2011 Application for admission under the mutual recognition agreement

with the Chartered Institute of Management Accountants (CIMA)

Level of membership I am applying for: CPA FCPA

A. Your details
A1 Your personal details Title: Family name: First name: Middle name: Preferred name: Date of birth: Mr Ms Miss Mrs Other

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D D M M

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Y Y

A2 Your home contact details

This is my preferred mailing address (please tick)

Home address: Suburb: Postcode: Home phone: Country: State:

Mobile:

A3 Your employment contact details Position title: Company name: Company address: Suburb: Postcode: Work phone: Country:

This is my preferred mailing address (please tick)

State:

Work fax:

A4 Your email address Preferred email Please supply an email address to receive important membership information

A5 Your CIMA membership number

B. Identification requirements B1. 100 points identification requirements

For proof of identity, you need to provide us with a minimum of 100 points of identification from the list below AND each piece of identification provided must be certified as a true copy of the original See the Applicant Guide for more information and tick the relevant boxes Type of identification Birth Certificate Citizenship Certificate Passport National Identity Card Points 70 70 70 70 Type of identification A written reference Licence issued under law Permit issued under law Public Service ID Card Points 50 40 40 40 Type of identification Social Security ID Card Tertiary Student ID Card Australian Medicare Card Credit or other Bank Card Points 40 40 25 25

B2. Background information

Please answer these questions to help us determine your eligibility as a member. (i) have you ever been convicted in the past of a criminal offence, notifiable offence or are there any pending charges against you? Yes Yes Yes Yes Yes No No No No No

(ii) are you, or have you ever been a debtor in any Sequestration Order, Deed of Assignment Composition, or Deed of arrangement, under the provisions of the Bankruptcy Act? (iii) are you, or have you ever been a Director of a Company to which a Receiver, a Provisional Liquidator, a Liquidator, a Scheme Manager, or an Official Manager has been appointed while you were a Director, or within six months after you ceased to be a Director? (iv) have you ever been refused membership, or had membership forfeited, of a statutory, professional or other body? (v) have you ever been subject to disciplinary proceedings by a statutory, professional, academic institution or other body which may have bearing on your professional capacity?

If you have answered YES to any of these questions, your application will be considered on its merits. Please provide details on separate sheets and attach them to this application form and mail to the General Manager, Membership. Refer to the Applicant Guide for details.

B3. Declaration
Please read the following and sign. I apply for membership of CPA Australia Ltd (CPA Australia) and agree to the terms and regulations as detailed in the Application Guide. I hereby declare that: I am a member of CIMA and I am in good standing for membership with CPA Australia under the terms of the Mutual Recognition Agreement. I give permission for CPA Australia to contact CIMA to verify my documentation and to confirm that I have maintained my membership with both bodies annually. I agree to maintain membership of both CPA Australia and CIMA. If admitted as a member, I shall be bound by CPA Australias Constitution, By-Laws, Code of Professional Conduct, Professional and Technical Standards and Pronouncements of the Board in force or which may hereafter from time to time be in force.* I may be required to provide additional information or clarification of any matter concerning this application and will do so within ten business days of receipt of a request from CPA Australia. CPA Australia has the right to vary or cancel an application or subsequent enrolment made on the basis of incorrect or incomplete information. I will undertake, and keep a record of my Continuing Professional Development obligations (120 hours per triennium, with a minimum of 20 hours per year). I acknowledge that CPA Australia has an online CPD Diary which can electronically record my CPD hours. I can view and update this diary at any time via cpaaustralia.com.au/cpddiary Completion of the CPA Australias CPD requirements will also satisfy CIMAs CPD requirements. I will report annually to both CIMA and CPA Australia with respect to CPD requirements. I have read the Privacy Statement in the CPA Australia Applicant Guide and I consent to my personal information being collected, used and disclosed for the purpose outlined as stated in the Privacy Statement. The information provided in this application (including any attachments) is true and correct and I make it in the understanding that a person making a false declaration is liable to the penalties of perjury. Applicants Signature Date
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M M

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Y Y

*The Constitution of CPA Australia, Code of Professional Conduct and other documents which bind members, may be inspected at any office of CPA Australia. They are available to every member via cpaaustralia.com.au

C. Privacy statement
CPA Australia is committed to protecting your privacy and the confidentiality and security of personal information provided by you to us. You have the right to access any such information held by CPA Australia which relates to you and to correct information which is inaccurate. Access and/or correction requests can be made at your local CPA Australia office or via the Update your profile service at cpaaustralia.com.au The information you provide us in this Application Form will be used to process your application. For more information on CPA Australias Privacy Policy, please refer to the full Privacy Statement in the Applicant Guide. If you do not want us to pass on your information to our business and marketing partners, please tick this box.

