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READMISSION APPLICATION
FOR ASSOCIATES
2014 SPECIAL OFFER
PLEASE READ THESE INSTRUCTIONS CAREFULLY
You can enter your details directly into the application form on your computer and then send us a printed and signed copy.
We recommend that you keep a copy for your own records.
WHAT IS THIS APPLICATION FOR?
This application will help determine your eligibility for membership if you were a previous member of CPA Australia and your membership fee is overdue by
more than 12 months.
If your membership fee is overdue by less than 12 months, please contact your nearest CPA Australia office to make payment.
You will find a list of our offices on the CPA Australia website at cpaaustralia.com.au/contact
CONDITIONS FOR READMISSION
As a former member you must:
• submit a completed readmission form
• pay the application fee and the membership fee. Apply before 30 November 2014 and we will waive the application fee.
• satisfy the criteria for readmission
• provide evidence that you hold a degree if membership has ceased for 5 years or more
• complete 20 hours of CPD in the 12 months after readmission if you do not work with a Recognised Employer. A list of Recognised Employers can be found
on the CPA Australia website at cpaaustralia.com.au/employerpartners
Public Practitioners are subject to regulation and have additional training needs and responsibilities. For further information, please visit
cpaaustralia.com.au/publicpracticecertificate
In accordance with CPA Australia's Constitution and By-Laws, the Board of CPA Australia may waive or vary any of the above conditions generally or in a particular case
or refuse to accept any application for readmission.
IF YOU NEED HELP OR MORE INFORMATION
Please contact your nearest office directly. You will find a list of our offices on the CPA Australia website at cpaaustralia.com.au/contact
SEND US YOUR APPLICATION
There is an application fee for your assessment
There is a non-refundable fee to assess your application. Apply before 30 November 2014 and we will waive this fee.
We accept applications throughout the year
You can:
• scan* and email it to ma.comms@cpaaustralia.com.au, or
• mail your application to the address on page 5, or
• take your application to your nearest office. You will find a list of our offices on the CPA Australia website at cpaaustralia.com.au/contact
*Scanned copies of certified documents must be in PDF format. We will not accept JPEG, GIF, TIFF or any other types of digital image file formats. It is the applicant's
responsibility to ensure that all scanned copies of documents are clear and legible. If not, this may delay your assessment and possible enrolment in the CPA Program.
Incomplete applications cannot be processed.
2 | Readmission application for Associates 2014 Special Offer
(A) YOUR PERSONAL DETAILS
Former member
number (optional)
Title
First name
Last name
Preferred name (optional)
Date of birth
Gender
Male Female
Home address
Suburb or city
Postcode/ZIP
State, Province
or Region
Country
Home phone
Mobile/Cell
Are your membership fees overdue by more than 12 months?*
Yes Please complete this form
No You do not need to complete this form. Please contact CPA Australia by phone to renew your membership.
*membership fees are due on January 1 each year.
YOUR ADDRESS DETAILS
!
If your mailing address is the same as your home address, please ignore this section.
Mailing address
Suburb or City
Postcode or ZIP
State, Province
or Region
Country
YOUR EMPLOYMENT CONTACT DETAILS
!
If you are not currently employed, please ignore this section.
Organisation name
Position title
Address
Suburb or City
Postcode or ZIP
State, Province
or Region
Country
YOUR COMMUNICATION PREFERENCES
We need your email address to send your assessment result and other important information.
This is mandatory. Please ensure that your
email address is written clearly.
Email address
Which is your
preferred phone
number?
Home Mobile/Cell Please choose one only.
3 | Readmission application for Associates 2014 Special Offer
BACKGROUND INFORMATION – FITNESS TO BECOME A MEMBER
All of these questions must be answered for your assessment.
Have you ever been convicted in the past of a criminal offence or are there any charges pending against you?
Yes No
There is no requirement to reveal a spent conviction. A conviction is a spent conviction if it is 10 years or more since the date of the conviction (5 for a juvenile), and the
sentence imposed was a fine, bond, community service order or imprisonment for a period of less than 30 months and there have not been any further offences in the
last 10 years.
Are you or have you ever been made bankrupt or made the subject of an official assignment for the benefit of creditors?
Yes No Are you or have you ever been a director of a company to which a receiver, receiver manager, an enforcer of a security interest, provisional liquidator or liquidator
has been appointed while you were a director or within six months after you ceased to be a director?
Yes No
Have you been or are you disqualified from managing a corporation or banned from being a director of a corporation?
Yes No
Have you ever been refused membership to a professional body for which you have the appropriate academic qualifications?
Yes No
Have you ever had to forfeit your membership of a statutory, professional or other body?
Yes No
Are you or have you ever been the subject to disciplinary proceedings by a statutory, professional or other body?
Yes No
Are you acting as a principal in public practice, holding yourself as being a principal in public practice, or undertaking any public accounting services in your own right,
either within Australia or New Zealand, or for Australian or New Zealand clients?
Yes No
If so, you must have the appropriate academic qualifications, licences and professional indemnity insurance to comply with CPA Australia regulations.
Public accounting services include any accounting, bookkeeping, taxation, auditing and assurance services, insolvency and corporate reconstruction, management
accounting, financial planning or financial reporting activities performed for government, the public or business, excluding in the capacity as an employee.
Public practitioners are subject to regulations and have additional training needs and responsibilities.
The requirements do not diminish in any way the Applicant’s obligation to disclose any matter that may bear upon their fitness for admission or continuing membership.
!
If you answered “Yes” to any of these questions
Please provide more information about the nature of your situation on a separate sheet and any related official documentation to support your application.
