美国注册财务策划师协会

美国注册财务策划师协会 CONFIDENTIAL保密資料 info@rfptw.org www.rfpi.com.tw 美國註冊財務策劃師協會 台灣管理中心 RFPI Taiwan Management Office 會員申請表 Individual Membership Application Form Surname 姓氏 (中) (英) Given Name 名字 (中) (英) Daytime Tel No. 日間聯絡電話 Email Address電郵地址 Fax Number 傳真 申請成為 Applied for: ? 正式會員 Full Member ? 附屬會員 Affiliate Member 申請晉升:供附屬會員使用: Applied for progression to (For Affiliate Member) ? 正式會員 Full Member :會員編號 Membership No.:___________________: OFFICE USE ONLY 協會專用 DATE RECEIVED APPROVED BY MEMBERSHIP NO. PAID DATE AMOUNT 收件日期 經手人 會員編號 繳款日期 金額 請將填妥之表格、繳費證明及參考文件:如適用:一併郵寄/親自交回: 10045台北市中正區衡陽路51號12樓 Please return the completed application form with payment receipt and supporting documents (if any) to: 12F., No.51, Hengyang Rd., Zhongzheng Dist., Taipei City 10045, Taiwan (R.O.C.) 台灣辦事處 Taiwan Office :電話 Tel +886-2-2313-1758 傳真 Fax +886-2-2313-1758 香港辦事處 Hong Kong Office :電話 Tel +852 2903 8200 傳真 Fax +852 2907 8082 RFPI_FMAM07TW RFPI_FMAM09_US Page 1 RFPI_MSP07TW Registered Financial Planners Institute ATTACH Designation & Membership ApplicationPHOTO HERE 美國註册財務策劃師協會 (Required) info@rfptw.org 資格及會員申請 www.rfpi.com.tw 相片 Please complete all areas. (Type information or complete in block letters) 請填寫所有部份,請以英文正楷填寫, Part I第一部份 Personal Particulars 個人資料 Name 中文姓名: Identity Card No. Last Name First 先寫姓氏 身份證號碼, Resident Address 住宅地址, City State/Country 城市, 地區/國家, Home Phone Business Phone 住宅電話, 辦公室電話, Cellular phone Fax number 行動電話, 傳真, Present Employer 現時僱主, Business Address 工作地址, City State/Country 城市, 地區/國家, Type of Business 工作性質, Current Position Date Started 現 現時職位, 職開始日期,(mm/yyyy) below 3 years 三年以下 ?? 3-5 years 三至五年 Years of Working Experience 工作年資, ? 6-10 years 六至十年 ? more than 10 years 十年以上 Other Business Experience and Number of Years (in chronological order) Part II第二部份 其他工作經驗及年期:請先列最近期者: From由To至 Type of business工作性Name of the Company公司名稱 Position職稱 State/Country 地區/國家 質 (mm/yyyy) (mm/yyyy) RFPI_FMAM09_US Page 2 Types of License(s) or Registrations / Certifications held 所持有的執業證照種類及其它登記、證書 Part III第三部份 Attorney Date Licensed State/Country 律師 取得日期(西元) 地區/國家 Insurance License No. Date Licensed State/Country 保險證照號碼 取得日期(西元) 地區/國家 Real Estate License No. Date Licensed State/Country 不動產證照號碼 取得日期(西元) 地區/國家 Securities License No. Date Licensed State/Country 證券證照號碼 取得日期(西元) 地區/國家 Brokerage Firm Date Licensed State/Country 經紀公司 ,含證券/保險, 取得日期(西元) 地區/國家 CPA / Tax Accountant Date Licensed State/Country 會計師/稅務會計師 取得日期(西元) 地區/國家 Banking Date Licensed State/Country 銀行 取得日期(西元) 地區/國家 Other Date Licensed State/Country 其他 取得日期(西元) 地區/國家 Please name training completed in any of the previous fields mentioned. Give Dates and number of credit hours received (please include company training) 請 提供過去曾参與有關上述資格的培訓課程資料、日期及其所獲得的時數,包括公司内部培訓,, From由(dd/mm/yyyy) To至(dd/mm/yyyy) Name of the Organization 機構名稱 Number of Credit Hours Received 所得時數 Please list your highest education completed 請 填寫您的最高學歷 (請同時填寫院校及學系名稱), High School 中學 Attained qualification 所得學歷, Attained Year 取得年份(西元), Graduate Degree 大學 Attained qualification 所得學歷, Attained Year 取得年份(西元), Specialty School/Other 專 科學校或其它 Attained qualification 所得學歷, Attained Year 取得年份(西元), Please list other organizations/designations that you have 請填寫您所持有的其它專業資格, Please give any