D. How to pay
D1. Calculate your fees payable Fees are outlined in the Applicant Guide and must be calculated in Australian dollars (AUD). Application fee $ + Membership fee $ = Total Fees Payable $

D2. Pay your fees by cheque or credit card I am paying by Cheque (make payable to CPA Australia Ltd and staple to your application form) I am paying by Credit card as ticked Cardholders name Credit card number Expiry date CVV code AMEX MasterCard Visa Diners

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M M Y Y

Total

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D D M M

Cardholders signature

Date

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Y Y

E. Checklist & mailing your application

For CPA Australia to process your application efficiently, please ensure you complete all sections of the application form and attach certified true copies of each item on the checklist. Answered all questions, signed and dated the Declaration on page 2 Attached 100 points of identification Provide payment details or attach a cheque for your admission and membership fee Attached your letter of good standing from CIMA (see Applicant Guide for details required in the letter) Change of name document if the name on your other documents is not the same as that on your Application for Admission form Applications must be mailed (not faxed) to the following address: CPA Australia Member Advisory & Information Services GPO Box 2820 Melbourne VIC 3001 Australia

F. Certified true copies

Documents will not be returned to you after assessment so we require that you submit certified true copies of your original documentation. For more information regarding the preparation of these documents please refer to the applicant guide.

Applicant guide
2011 Application for admission as a CPA/FCPA under the mutual recognition agreement with the Chartered Institute of Management Accountants (CIMA)
This document should be read in conjunction with Application Form for Admission under the Mutual Recognition Agreement with the Chartered Institute of Management Accountants (CIMA). Please retain this Applicant Guide for future reference. Do not submit with your Application Form. This form is relevant only for new members wishing to apply under the terms of the Mutual Recognition Agreement between CPA Australia and CIMA.

A. Your details
A1. Your personal details Ensure that you complete your personal details correctly on the form. If you have a preferred alternative first name, please include this information. If your name is different to any of your documents, please provide certified proof of change of name documentation (eg marriage certificate, government issued change of name documents). A2. & A3. Your home and employment details Ensure that you provide your home and employer address details in full (including suburb and postcode). Please tick only one address as your preferred mailing address. All mail will be sent to this address, including membership confirmation. Please do not enter a post office box if you do not live in Australia. A4. Your email address

Please ensure you supply an email address to receive important membership information. You must update your personal information with CPA Australia if it changes.

B1. 100 points identification requirement

Examples of 100 points identification:

Birth certificate (70) + drivers licence (40) = 110 points Drivers licence (40) + VISA card (25) + AMEX card (25) + Australian Medicare Card (25) = 115 points National identity card (70) + written reference (50) = 120 points B2. Background information

All questions must be answered for membership evaluation. Each application will be considered individually on its merits and the processing of your application may take longer than anticipated. If you answered yes to any of these questions, please provide details on a separate sheet together with your application and mail it in a sealed envelope to the General Manager, Membership at the Australian address listed on page iv. B3. Declaration Please ensure that you have read and answered the questions regarding your eligibility. CPA Australia will confirm your membership details with CIMA on a regular basis. Ensure you read the Declaration in full, and sign and date the application form. Application forms that are received by CPA Australia without being signed and/or dated, will be returned to the applicant for completion.

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Passport (70) + student travel concession card (40) = 110 points

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Please ensure you provide certified true copies of all identification documents (refer page iii for information on document certification). You must submit identification documents totalling at least 100 points.

