FPSA® Application Form Application form for FPSA® designation "*" indicates required fields I hereby apply for the designation "FPSA® - Fiduciary Practitioner South Africa" to be awarded to me.Title*AdvProfDrRevMrMrsMsOtherIf "Other" chosen above, please insert details here: Surname* Full Name(s)* SA ID Number* Address* Address Line 1 Address Line 2 City Province / Region Postal Code Telephone (W)CellphoneEmail Address* Employer* Employer Address* Employer Telephone No* Please list all your tertiary (i.e. post matric) academic qualifications(s), including the name of the tertiary education Institution and date received:ID Document*Max. file size: 100 MB.Qualifications*Max. file size: 100 MB.QUESTIONS: Please answer all the questions below by marking the appropriate box, e.g. if your answer to question 1 is “No”, tick the “No”-box or make a cross in the “No”-box. If you answer yes to any of the questions below, please supply full details in writing and send it to FISA with this form. Quote the number of the relevant question when supplying the details. Question 1 - Have you been declared mentally incapacitated or otherwise incapable of managing your own affairs?* Yes No Question 2 - Have you been removed (in your personal capacity or as a nominee of a corporation) by a competent court from the position of executor of an Estate, in accordance with the provisions of section 54(1)(a)(ii), (iii), or (iv) of the Administration of Estates Act, 66 of 1965 (the “Estates Act”)?* Yes No Question 3 - Have you been declared incapable, by a competent court, of holding the office of executor, in accordance with the provisions of section 54(4) of the Estates Act?* Yes No Question 4 - Have you been removed (in your personal capacity or as a nominee of a corporation) from the position of executor of an estate by a competent court in accordance with the provisions of section 54(1)(a)(v), or by the Master of the High Court in accordance with the provisions of section 54(1)(b)(ii), (iii), (iv), or (v) of the Estates Act?* Yes No Question 5 - Are you the subject of any disciplinary or appeal panel hearing, constituted in accordance with the provisions of the Disciplinary Regulations of FISA?* Yes No Question 6 - Have you been sequestrated, provisionally or finally, or surrendered your estate for the benefit of your creditors, or have you made an offer of compromise to your creditors in circumstances where your liabilities exceeded your assets?* Yes No Question 7 - Have you had a civil judgement, for the recovery of an unpaid debt, given against you?* Yes No Question 8 - Have you had a civil judgement given against you for any act or omission containing an element of dishonesty or misrepresentation on your part?* Yes No Question 9 - Have you been declared by a competent court to be over-indebted, or have you applied to be placed under debt review under the provisions of the National Credit Act, 34 of 2005, or any substituting or similar legislation.* Yes No Question 10 - Have you been removed as trustee (in your personal capacity or as a nominee of a corporation), by a competent court or by the Master of the High Court, in accordance with the provisions of section 20 of the Trust Property Control Act, 57 of 1988?* Yes No Question 11 - Have you been convicted by a court of criminal justice in the Republic or elsewhere of any criminal offence of which dishonesty is an element, or which is listed in the First Schedule to the Criminal Procedure Act, 51 of 1977 as amended (or an equivalent offence anywhere in the world), and, in the case of a First Schedule offence (or its equivalent) of which dishonesty is not an element, been sentenced to imprisonment without the option of a fine?* Yes No Question 12 - Are you under investigation for any criminal offence of which dishonesty is an element, or which is listed in the First Schedule to the Criminal Procedure Act, 51 of 1977 as amended (or its equivalent anywhere in the world), and, in the case of a First Schedule offence (or its equivalent) of which dishonesty is not an element, been sentenced to imprisonment without the option of a fine?* Yes No Question 13 - Have you been found guilty in a disciplinary hearing by an employer, a regulator in any industry or another association, institute or other membership organisation of misconduct of which dishonesty is an element, or which corresponds with a crime listed in the First Schedule to the Criminal Procedure Act, 51 of 1977, as amended?* Yes No Question 14 - Are you, your employer, or any business or partnership you are involved in, under investigation by any authority for conduct which may affect your fitness to be placed in a position of trust?* Yes No Date* MM slash DD slash YYYY DECLARATION: In submitting this application, I further confirm the following: 1. I am a member of the Fiduciary Institute of Southern Africa (“FISA”), as defined in the FISA Constitution; 2. I have passed the FPSA® Examination, or have complied with requirements to be awarded the Advanced Diploma in Estate and Trust Administration, or have been exempted from these requirements by a decision of the FISA council; 3. I hold an academic qualification at NQF level 6 or higher, or have been exempted from this requirement by a decision of the relevant FISA structure; 4. I have at least three (3) years’ experience in the fiduciary services industry; 5. I understand that I am bound by the FISA Constitution and Regulations; 6. I understand that: 6.1 the FPSA® designation, and any documentation that may be issued to me certifying that I hold the designation, belong to FISA; and 6.2 I am obliged to return such documentation to FISA in the event that I am no longer a member of FISA, for whatever reason; and 6.3 My right to use the FPSA® designation is dependent on my continued membership of FISA, and that I will not be entitled to the designation unless I am a member of FISA at the relevant time; 7. I undertake to comply with the Code of Ethics and of Professional and Responsible conduct of FISA; 8. I undertake to comply with the Continuing Professional Development (“CPD”) requirements as determined from time to time; 9. All information in this application is, to the best of my knowledge and belief, true and correct.CommentsThis field is for validation purposes and should be left unchanged.