other information which you feel may be helpful, i.e. educational background, and methods used, list of represented clients. If available, attach a list of credentials you submit to your clients 請 提供其它您認為對您的申請有幫助的資料,如學歷背景、學習方式、有代表性的客戶名單等,並附上給予客戶之個人資歷, RFPI_FMAM09_US Page 3 Good Reputation and Character Declaration 良好聲譽及品格聲明 Part IV第四部份 Are you currently licensed by other professional bodies? If YES, in which regulatory activity are you licensed? _________________________________________________________________ * YES / NO 4.1是 / 否 你現時是否獲得其他專業團體頒發之證照, 如是,請說明獲發的受規管活動之類別, ________________________________________________________________________________ If you answer YES to any questions below, full details must be recorded on a separate piece of paper. Have you ever received a warning letter issued by any professional bodies? * YES / NO Have you ever been the subject of a formal enquiry by any professional bodies? 4.2 是 / 否 如果您就以下任何問題答案為「是」,您必須將有關詳情另紙書寫。 你是否曾收過由其他專業團體所發出的警告信,你是否曾受過其他專業團體的正式調查, other professional bodies in any country, outside Taiwan? Have you ever been registered or licensed by If NO, please go to 4 ; If YES, state where and when: ___________________________________________________________________* YES / NO 是 / 否 4 條 如否,請回答你是否在台灣以外任何其他專業團體註冊或獲發給證照? 如是,請說明哪個國家及在何時 4.3 ________________________________________________________________________________________ If YES, were you ever disciplined in any way, that is cautioned, fined, suspended or awarded any kind of penalty or punishment by that authority? * YES / NO If YES, full details must be provided on a separate piece of paper. RFPI will make enquiries as it sees fit. 是 / 否 如是,你曾否遭受任何形式的紀律處分,例如受到警告、罰款、暫時吊銷證照或受到該局任何形式的懲罰或處分 ?如有,則必須提供詳細資料,並另紙書寫,本會將會就此事進行適當的查詢。 Have you ever been convicted for any offence in Taiwan or in any other jurisdiction involving fraud or dishonesty, or any offence under legislation relating to companies or investment institutions or insolvency, consumer credit or consumer * YES / NO 4.4 protection? 是 / 否 你曾否在台灣或任何其他司法區就任何有關公司或投資機構的詐騙事件、不誠實行為或觸犯法例的罪行,或就涉及無償債 能力事件、消費者信貸或消費保障等案件而定罪? Have you at any time been declared bankrupt or had your estate or any goods confiscated, or are you currently * YES / NO 4.5 the subject of bankruptcy proceeding, or any proceedings for the confiscation of your estate or goods? 是 / 否 你曾否被宣佈破產?你的財產或貨物曾否被扣押?你現在是否為破產程序的當事人?你現在的財產或貨物是否遭受扣押?Have you ever entered into any form of deed or arrangement with creditors for the settlement of debt, or are any such * YES / NO 4.6 matters pending? 是 / 否 你曾否與債權人訂立任何契約或安排,以清償債項? 你是否知悉到有任何有關這方面的事宜正等候進行? Have you ever, in any jurisdiction, been refused or had revoked any license or authorisation to practice a profession or continue in any employment, or have you ever been refused entry to any trade, employment or profession, or any * YES / NO position of trust? 4.7 是 / 否 你曾否在任何司法區被拒絕或被撤銷執業證照或認可資格,或被拒絕繼續出任某個職位,或曾否被拒加入任何行業、職業或專業 或任何需要具備誠信的職位? Have you ever knowingly been the subject of any investigation into any allegations or misconduct or malpractice * YES / NO 4.8 in connection with investment business? 是 / 否 你曾否在知情的情況下,就任何指稱你在投資業務方面有失當行為和不當手法而成為調查對象? Have you ever been disqualified by a court or other competent authority from acting as a director of a company, or from acting * YES / NO 4.9 in the management or conduct of affairs of any company? 