This Form and Its Appendices, Once Duly Filled Out

APPENDIX 1

APPLICATION FOR ACCREDITATION OF A PROFESSIONAL DEVELOPMENT ACTIVITY
FOR providers

The course provider must send the following documents via emailto the Chambre de la sécurité financière (CSF)or to the Institut québécois de planification financière (IQPF) for every course targeted by the accreditation application:

This form and its appendices, once duly filled out

The instructors’ career résumé

If you wish to fill out a common form for the CSF and the IQPF:

Check both organizations in the "Application filed with" field

Email all required documents to the CSF and the IQPF.

Email address for the CSF:

Email address for the IQPF:

Application filed with: / CSF
IQPF

If the activity has been accredited in the past, please state former number:

CSF accreditation number: / CSF--
Former IQPF accreditation number: / IQPF---

Course provider identification

Name of course provider:
Address:
City:
Province:
Postal code:
Telephone number:
Fax number:
Email address:
Website address:

ACC-A-017-ang1

Type of organization

Training organization
Independent course provider (individual)
Educational institution recognized by the Ministère de l’Éducation, du Loisir et du Sport du Québec (MÉQ) (university, cégep or other)
Personal insurance company
Group insurance company
Mutual fund dealer
Scholarship plansdealer
Firm in financial planning
Others, specify:

Contact information

Ms. Mr.
First name:
Last name:
Address (if different from that of the course provider):
City:
Province:
Postal code:
Telephone number:
Fax number:
Email address:

Identification of the instructor(s)

To be filled out for as many instructors as applicable (attach a document to the application if there is more than one instructor)

Name of instructor:
Company or organization:
Address (if different from that of the course provider):
City:
Province:
Postal code:
Telephone number:
Fax number:
Email address:
Website address:
Career résumé: / Attach the instructor’s career résuméto the application
For applications filed with the IQPF, please specify whether your instructor is a financial planner: / Yes No

By completing this section, you confirm that the instructor chosen to offer the training activity for which you are applying for recognition has:

The related knowledge

The required experience

The capacity to transmit the knowledge

Name:
Date:

Iunderstand that selecting this check box constitutes my legally binding signature.

Identification of the professional development activity

Activity title in French:
Activity title in English:
When would you like the accreditation of your training activity to start(yyyy-mm-dd):
Your training activity is offered in: / French
English
Has your course been accredited or will it be accredited with other organizations? / Yes No
If so, which ones?
Is the training activity being offered: / Once or multiple 1 year 2 years
Is this training activity only offered to people who are part of your organization? / Yes No
Regions where the activity is being offered
All
Eastern Abitibi
Lower St. Lawrence, Gaspé Peninsula and Magdalen Islands
Beauce-Amiante
Drummond-Athabaska
Duplessis
Eastern Townships
Grande-Mauricie
Haute-Yamaska
Lanaudière
Laurentians / Laval
Manicouagan Manicouagan »
Montreal
Outaouais
Québec
Richelieu-Longueuil
Rivière-du-Loup
Rouyn-Noranda
Saguenay-Lac-Saint-Jean
Southwestern Quebec
Is there a registration fee? / Yes No
If so, how much? $

Brief description of the training activity:

Would you like the training to be listed on the IQPF’s website? / Yes No
If so, please supply us with a brief description. If your activity is bilingual, you must also provide us with an English version.
Description of the activity in French:
Description of the activity in English:
If you would like us to post a contact email address on our website with the description of your course, please enter it here:

Type of activity:

Classroom course
Symposium, lecture, convention
Distance education course / Webinar
Videoconference

Target audience:

Life and health insurance representatives
Group life and health insurance representatives
Group savings brokerage firm representatives
Scholarship plan brokerage firm representatives
Financial planners

Difficulty level:

Beginner / Intermediate / Advanced

Targeted subject(s) forthe CSF
Check the subject(s) addressed in your training activity.

