THE INSTITUTE OF CHARTERED SECRETARIES AND ADMINISTRATORS INTERNATIONAL QUALIFYING SCHEME IQS *APPLICATION FOR ( ) NEW STUDENT REGISTRATION ( ) RE-REGISTRATION AS A STUDENT * Please tick where applicable AFFIX A RECENT PASSPORT SIZE PHOTOGRAPH HERE To: THE INSTITUTE OF CHARTERED SECRETARIES AND ADMINISTRATORS (ICSA) I submit my registration to pursue the International Qualifying Scheme (IQS) and comply with the regulations as a student of ICSA. I confirm that the information given is accurate and to the best of my knowledge. Name (As in NRIC/Permit) Have you previously registered as a student of ICSA? Yes No If YES, please give details below: First registration date: Student registration No. To Be Completed By Referee I hereby recommend the abovenamed for registration as a student of ICSA. In my opinion, the applicant is a fit and proper person for admission to pursue the IQS Qualification. I have known him/her for years. Name (In block letters) Designation: Telephone: (Office) Organisation: (The signatory should preferably be a member of SAICSA, or the Company Secretary of the applicant s company, immediate supervisor of applicant s department, or the head of school/department of a recognised tertiary institution.) For Official Use: Registration Date Intake Diet Module (s) Registered Approved By Student Registration Number New Registration Re-Registration Remarks Qualifications Awarded By No. of Exemptions Exempted Module(s) Checklist: Enclosed recent passport-sized photograph Completed all relevant sections of the application Enclosed Photocopy of Identity Card/Employment Card Personal Data Protection Act (PDPA) consent form signed Enclosed Exemption Reply (email) Exemption fee and Examination fee paid Enclosed certified copies of educational certificates and transcripts Page 1/5
PERSONAL PARTICULARS Name (as in NRIC/Permit) [Mr/Miss/Mdm] Underline Surname Home Address: Mobile: Office : Home E-mail (Personal-Compulsory) E-mail(Office) NRIC No: Nationality: Race : Religion : Fin No: Date of Expiry: Country of Origin: (Singapore PR/Permit Holders) Date of Birth: Age: Gender: Marital Status : CURRENT EMPLOYMENT Job Title: Working Experience: Organisation: Date of Commencement: Address: Tel: Fax: Nature of Business: PREVIOUS EMPLOYMENT Job Title: Working Experience: Organisation: Nature of Business: Please tick the appropriate box to indicate your employing organisation:- Public Listed Company Professional Firm Private Limited Company Law Civil Service Accountancy Statutory Board, please specify: Corporate Secretarial Education Management Consultancy Financial Institution Insurance Others (Please specify): Please indicate main area of activity of your current job: Accounting Human Resource Banking Insurance Corporate Planning Internal Audit Corporate Secretarial Practice / Corporate Governance Property Administration Education Share Registration Financial Management Others (Please specify): Page 2/5
(Certified true copies of relevant educational qualifications must be submitted) Professional Qualifications Awarding Body Full-time / Parttime Completion Date of Admission to Membership University Master/Bachelor Degree Awarded Full-time/ Part- time Graduation Local Polytechnic /Other Diploma Awarded Full-time/ Part- time Graduation EXEMPTION (Complete this section if you are eligible for exemption) Please tick your exempted module (s) Professional Part I Strategic and Operations Management Financial Accounting Singapore Taxation Corporate Law Corporate Financial Management Applicable to Route 2 Only* Note: Scan in your qualifications - to education@csis.org.sg for admission eligibility and exemptions review. - Diploma / Degree (Certificates and Transcripts) - Membership Certificate if any Exemptions given will be based on educational qualifications and not based on working experience. Partial or incomplete qualifications will not be entitled for any exemptions. If the supporting qualifications is in a language other than English, the applicant will need to provide a translation of the qualifications. Page 3/5
New Admission Criteria (Complete this section if applicable) 1. With effect of 1 st Jan 2016, applicants who have one of the following qualifications: Accountancy Degree from a recognised University ; Member in one of the following Professional Accountancy Bodies: ACCA (Association of Chartered Certified Accountants) CIMA (Chartered Institute of Management Accountants) CIPFA (Chartered Institute of Public Finance Accountants) ICAEW (Institute of Chartered Accountants England & Wales) ICAI (Institute of Chartered Accountants Ireland) ICAS (Institute of Chartered Accountants Scotland) CPA (Certified Practising Accountant) Will have an option of Route 1 or Route 2 to complete the examination requirements of the ICSA International Qualifying Scheme. 2. Only one relevant educational qualification will be considered for either route. 3. No changes of the routes of entry to ICSA International Qualifying Scheme will be allowed after the registration. 4. Students who register the entry point under Route 2 will have to pass the Corporate Law subject in ICSA Professional Programme Part I before proceeding to ICSA Professional Programme Part II. Route 1 Route 2 ICSA IQS Professional II Corporate Administration Corporate Financial Management Corporate Governance Corporate Secretaryship ICSA IQS Professional Programme I Corporate Law ICSA IQS Professional Programme II Corporate Administration Corporate Governance Corporate Secretaryship Only applicable for those who are given the option of Route 1 / Route 2 I decide to register Route for ICSA International Qualifying Scheme. I fully understand that I am not allowed to make any changes of the route after the registration. Name Chartered Secretaries Institute of Singapore (CSIS) 149 Rochor Road, #04-05 Fu Lu Shou Complex, Singapore 188425 Tel: 6334 4302 Fax: 6334 4669 E-mail: students@csis.org.sg Website: www.saicsa.org.sg Page 4/5
PERSONAL DATA PROTECTION ACT 1. In compliance with the Personal Data Protection Act ( PDPA ), Chartered Secretaries Institute of Singapore ( CSIS ) seeks your consent to collect, use and disclose your personal data (i.e. Name, NRIC, contact numbers, mailing and email addresses) in order to maintain the CSIS registry of students and to disclose such personal data to CSIS s affiliated organisations where necessary ( Purposes ). 2. CSIS will collect, use and disclose your personal data to provide you with information on studentship, examination and activities such as upcoming events, seminars, workshops, conferences and training programmes organised by CSIS and its affiliated organisations which may be relevant to you ( Services ). 3. CSIS respects your privacy and assures that your personal data will be kept securely according to PDPA. CONSENT FORM 1. I hereby acknowledge and give my consent to CSIS to use my personal data for the aforesaid Purposes and Services. 2. In the event that I have registered my Singapore telephone numbers(s) with the Do Not Call Registry and wish to withhold or withdraw my consent to CSIS in respect of receiving telephone calls and/or SMS, I endeavour to provide sufficient notice to CSIS of such as soon as reasonably practicable. I further agree to indemnify CSIS against any financial penalties imposed by the Personal Data Protection Commission or any court of law in Singapore as a direct or indirect result of my failure to inform CSIS of my registration with the Do Not Call Registry. 3. I agree that my consent will remain in place until my withdrawal by officially notifying CSIS in writing at students@csis.org.sg. Name : (Full Name as in NRIC) NRIC No. / FIN.No. : Contact No. : Email : Signature : Date : IQS Page 5/5