是 / 否 你曾否被法院或其他主管當局裁定不得出任公司董事,或不得參與任何公司的管理或運作? Has any company of which you were at the time, or in the 12 months prior, a director or partner, or in whose management you were directly concerned, been put into compulsory liquidation or had a receiver or administrator appointed, or entered * YES / NO 4.10 into arrangement with its creditors? 是 / 否 你現時或之前12個月內身為董事或合夥人的公司,或你直接參與其管理的公司,曾否被強制清算,或曾委出接管人或管理人或 曾否與債權人訂立債務重組協議? RFPI_FMAM09_US Page 4 Part V第五部份 Supplementary Information 附加資料 Where the answer to any question in section 4.2 to 4.3 is YES, and/or if there is not enough space for part II and III, please provide full details on a separate piece of paper. It must be firmly pinned or stapled here with this form and other supporting documents, and each page numbered and initialed by the applicant. 如4.2至4.3的問題為「是」及/或 第二至三部份之位置不敷應用,請另紙書寫詳情,並與本表格及相關證明文件影印本釘成一疊,編上頁碼及加簽。 Referee (Referee should know the applicant at least 2 years or above) 份 Part VI第六部 諮詢人:諮詢人必須認識申請人兩年或以上: List below the names, addresses and phone numbers of three references who can attest to your character and financial planning ability in your respective field. All referees should fill in the Referee’s Report Form (Attachment 1). The forms should be returned together with this application form in person or in sealed envelope (marked FMAM). 請於下欄提供三名諮詢人姓名、其地址及電話以供查核您的品格及對財務策劃的能力。三位諮詢人均須填寫諮詢人資料表,附件一,,連同本申請表格一併親自交回/郵寄至協會,註明FMAM,。 NAME 姓名 ADDRESS 地址 PHONE NUMBER 電話號碼 Declaration by the Applicant申請人聲明 Part VII第七部份 Please read the following statement carefully before signing 請在簽署前細閱以下聲明: I hereby submit this application to the Registered Financial Planners Institute and declare that all information to the best of my knowledge is accurate and complete. If approved, I shall abide by the rules, regulations and Code of Ethics of the Registered Financial Planners Institute. If not approved, I understand that I will be refunded my application fee. I also agree to attend continuing education requirement imposed in my respective field and supply proof of credits earned to the Institute during the required reporting period if required. I also understand that my names, specialty, business number and email address will be shown on the Internet unless specifically requested. 本人現申請成為美國註册財務策劃師協會會員並聲明所申報資料是準確及完整。如本人被接納為會員,本人將遵守協會所制定之章程及專業操守。如本人入會被拒,所交申請入會費用將被發還。本人亦同意遵守協會所訂明之持續進修要求及如有需要,可提供所需資料予協會,以作審批。除非清楚列明,否則本人的資料包括姓名、公司名稱、聯絡電話、電郵地址等,將會顯示於協會之網頁上。 Signature of Applicant 申請人簽署 Date 日期 E-mail Address 電 子 郵 箱, Website 網 址, RFPI_FMAM09_US Page 5 Please sign here if you do not want your information on Registered Financial Planners website member directory 如您不欲將個人資料放在美國註册財務策劃師協會網址内的會員名冊上,請於下欄簽署, I prefer not to be listed on the Internet 本人不欲將個人資料放在網上 Part VIII第八部份 Subscription Fees 會費 Membership 會籍 Annual Fee 年費 Fee 費用 USD 220 ? Full Member 正式會員 New application 新會員? 申請成為 USD 150 ? Affiliate Member 附屬會員 Applied for progression to Full Member USD 220 ? 晉升成為正式會員 Payment method 付款 ,請在適當空格內填上","號, 請將款項存入本協會之銀行帳戶,詳情如下, 受款銀行 ,The Hong Kong and Shanghai Banking Corporation Ltd 受款人名稱 ,Splendor Finance Institute Ltd 電匯賬戶號碼 ,809-290810-838 國際匯款識別碼,HSBCHKHHHKH , 電匯 受款銀行地址 ,1/F, Causeway Bay Plaza Two, 463-483 Lockhart Rd., Causeway Bay, HK. * 使用電匯服務所需的手續費、中介銀行手續費及協會需繳付銀行的一切相關費用,一概由申請人支付。 * 本協會不會接納未能出示繳款證明之申請。建議申請人保留匯款水單之副本以作記錄。 * 對一切因申請人或銀行導致的過賬失誤,協會概不負責。倘若因過賬失誤而導致逾期遞交之申請表,協會恕不受理。 * 請將匯款水單或電文存根正本實貼於以下黏貼處。 <匯款水單或電文存根正本黏貼處> <請務必實貼於黏貼處> 有效期至, (持卡人必須為申請人) 持卡人信用卡上之英文姓名, , VISA , 信用卡 ____________ ___________________________________________________ /____________ , MasterCard MM月 / YY年 信用卡號碼, — — — 從右列信用卡繳付以上款項 信用卡檢查碼 (卡片背面簽名欄上緊接於卡號後四碼之三位阿拉伯數字) RFPI_FMAM09_US Page 6 持卡人簽署, 日期, _________________________________________________________________________ __________________________________________________ (簽名必須與信用卡上相同 ) 註, 如申請人選擇以信用卡付款,交易將以港幣進行,匯率鎖定為1美元兌7.8港元,電匯付款則不在此限,申請人仍需以美元支付會員申請費 用。協會保留調整匯率及扣款安排之權利。 RFPI_FMAM09_US Page 7 Part IX第九部份 The RFPI Code of Ethics 美國註冊財務策劃師協會會員守則 , A RFP only perform the financial planning service in their field of expertise and maintain the interest of the client first. 只能在其專業知識範圍內 籌劃理財並以維護客戶的利益為先。 , A RFP should maintain competency of practice by continuous education, training, study and expertise. 應通過持續教育、訓練、學習及累積經驗 來維持實務的技能。 , A RFP is discouraged from making any misleading, false or unwarranted statements to a client or prospective client. 禁止向客戶作出任何誤導、 虛假或無根據的陳述。 , A RFP establishes personal responsibility for knowledge of the laws and regulations of the field in which their work for remunerations is involved. 要瞭解因工作獲取報酬時所涉及的相關法律及條例以確立個人的責任感。 , A RFP will not accept and complete a financial planning assignment without having acquired the knowledge to complete such assignments competently, unless the planner is associated with such person who has knowledge, or discloses the lack of knowledge to the client prior to accepting the assignment. 當缺乏勝任能力完成一項財務策劃工作所需的知識時,不得接受和完成該項工作,除非與具有此相關知識的專業人士 合作,並且在接受該項工作之前向客戶披露自己缺乏此方面的知識。 , A RFP must disclose to the client the possibility of receiving compensation from sources other than the client if work is being performed on a fee basis, and the client acts upon your recommendation. 必須向客戶披露自己獲取報酬的途徑。 , A RFP should report anyone who represents themselves as a member of the Institute fraudulently. 應該舉報任何虛假聲稱自己是本協會會員、 使用RFP標誌或職銜的人士。 , A RFP must not discriminate between race, creed or color for prospective client desiring the services of a member. 當客戶要求提供專業服務, 絕不可以因種族、宗教或膚色而有所歧視。 , A RFP shall comply with any other code of ethics or laws as set forth by their particular state and profession. 應該遵從所在國家或地區所制定的 任何其他道德規範及法律。 Part X第十部份 Information for Membership Statistics會員統計資料收集 Field of Employment 現職性質 Accounting Practice 會計 Insurance 保險 1 12 Auditing 稽核 Investment Planning / Advising 投資計劃/顧問 2 13 Banking 銀行 Legal Practice 法律 3 14 Clearing / Trustee 結算/ 信託 Media 傳媒 4 15 Corporate Finance 企業融資 Merchant / Investment Banking 商人/投資銀行 5 16 Consultant 顧問 Non-Banking Financial Institutions 金融機構(不包括銀行) 6 17 Governmen t/ Regulator / Exchanges 政府/監管/交易所 Stock broking 股票買賣 7 18 Education 教育 Unit Trust Company 單位信託公司 8 19 Futures / Derivatives 期貨/衍生工具 Other 其他 (Please specify 請註明 ) 9 20 Fund Management 基金管理 Not Presently Working 沒有工作 10 21 Industrial / Commercial 工業/ 商業 Retired 已退休 11 22 RFPI_FMAM09_US Page 8 Part X第十部份 Information for Membership Statistics會員統計資料收集 (續) Current Job Functions(s) (you can choose more than one) 