General subjects

Management of a financial services firm
Civil Code
Accounting
Economics
Finance
Business planning for clients
Business planning for representatives
Financial planning
Tax planning
Actuarial science
Legal environment
Intestate and testamentary successions

Personal insurance

Client counselling
Underwriting or risk management
Disability insurance
Life insurance
Trusts
Risk management in personal insurance
Underwriting in personal insurance
Accident or health insurance plans
Segregated funds
Strategy of wealth accumulation and use
Financial needs analysis
Deferred income plan
Investor profiles and asset allocation
Investment strategy
Retirement and estate planning

Group insurance

Client counselling
Underwriting or risk management
Disability insurance
Life insurance
Group insurance and group pension plans
Benefits and underwriting in group insurance and group annuity plans
Setting up a group insurance and group annuity program
Preparinga rate schedule and analyzing group insurance and group annuity quotes
Preparing a group insurance and group annuity recommendation
Public and private plans
Processing group insurance claims

Group savings brokerage

Client counselling
Underwriting or risk management
Retirement and estate planning
Trusts
Strategy of wealth accumulation and use
Deferred income plan
Mutual funds
Investor profile and asset allocation
Investment strategy
Knowing the client
Registered plans

Scholarship plans

Client counselling
Underwriting or risk management
Investor profile
Knowing the client
Strategy of wealth accumulation and use
Scholarship plans

Compliance with standards, ethics and business conduct

Here is a non-exhaustive list, for information purposes only, of subjects that can be placed in this category:
Notions of ethics, code of conduct and professional ethics
Code of ethics of the Chambre/ Regulation respecting the rules of ethics in the securities sector
Disciplinary committee’s jurisprudence
Role of the syndic and investigation process
Role of the disciplinary committee and disciplinary process
Compliance notions and program
Legal and regulatory obligations of registrants
Legal and regulatory obligations of representatives
Laws and regulations concerning the practice of registrants and representatives
Others:

Targeted subjects for the IQPF

Legal aspects
Insurance
Finance
Taxation
Investment
Retirement
Estates
Training in compliance with standards, ethics and professional practice (SC)
Training in compliance with standards, ethics and professional practice related specifically to financial planning (SC-FP)

Complete activity description

Knowledge, competencies and professional skills

Identify the knowledge, competencies and professional skills that are expected to be developed via the activity and briefly explain how the activity will help develop the knowledge, competencies and skills (reference to the Regulation respecting the Professional Development of Financial Planners – Section 18 for the CSF and Section 16 for the IQPF).

Method of assessment:

For a distance training activity, describe the summative assessment and the required result that will confirm the participant’s success.

Course outline:

Fill out the attached course outline (Appendix 1A) by listing every topic and subtopic addressed, as well as the time breakdown for each and the objective(s) related to the topic. You may also create your own course outline with the same information.

Requested accreditation

Total activity duration (minimum 1 hr): / hr
Number of professional development units (PDUs) requested:
CSF subjects / Number of hours / Number of PDUs
General subjects
Personal insurance
Group insurance
Group savings plan brokerage
Scholarship plan brokerage
Compliance with standards, ethics and business conduct
Total
IQPF subjects / Number of hours / Number of PDUs
SFPA
SC
SC-FP
Total

To be completed only for a request for recognition from the IQPF

This course contains information that promotes specific financial products or services.
Yes.How many hours or minutes?
No

Statement

I, , confirm that all the information supplied in the present form is true and that I agree with every condition respecting training activity accreditation.
I, , have read the provider’s duties and obligations attached to the accreditation application and I agree to comply with these duties and obligations.
Date:
I understand that checking this box constitutes my legally binding signature.

APPENDIX 1A: TRAINING PLAN

Fill out this training plan by listing every topic and subtopic addressed, as well as the time breakdown for each and the objective(s) related to the topic. You may also create your own course outline with the same information.

Activity title:
General objective:
At the end of the training activity, the participant will be able to…
Specific objectives
States what the participant will be able to do at the end of the training activity. Contains anaction verb describing an observable behavior / Elements of content
Topics addressed by the training activity with respect to the specific objective / Learning strategy
e.g.,lecture, practical exercises, group discussion, team workshop, case studies, etc. / Teaching material
e.g., PowerPoint, textbook, tools, exercise book, etc. / Duration
For each element of content / Subjects*
CSFGLHILHIGSBCOSPBGS
IQPFSCSC-FPSFPA
CSFGLHILHIGSBCOSPBGS
IQPFSCSC-FPSFPA
CSFGLHILHIGSBCOSPBGS
IQPFSCSC-FPSFPA
CSFGLHILHIGSBCOSPBGS
IQPFSCSC-FPSFPA
CSFGLHILHIGSBCOSPBGS
IQPFSCSC-FPSFPA
CSFGLHILHIGSBCOSPBGS
IQPFSCSC-FPSFPA
CSFGLHILHIGSBCOSPBGS
IQPFSCSC-FPSFPA
CSFGLHILHIGSBCOSPBGS
IQPFSCSC-FPSFPA
CSFGLHILHIGSBCOSPBGS
IQPFSCSC-FPSFPA
CSFGLHILHIGSBCOSPBGS
IQPFSCSC-FPSFPA