If you answered "Yes" to providing public accounting services, please provide details of your role and ownership of the business, outline services offered to
the public and classification of the accounting services your business provides.
Attach supporting documents to this application and mail to:
General Manager, Membership
CPA Australia
GPO Box 2820
Melbourne VIC 3001
AUSTRALIA
Your application will be considered individually on its merits and may take longer to process.
4 | Readmission application for Associates 2014 Special Offer
(B) DECLARATION
I have read the Privacy Policy and Statement at cpaaustralia.com.au/privacypolicy and consent to my personal information being collected, held, used and disclosed in
the manner and for the purposes stated there.
I declare that:
• I am not aware of any further matter that may be relevant to your assessment of my qualifications and whether I am a fit and proper person to be a member of
CPA Australia.
•
If readmitted as a member, I will continue to be a fit and proper person and will disclose any circumstance(s) that affect this requirement.
•
I warrant that my supporting documentation has not been altered prior to certification or prior to submitting my documentation in digital form.
•
I have arranged certification of my supporting documentation by a person authorised to certify documents in accordance with the guidelines of this application.
•
If requested by CPA Australia, I will provide my original documentation and/or the original certified copy of my documentation.
•
The information and the answers I have provided to any questions are complete and accurate and I will, if anything alters in the future, notify CPA Australia.
•
If readmitted as a member, I will be bound by CPA Australia’s Constitution, By-Laws, Code of Professional Conduct and applicable Regulations of the Board from time
to time in force.
•
I authorise CPA Australia to obtain any information from any person or entity about me as it considers necessary in order to process my application and to service and
maintain my membership. I authorise such person or entity to release this information to CPA Australia.
•
If readmitted as a member I acknowledge that, unless I meet the requirements of CPA Australia, I am not permitted to act as a principal in public practice or hold myself
out as being a principal in public practice, or undertake any public accounting services in my own right.
•
CPA Australia has the right to assess my application and vary my level of membership accordingly.
•
I will undertake and keep a record of my continuing professional development obligations (currently 120 hours over a three-year period [triennium] with a minimum of
20 hours in any one year)
Signature
Date
/
/
Members must comply with CPA Australia's Constitution, By-Laws, Codes of Conduct and Regulations. These can be found at cpaaustralia.com.au/memberconduct.
Failure to comply may expose a member to disciplinary conduct.
(C) HOW TO PAY
HOW MUCH IS THE APPLICATION FEE?
There is a non-refundable fee to assess your application. You can pay this fee by credit card, cheque or bank draft.
If your home address is in Australia
Fee
Readmission application
AUD$160 (Waived – 2014 Special Offer)
HOW MUCH IS THE ASSOCIATE MEMBERSHIP FEE?
If your home address is in Australia
The full year fee is...
2015 Associate membership*
AUD$310 (GST inclusive)
*Applications received on or after 1 October 2014 will receive the remainder of 2014 membership for free
If your home address is in Hong Kong, New Zealand, Malaysia, Singapore or the United Kingdom – local currency equivalents apply. To find your applicable fee in your
local currency, please go to: cpaaustralia.com.au/fees*
If your home address is in any other location, fees are to be paid in Australian dollars (exclusive of GST). To find your applicable fee, please go to cpaaustralia.com.au/fees*
*all prices are subject to change.
5 | Readmission application for Associates 2014 Special Offer
IF YOU ARE PAYING BY CREDIT CARD
Payment method
Card Type
Credit card Cheque: Make payable to ‘CPA Australia Ltd’.
CPA Australia American Express AMEX Visa MasterCard Diners
Name on card
Application fee
Total amount
Waived – 2014 Special Offer*
Membership fee
Card number
Expiry date
/
I authorise CPA Australia to debit my credit card for this total amount.
Cardholder's
signature
Date
/
/
Please ensure card numbers are entered clearly and correctly.
Please print and sign. We do not accept digital signatures.
Please note, if there are other fees or charges outstanding, you will be advised as part of the readmission process.
*CPA Australia retains full discretion in granting this offer.
IF YOU ARE PAYING BY CHEQUE
Your cheque should be made payable to “CPA Australia Ltd”.
Personal cheques will only be accepted if drawn from an Australian or New Zealand bank account unless paying directly to our offices in Hong Kong, Malaysia, Singapore
or the United Kingdom. You will be liable for any fees incurred from a dishonoured cheque.
If you are paying from outside of Australia, the bank draft must nominate a corresponding Australian bank through which we can process the payment.
You will be liable for any fees incurred from a dishonoured cheque.
Tick this box if you are paying by cheque and staple your cheque to this page
WHERE TO SEND YOUR APPLICATION
Your application and documents can be:
• scanned* and emailed to ma.comms@cpaaustralia.com.au, or
• mailed to the address below, or
• brought to your nearest CPA Australia office listed on the CPA Australia website at cpaaustralia.com.au/contact
CPAH1163_10.2014
*Scanned copies of certified documents must be in PDF format. We will not accept JPEG, GIF, TIFF or any other types of digital image file formats. It is the applicant's
responsibility to ensure that all scanned copies of documents are clear and legible. If not, this may delay your assessment and possible enrolment in the CPA Program.
YOUR LOCATION
MAIL YOUR APPLICATION TO
Australia & all other locations
CPA Australia
Member Advisory and Information Services
GPO Box 2820
Melbourne VIC 3001
AUSTRALIA
Telephone: 1300 73 73 73 (in Australia) or + 61 3 9606 9677 (outside Australia)