現職工作範圍 :可選擇多項: 23Academic 學術 Futures 期貨1 242 Accounting 會計 Human Resource Management 人事管理 253 Actuarial 精算 Investment Analysis / Research 投資/ 研究 264 Administration 行政管理 Journalism 傳媒 27Auditing 核數Management 管理5 28 Banking -- Retail 銀行--零售業務Marketing 市場推銷6 29 Banking --Private 銀行--私人理財Mergers / Acquisitions 合併/ 收購7 30 8 Banking --Securities 銀行--證券業務 Money Market 貨幣市場 31 9 Compliance 監察 Options 期權 3210 Computer Systems / Info Technology 電腦/資訊科技 Personal Investment Planning 個人投資規劃 33Corporate Advice 企業顧問Project/Export Finance 計劃/ 出口融資11 Corporate Lending 企業借貸 34Property 地產12 Corporate / Securities Law 公司/ 證券法例Public Relations / Communications 公共關係35 13 Corporate Treasury 企業財政Stock broking -- Institutional 企業股票買賣36 14 Credit Analysis 借貸分析Stock broking -- Private 私人股票買賣37 15 Derivatives 衍生工具Settlements 結算38 16 Strategic Planning 策略規劃 Economics 經濟39 17 Structured Finance / Leasing 結構金融/ 借貸 Equities Dealing 證券買賣1840 Tax 稅務 Fixed Interest Investment Tools 定息投資工具1941 Training 培訓 Foreign Exchange 外匯買賣20 42 Underwriting 包銷 Funds Management - Institutional 企業基金管理21 43 Other 其他 (Please specify 請註明 Funds Management --Retail 零售基金管理44 22 RFPI_FMAM09_US Page 9 Registered Financial Planners Institute Attachment 1 附件一 Referee’s Report Form 美國註册財務策劃師協會 info@rfptw.org 諮詢人資料表格 www.rfpi.com.tw Important Note 重要事項: RFPI Taiwan Management Office might contact the referee if there is a need. 如有需要,本協會將會聯絡諮詢人。 Referee should know the applicant for at least 2 years or above. 諮詢人必須認識申請人兩年或以上。 The applicant should return the completed ORIGINAL Referee’s Report Form together with the Individual Membership Application Form to the RFPI Taiwan Management Office in person or by mail in a sealed envelope (marked FMAM). 請把【諮詢人資料表】之正本,連同【會員申請表】一併親自交回/郵寄至協會,註明FMAM,。 第一部份 PART A - 申請人填寫 To be completed by the applicant 申請人填寫此部份後,須送交諮詢人填寫第二部份。 The applicant should complete this part and then invite a referee to complete Part B. 申請人姓名 Name of Applicant: 英文 in English 中文姓名 in Chinese (請先填姓氏,並以正楷填寫 Please use BLOCK letters & Surname First) *申請成為 Applied for: ， RFPI Full Member 正式會員 ， RFPI Associate Member 附屬會員 ,*請在適當之方格內加上‘?’ 號。., Please tick where appropriate 第二部份 PART B - 諮詢人填寫 To be completed by the referee 本人是上述申請的諮詢人,現提供下列資料予美國註冊財務策劃師協會台灣管理中心, I am a referee of the above applicant and would like to provide the following information to the Registered Financial Planners Institute Taiwan Management Office for reference: (1) 本人與上述申請人之關係,請在適當之方格內加上‘?’ 號, My relationship with the above applicant (Please tick where appropriate): ， 商業關係 Business relationship ， 僱傭關係 Employer-employee relationship ， 其他關係,請註明,Other relationship,please specify,___________________________________________ (2) 本人與申請人維持上述關係之期間約為 ______ 年 ______ Ihave maintained relationship with the above applicant for about: year(s) (3) 本人對上述申請人在以下各方面之評價為,請在適當之方格內加上‘?’ 號,: My assessment of the above applicant in the following aspects is as follows (Please tick where appropriate), 未能置評 優良一般差 Unable to Average BelowExcellent Good Average Assess 誠實 ， ， ， ， ， Integrity 可靠 ， ， ， ， ， Trust-worthiness 3 信用 ， ， ， ， ， Credit-worthiness 財政狀況 ， ， ， ， ， Financial Standing 教育及資歷 ， ， ， ， ， Education and Qualification 理財策劃經驗 ， ， ， ， ， Experience in Financial Planning RFPI_FMAM09_US Page 10 (4) 申請人執行業務時,是否常持真誠及誠實之態度,是否能給予客觀及獨立的意見,Has the applicant at all times conducted his / her business with utmost good faith and integrity, and provide advice objectively and independently? ， 是 YES ， 否 No ， 未能置評 Unable to Assess (5) 請根據申請人之能力及潛質,評論申請人是否適合成為美國註冊財務策劃師之正式會員。 