description(s) covering the set requirement certified by your supervisor(s) as perr the CIA template. Associate applications must include the following: An official transcript from the examining actuarial body, listing all exams passed. Certificatee of attendance at the CIA Professionalism Workshop, or the Casualty Actuarial Society Professionalism Workshopp when offered in Canada. For applications through a *mutual recognition agreement (MRA),, a proof of highest actuarial qualification and current membership in good standing in the actuarial association in your home country is required. Affiliate applications must include the following: Affiliate application processing fee of $300 (in addition to the required admission fees) ). Proof of residence in Canada. A list of previous employers (for reference). Any additional required documents indicated to you in your primary assessment (if applicable). Proof of Fellowship (or highest actuarial qualification) and current membership in good standing in the actuarial association in your home country. Description of your actuarial work experiencee in your home country (if not already provided). Description of the courses and/or examinations completed in order too obtain your actuarial qualification in your home country as well as proof of any additional examinations passed (iff not already provided). An officiall transcript from the examining actuarial body, listing all exams passed (if applicable). How to submit applications: E mail: membership@ @cia ica.ca Fax: 613 233 45522 Mail: Canadian Institute of Actuaries 1740 360 Albert St., Ottawa, ON K1R 7X7 Page 1 of 6
What status are you applying for? Have you ever applied for this status before? Route: Fellow No Associate Yes year: Correspondent Conventional * Mutual Recogni on Affiliate Personal Information Language for preferred communication: English French Both Mr. Miss Name: Mrs. Ms. Date of birth (mm/dd/yy): (for CIA use only) Given Middle Surname Other initials Previous name (if applicable): Company name: Addresss 1: Addresss 2: City: Province/State: Country: Postal Code/ZIP: Telephone: E mail address: I consent to receive actuarial news and events via e mail from the Canadian Institute of Actuaries. I consent to having the above information published in the CIA s public membership directory. Other Qualifications Other actuarial qualifications with year obtained (e.g., ASA, FCAS,CERA): Highest education (e.g., BScAct, MSc): Institution: Year: Chartered Enterprise Risk Analyst (CERA) Yes, I would like the CIA to grant the CERA designation. (additional form will be provided after membership approval) Office Use ID #: CHQ #: DATE REC D: AMOUNT: P C Page 2 of 6
Declarations and Signature Applicants to the Canadian Institute of Actuaries (CIA) are requiredd to disclose any past criminal convictions. The CIA C Bylaws define a criminal conviction as follows: Any criminal offence, penal offence punishable by incarceration or offences of a similar nature for which the individual is convicted, found guilty of or pleads guilty to, and for which he or she has not been granted a record suspension, or a disciplinary determinationn of guild other than a CIA Disciplinary Tribunal decision. Do you have a criminal conviction to disclose to the CIA? YES NO (Please note that if you answered YES, the CIA Head Office will contact you for further information regarding your conviction, which will be reviewed and assessed pursuant to the CIA Policy on Disclosure of Criminal Convictions before your enrolment application is processed.) I hereby apply for enrolment in the Canadian Institute of Actuaries. I am aware that I am subject to the Bylaws,, Rules of Professional Conduct, and policies of the Institute that govern the professional activities of persons enrolled in the Canadian Institute of Actuaries. Name: Signature: Date: Page 3 of 6
Practice Area Actuarial Evidence Marriage Breakdown Personal Injury Actuarial Evidence Other Secondary Secondary Secondary Secondary Enterprise Risk Management (ERM) Group Benefits Individual Insurance and Living Benefits Investment Property/Casualty (P&C) Insurance Pensions Non traditional Actuarial Retired Other Asset Liability Management Modelling ERM Other Employee Benefits Post employment Benefits Workers Compensation Group Othe er Individual Annuity Individual Critical Illness Creditor Individual Disability Individual Health & Dental Individual Life Special Risk Individual Life Other Financial Reporting Portfolio Management Investment Other Commercial Personal P& &C Other Defined Benefit Defined Contribution, RRSP Pension Other Secondary Secondary Secondary Secondary Secondary Secondary Secondary Secondary Secondary Secondary Secondary Secondary Secondary Secondary Secondary Secondary Secondary Secondary Secondary Secondary Secondary Secondary Secondary Secondary Secondary Secondary Page 4 of 6
Employer Type Consulting Firm Small (five or less fully qualified FCIAs employed) Government Other Financial Institution Fund Management Company Retired Consultingg Firm Large ( more than five fully qualified FCIAs employed) Insurance Company Reinsurance Company University or College Unemployed Other Major Job Function Consultant Client Relationship Manager Executivee Finance/Financial Reporting Investment Management Pricing Product Development Reinsurance Risk Management Sales & Marketing Valuation Other Volunteering at the CIA Would you be interested in serving on a CIA committee and/orr task force, now or in the future? YES NO If yes, please complete the volunteer enrolment form in appendix A. It allows you to identify any committees or task forces on which you would like to service, and to manage the information that the CIA maintains in your file regarding your volunteer skills, experience, and interests. Page 5 of 6
Application Fee The fees below are valid from July 16, 2017 to October 15, 2017. Applications received during this period will be processed for the 2017/2018 membership year ending May 31, 2018. Fee Structure The payment of this application fee is for (applicant s name): Please select the fee of the membership status you are applyingg for: Fellow Associate >= 5 years Associate Affiliate Correspondent Total amount due: $650.00 $550.00 $192.50 $192.50 $192.50 $ ( + $300.00 processing fee) Note: fees are subject to change without notice. Payment Options (Please note: for security reasons, applicants should never e mail their credit card information) Online please click heree or https://www.cia-ica.ca/reinstatementapplication By cheque (payable to the Canadiann Institute of Actuaries) By phone please call the membership department at 613 236 8196 ext. 102 Office Use ID# CHQ #: REC: MEMBER TYPE: Page 6 of 6