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B. Identification requirements

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Once your application has been processed, you can easily update your profile by using the following link cpaaustralia.com.au/updateyourprofile

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C. Privacy statement
CPA Australia Ltd (CPA Australia) is committed to protecting the privacy and security of your personal information. The personal information you provide will be used by CPA Australia to: Process your application form for membership with CPA Australia Record your membership details and profile information Manage your membership of CPA Australia Ensure you comply as a member with CPA Australias Constitution and By-Laws Conduct market research in order to identify and analyse the ongoing needs of CPA Australia members Provide you with access to the information about a range of current and future membership benefits. Notify you about CPA Australia events Aggregated and used for internal review to analyse trends and statistics CPA Australia may disclose the personal information you provide to: CPA Solutions business and marketing partners so that they may contact you about their products and services. For a full list of CPA Solutions business and marketing partners see the CPA Australia website cpaaustralia.com.au External service providers whom we have contracted out functions such as printers, mailing houses and IT companies, but only for the purposes of processing your application, and CIMA and regulatory bodies Universities and other education providers, professional bodies, Governmental Departments ie. the Department of Immigration and Citizenship, Australian Educational International - National Office for Overseas Skills Recognition and Department of Education, Employments and Workplace Relations. The personal information you provide will be treated by us in the following ways: Your personal information may be transferred or stored outside the country where the information was collected for the purposes stated above

D. How to pay
D1. Calculate your fees payable

Your fees payable include a membership fee and application fee. All fees are quoted in Australian dollars.

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Determine your total Membership Fee for 2011

Australia preferred address (GST Incl) Half Year If paying after 1 Jul 11
138.00 299.00 437.00

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New Zealand preferred address (NZGST Incl) Full Year If paying before 30 Jun 11
144.00 626.00 770.00

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You may also request the correction of information which is inaccurate. Access and/or correction request can be made at your divisional CPA Australia office or visit the Update your Profile service at cpaaustralia.com.au CPA Australia processes membership and other payments using EFTPOS and online technologies. All transactions processed by CPA Australia meet industry security standards to ensure members details and payments are protected. For more information about our security procedures and payment processes contact +61 3 9606 9606. For more information on our Privacy Policy, visit our website cpaaustralia.com.au

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You have the right to access any personal information which CPA Australia holds about you, subject to exception in any applicable privacy legislation

Overseas preferred address Full Year If paying before 30 Jun 11

125.00 545.00 670.00

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Full Year If paying before 30 Jun 11

138.00 599.00 737.00

Half Year If paying after 1 Jul 11

144.00 313.00 457.00

Half Year If paying after 1 Jul 11

125.00 272.50 397.50

Application Fee (one off) CPA Membership Fee

Total CPA Membership Fee Notes:

i. All prices are quoted in Australian dollars (AUD). ii. If your preferred mailing address is in either Australia or New Zealand you must pay GST on your membership fees. iii. Membership fees for those residing in New Zealand are quoted in Australian dollars and include the 15% NZ GST. iv. Applications received by CPA Australia between 1 January and 30 June must pay full year membership fees. Only applications lodged on or after 1 July are eligible for half year fees. v. The application fee is a once only non-refundable fee payable with all applications for membership. vi. Your CPA Australia membership expires on 31 December 2011, regardless of your joining date. You will receive a renewal notice in late 2011 advising you of membership details for 2012. vii. CVV Code stands for Credit Card Validation (or verification) value. The CVV is a 3 or 4 digit code embossed or printed on the reverse side of the Mastercard or Visa cards, and on the front of American Express cards.
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D2. Pay your fees by cheque or credit card You can pay your fees by cheque or credit card. Please make cheques payable to CPA Australia Ltd and if you are paying from outside of Australia the bankdraft must nominate a corresponding Australian bank through which we can process the payment. Personal cheques will only be accepted if drawn on an Australian bank account. Please note, you will be liable for any fees incurred from a dishonoured cheque. If you are paying by credit card please ensure that the card number is written correctly and that you include the expiry date and CVV number.

E. Checklist & mailing your application

For CPA Australia to process your application efficiently, please ensure you complete all sections of the application form and attached certified copies of each item on this checklist: Answered all questions, signed and dated the Declaration Attached your 100 points of identification as outlined in B Identification Requirements Provided payment details or attached a cheque for your admission and membership fee as outlined in D How to Pay Attached your letter of good standing from CIMA. You will need to request the letter to contain the following: date joined date advanced to current membership status date current membership is paid to advice as to whether you are a member of CIMA by virtue of another MRA and if so, which one confirmation you are not currently under any disciplinary sanctions or investigations and have not been subject to any disciplinary sanctions in the past 5 years.