Please give your evaluation of the applicant's suitability (in terms of ability and potential) for being a Registered Financial Planner? ， 是 YES ， 否 No ， 未能置評 Unable to Assess 如在上述任何一項對申請人未能置評,請說明原因, Please give reason(s) if you are unable to assess any o f the above aspects of the applicant, 諮詢人簽名 機構/公司名稱 Signature: Name of Institution/organization: 連同公司印章 (with company chop) 諮詢人姓名Name of Referee: 職位名稱 ,英 English, Position Held: ,中 Chinese, 電話 日期 Date: Tel. No.: CONFIDENTIAL保密資料 RFPI_FMAM09_US Page 11 Registered Financial Planners Institute Attachment 1 附件一 Referee’s Report Form 美國註册財務策劃師協會 info@rfptw.org 諮詢人資料表格 www.rfpi.com.tw Important Note 重要事項: RFPI Taiwan Management Office might contact the referee if there is a need. 如有需要,本協會將會聯絡諮詢人。 Referee should know the applicant for at least 2 years or above. 諮詢人必須認識申請人兩年或以上。 The applicant should return the completed ORIGINAL Referee’s Report Form together with the Individual Membership Application Form to the RFPI Taiwan Management Office in person or by mail in a sealed envelope (marked FMAM). 請把【諮詢人資料表】之正本,連同【會員申請表】一併親自交回/郵寄至協會,註明FMAM,。 第一部份 PART A - 申請人填寫 To be completed by the applicant 申請人填寫此部份後,須送交諮詢人填寫第二部份。 The applicant should complete this part and then invite a referee to complete Part B. 申請人姓名 Name of Applicant: 英文 in English 中文姓名 in Chinese (請先填姓氏,並以正楷填寫 Please use BLOCK letters & Surname First) *申請成為 Applied for: ， RFPI Full Member 正式會員 ， RFPI Associate Member 附屬會員 ,*請在適當之方格內加上‘?’ 號。., Please tick where appropriate 第二部份 PART B - 諮詢人填寫 To be completed by the referee 本人是上述申請的諮詢人,現提供下列資料予美國註冊財務策劃師協會台灣管理中心, I am a referee of the above applicant and would like to provide the following information to the Registered Financial Planners Institute Taiwan Management Office for reference: (5) 本人與上述申請人之關係,請在適當之方格內加上‘?’ 號, My relationship with the above applicant (Please tick where appropriate): ， 商業關係 Business relationship ， 僱傭關係 Employer-employee relationship ， 其他關係,請註明,Other relationship,please specify,___________________________________________ (6) 本人與申請人維持上述關係之期間約為 ______ 年 ______ Ihave maintained relationship with the above applicant for about: year(s) (7) 本人對上述申請人在以下各方面之評價為,請在適當之方格內加上‘?’ 號,: My assessment of the above applicant in the following aspects is as follows (Please tick where appropriate), 未能置評 優良一般差 Unable to Average BelowExcellent Good Average Assess 誠實 ， ， ， ， ， Integrity 可靠 ， ， ， ， ， Trust-worthiness 3 信用 ， ， ， ， ， Credit-worthiness 財政狀況 ， ， ， ， ， Financial Standing 教育及資歷 ， ， ， ， ， Education and Qualification 理財策劃經驗 ， ， ， ， ， Experience in Financial Planning RFPI_FMAM09_US Page 12 (8) 申請人執行業務時,是否常持真誠及誠實之態度,是否能給予客觀及獨立的意見,Has the applicant at all times conducted his / her business with utmost good faith and integrity, and provide advice objectively and independently? ， 是 YES ， 否 No ， 未能置評 Unable to Assess (5) 請根據申請人之能力及潛質,評論申請人是否適合成為美國註冊財務策劃師之正式會員。 