*Subject list and abbreviations:

CSF

GLHI: Group life and health insurance; LHI: Life and health insurance; GSB: Group savings brokerage; CO: Compliance; SPB: Scholarship plan brokerage; GS: General subjects

IQPF

SC: Training in compliance with standards, ethics and professional practice, SC-FP: Training in compliance with standards, ethics and professional practice related specifically to financial planning; SFPA: Law, insurance, finance, taxation, investment, retirement and estates

APPENDIX 2A: credit card Authorization for the CSF – QuEbec

I hereby authorize the Chambre de la sécurité financière to charge $, representing the fees described below for the following training activity,to the credit card account appearing hereunder:
Activity title:
Name of course provider:

Credit card

Visa
MasterCard
Credit card number:
Expiry date (yyyy-mm):
Cardholder:
I understand that checking this box constitutes my legally binding signature.

Amount description

This amount covers the following charges:

Activity accreditation:
Activity offered once / Basic fee of $362.17 ($315.00 plus $15.75 (5% GST) and $31.42 (9.975% QST))
Additional fee of $72.43 for every hour exceeding 5 hours ($63.00 plus $3.15 (5% GST) and $6.28 (9.975% QST))
Activity offered several times / Basic fee of $425.41 ($370.00 plus $18.50 (5% GST) and $36.91 (9.975% QST))
Additional fee of $85.08 for every hour exceeding 5 hours ($74.00 plus $3.70 (5% GST) and $7.38 (9.975% QST))

Federal tax: 875755423 RT
Provincial tax: 1022122980

APPENDIX 2B: credit card Authorization for the CSF– Ontario

I hereby authorize the Chambre de la sécurité financière to charge $, representing the fees described below for the following training activity, to the credit card account appearing hereunder:
Activity title:
Name of course provider:

Credit card

Visa
MasterCard
Credit card number:
Expiry date (yyyy-mm):
Cardholder:
I understand that checking this box constitutes my legally binding signature.

Amount description

This amount covers the following charges:

Activity accreditation
Activity offered once / Basic fee of $355.95 ($315.00plus $40.95 (13% HST))
Additional fee of $71.19for every hour exceeding 5 hours ($63.00 plus $8.19 (13% HST))
Activity offered several times / Basic fee of $418.10 ($370.00 plus $48.10 (13% HST))
Additional fee of $83.62 for every hour exceeding 5 hours ($74.00 plus $9.62(13% HST))

Federal tax: 875755423 RT
Provincial tax: 1022122980

APPENDIX 2C: credit card Authorization for the CSF – Manitoba

I hereby authorize the Chambre de la sécurité financière to charge $, representingthe fees described below for the following training activity, to the credit card account appearing hereunder:
Activity title:
Name of course provider:

Credit card

Visa
MasterCard
Credit card number:
Expiry date (yyyy-mm):
Cardholder:
I understand that checking this box constitutes my legally binding signature.

Amount description

This amount covers the following charges:

Activity accreditation:
Activity offered once / Basic fee of $355.95 ($315.00 plus $15.75 (5% GST) and $25.20 (8% RST))
Additional fee of $71.19 for every hour exceeding 5 hours ($63.00 plus $3.15 (5% GST) and $5.04 (8% RST))
Activity offered several times / Basic fee of $418.10 ($370.00 plus $18.50 (5% GST) and $29.60 (8% RST))
Additional fee of $83.62 for every hour exceeding 5 hours ($74.00 plus $3.70 (5% GST) and $5.92 (8% RST))

Federal tax: 875755423 RT
Provincial tax: 1022122980

Annexe 2D: credit card Authorization for the iqpf

Accreditation fees

A $287.44* fee (taxes included) is charged to open and analyse a file for each course accreditation application received by the IQPF. This amount is not refundable.
A $229.95* fee (taxes included) is charged for the attribution of one to six PDUs.
An additional $74.73* fee (taxes included) is to be charged for every additional PDU.

Method of payment

Visa / Master Card / American Express
Amount: $
Credit card number:
Expiry date (yyyy-mm):
Security Code (3 or 4 numbers)
Cardholder’s name:
I understand that checking this box constitutes my legally binding signature.

Federal tax: 128798345
Provincial tax: 1012743811TQ0001

*Rates subject to change without notice.