Please mail your Application Form (including documents and fees payable) to the address below. Please note, faxed applications will not be accepted. CPA Australia Member Advisory and Information Services GPO Box 2820 Melbourne VIC 3001 Australia

F. Certified true copies

an Australian CPA/FCPA (this person cannot be an Associate member) a solicitor, lawyer, dentist, medical practitioner, pharmacist, veterinary surgeon, bank manager, school principal, registered migration agent a police officer, sheriff or sheriffs officer a notary officer a full member of a recognised IFAC professional body as listed on http://www.ifac.org/about/member_bodies

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2. Take your original documents and photocopies to one of the following recognised authorities and have each page certified with a signature, contact details, capacity and registration number of the certifier and date sighted. The certification must be dated no longer than 12 months ago. a Justice of the Peace

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1. Photocopy your original documents.

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All documents provided must be copies of original documents certified as true. Do not submit original documents as they will not be returned. Certified as true (or notarised) copies are photocopies of your original documents that have been confirmed as true copies of the originals.

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Please include a certified true copy of change of name document if the name on your other documents is not the same as that on your Application for Admission form.

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G. CPA Australia divisional offices and contact details

For further information please call or write to your nearest office Australia Member Advisory & Information Services CPA Australia Level 20, 28 Freshwater Place Southbank VIC 3006 AUSTRALIA Phone: 1300 73 73 73 Fax: 1 300 78 76 73 (Australia Only) International fax: +613 9606 9844 Email: mais.admission@cpaaustralia.com.au Mainland China Beijing CPA Australia Units 307308B, Level 3 Office Tower C2, Oriental Plaza 1 East Chang An Avenue Dong Cheng District Beijing 100738 CHINA Phone: +8610 8518 5575 Fax: +8610 8518 7001 Email: beijing@cpaaustralia.com.au Mainland China Shanghai CPA Australia Suite 1407, 14/F CITIC Square 1168 Nanjing West Road Shanghai 200041 CHINA Phone: +8621 3218 1860 Fax: +8621 5292 5589 Email: shanghai@cpaaustralia.com.au Hong Kong CPA Australia 20/F Tai Yau Building 181 Johnston Road Wanchai HONG KONG Phone: +852 2891 3312 Fax: +852 2832 9167 Email: hk@cpaaustralia.com.au New Zealand CPA Australia 39 Market Street Viaduct, Auckland NEW ZEALAND 1011 Phone: +64 9913 7450 Fax: +64 9914 8790 Email: nz@cpaaustralia.com.au

Mainland China Guangzhou CPA Australia Room 1714-15 Main Building Guangdong International Hotel 339 Huanshidong Road Guangzhou 510098 CHINA Phone: +86 20 2237 2846 Email: guangzhou@cpaaustralia.com.au

Singapore CPA Australia 1006 StarHub Centre 51 Cuppage Road SINGAPORE 229469 Phone: +65 6836 1233 Fax: +65 6836 2722 Email: sg@cpaaustralia.com.au

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Mainland China Macau CPA Australia Rua Dr Pedro Jose Lobo 1-3A Luso International Bank Building 14th Floor, Room 1404-1405 MACAU Phone: +853 2838 9207 Fax: +853 2857 9238 Email: macau@cpaaustralia.com.au

Vietnam Hanoi CPA Australia Press Club Building Suite 432 4th Floor 59A Ly Thai To Street Hanoi VIETNAM Phone: +84 4 3936 0431 Fax: +84 4 3934 4301 Email: hanoi@cpaaustralia.com.au Vietnam Ho Chi Minh City CPA Australia Unit 717-3, 7th floor, Melinh Point Tower 2 Ngo Duc Ke Street, District 1, Ho Chi Minh City VIETNAM Phone: +84 8 3520 2824 Fax: +84 8 3823 7840 Email: hochiminh@cpaaustralia.com.au

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Europe CPA Australia Australia Centre, The Strand London, WC2 B4LG UNITED KINGDOM Phone: +44 20 7240 8266 Fax: +44 20 7240 3452 Email: europe@cpaaustralia.com.au

Malaysia CPA Australia Suite 10.01, Level 10 The Gardens South Tower Mid Valley City Lingkaran Syed Putra 59200 Kuala Lumpur MALAYSIA Phone: +603 2267 3388 Fax: +603 2287 3030 Email: my@cpaaustralia.com.au

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CPA170230 10/2010

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