Please give your evaluation of the applicant's suitability (in terms of ability and potential) for being a Registered Financial Planner? ， 是 YES ， 否 No ， 未能置評 Unable to Assess 如在上述任何一項對申請人未能置評,請說明原因, Please give reason(s) if you are unable to assess any o f the above aspects of the applicant, 諮詢人簽名 機構/公司名稱 Signature: Name of Institution/or ganization: 連同公司印章 (with company chop) 諮詢人姓名Name of Referee: 職位名稱 ,英 English, Position Held: ,中 Chinese, 電話 日期 Date: Tel. No.: CONFIDENTIAL保密資料 RFPI_FMAM09_US Page 13 Registered Financial Planners Institute Attachment 1 附件一 Referee’s Report Form 美國註册財務策劃師協會 info@rfptw.org 諮詢人資料表格 www.rfpi.com.tw Important Note 重要事項: RFPI Taiwan Management Office might contact the referee if there is a need. 如有需要,本協會將會聯絡諮詢人。 Referee should know the applicant for at least 2 years or above. 諮詢人必須認識申請人兩年或以上。 The applicant should return the completed ORIGINAL Referee’s Report Form together with the Individual Membership Application Form to the RFPI Taiwan Management Office in person or by mail in a sealed envelope (marked FMAM). 請把【諮詢人資料表】之正本,連同【會員申請表】一併親自交回/郵寄至協會,註明FMAM,。 第一部份 PART A - 申請人填寫 To be completed by the applicant 申請人填寫此部份後,須送交諮詢人填寫第二部份。 The applicant should complete this part and then invite a referee to complete Part B. 申請人姓名 Name of Applicant: 英文 in English 中文姓名 in Chinese (請先填姓氏,並以正楷填寫 Please use BLOCK letters & Surname First) *申請成為 Applied for: ， RFPI Full Member 正式會員 ， RFPI Associate Member 附屬會員 ,*請在適當之方格內加上‘?’ 號。., Please tick where appropriate 第二部份 PART B - 諮詢人填寫 To be completed by the referee 本人是上述申請的諮詢人,現提供下列資料予美國註冊財務策劃師協會台灣管理中心, I am a referee of the above applicant and would like to provide the following information to the Registered Financial Planners Institute Taiwan Management Office for reference: (9) 本人與上述申請人之關係,請在適當之方格內加上‘?’ 號, My relationship with the above applicant (Please tick where appropriate): ， 商業關係 Business relationship ， 僱傭關係 Employer-employee relationship ， 其他關係,請註明,Other relationship,please specify,___________________________________________ (10) 本人與申請人維持上述關係之期間約為 ______ 年 ______ Ihave maintained relationship with the above applicant for about: year(s) (11) 本人對上述申請人在以下各方面之評價為,請在適當之方格內加上‘?’ 號,: My assessment of the above applicant in the following aspects is as follows (Please tick where appropriate), 未能置評 優良一般差 Unable to Average BelowExcellent Good Average Assess 誠實 ， ， ， ， ， Integrity 可靠 ， ， ， ， ， Trust-worthiness 3 信用 ， ， ， ， ， Credit-worthiness 財政狀況 ， ， ， ， ， Financial Standing 教育及資歷 ， ， ， ， ， Education and Qualification 理財策劃經驗 ， ， ， ， ， Experience in Financial Planning RFPI_FMAM09_US Page 14 (12) 申請人執行業務時,是否常持真誠及誠實之態度,是否能給予客觀及獨立的意見,Has the applicant at all times conducted his / her business with utmost good faith and integrity, and provide advice objectively and independently? ， 是 YES ， 否 No ， 未能置評 Unable to Assess (5) 請根據申請人之能力及潛質,評論申請人是否適合成為美國註冊財務策劃師之正式會員。 Please give your evaluation of the applicant's suitability (in terms of ability and potential) for being a Registered Financial Planner? ， 是 YES ， 否 No ， 未能置評 Unable to Assess 如在上述任何一項對申請人未能置評,請說明原因, Please give reason(s) if you are unable to assess any o f the above aspects of the applicant, 諮詢人簽名 機構/公司名稱 Signature: Name of Institution/organization: 連同公司印章 (with company chop) 諮詢人姓名Name of Referee: 職位名稱 ,英 English, Position Held: ,中 Chinese, 電話 日期 Date: Tel. No.: CONFIDENTIAL保密資料 RFPI_FMAM09_US Page 15