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Associate Membership

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* 1. 1.　PERSONAL INFORMATION
Check all that apply

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* 2. Date of Birth

Date

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* 3. Gender:

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* 4. Print your name:

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* 5. Your CFA level

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* 6. 3. MAILING INFORMATION
Preferred Mailing Address:

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* 7. 3. MAILING INFORMATION
Preferred Mailing Address:

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* 8. Business address

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* 9. Home address

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* 10. 4. PROFESSIONAL CONDUCT STATEMENT
Answer  the  following  five  questions  by  marking  one  of  the  appropriate  boxes  below.  You  must  mark  an  affirmative response  if  any  one  of  the  questions   applies.   Note  that  any  matter  described   in  the  following  questions  must  be disclosed, even if the matter is still pending.


Have you ever been:
A. The subject  of, a defendant in,  or  respondent  in any investigation,   civil  litigation,  arbitration,   or  other  action or   proceeding  in  which  your   professional   conduct,   in

either a direct or supervisory capacity, was at issue?

 

B. The subject of a written complaint   regarding  your professional  conduct   in   either  a  direct  or  supervisory capacity?

 

C.   Permanently   or   temporarily   prevented    from:   (i) acting  as  a  person  required  to  be  registered  under  any law or regulation  (i.e., investment  adviser,  broker,  dealer, etc.);  (ii)  acting  as  an  affiliated  person  or  employee  of any  entity  required  to  be  registered  under  any  law  or


regulation  (i.e.,  investment  company,   bank,  etc.);  or  (iii)

trading on any securities or contract market?

 

D.        Found        to        have        aided,        abetted,       counseled, commanded,   induced,   or   procured   the  violation   by  any person  or  entity  of  any  securities  or  commodities-related law or regulation or any rule promulgated thereunder?

 

E.  Convicted  of  (i)  any  felony  or  other  crime  punishable by  more  than  one  year  in  prison,  or  (ii)  a  misdemeanor involving   moral   turpitude   (lying,   cheating,   stealing,   or other  dishonest   conduct)   or  any  substantially   equivalent crime in any court of law?

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* 11. I represent that my response to the Professional Conduct Statement and Member’s

Agreement, and all information provided by me herein is truthful and complete, and I agree to notify CFA Society of Japan or CFA Institute of any material changes to my response to the foregoing statements.

6. MEMBER'S AGREEMENT

I agree to

(i)  adhere to  all applicable rules and regulations of the CFA Society of Japan (the Society) and of CFA Institute, including but not limited to their Articles of Incorporation, their Bylaws, the Code
of Ethics, Standards of Professional Conducts and other rules relating to professional conduct and membership, all of which may be amended from time to time;

(i)  be subject to the disciplinary jurisdiction and sanctions of the Society and CFA Institute;

(ii)  submit information relating to professional conduct and activities as the Society or CFA Institute may request;

(iv)  produce documents, testify, and otherwise cooperate in disciplinary proceedings of CFA Institute and adhere to such other applicable requirements as set forth from time to time by

CFA Institute  and the Society; and

(v)  maintain membership In Good Standing with

CFA Institute.

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* 12. Name of College/ University attended:

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* 13. Highest degree received:

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* 14. Non-U.S. Applicants only: Is your degree equivalent to a U.S.Bachelor's degree or higher?

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* 15. If student, expected graduation date:

Date

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* 16. 備考：事務局使用欄

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