Deferral or Withdrawal Form - The Financial Planning Association of

CFP® Certification Program
2014 WITHDRAWAL/DEFERRAL FORM
FPA Membership No
Unit of Study & Semester
First Name
Surname
Email
Contact Phone
Withdrawals
Full Refund
Partial Refund (less $550
of enrolment fee for CFP
1-4) (less $850 of
enrolment fee for CFPC)
No Refund
Semester 1
Semester 2
Summer Semester
All units
By 21 February
All units
By 22 July
CFP 1 and 4 only
By 7 November
21 February – 28 March
23 July – 22 August
7 November – 12 December
From 31 March
From 25 August
From 15 December
All refunds will be returned by electronic funds transfer within 10 working days of receipt of this form. Please provide the following details
BSB Number
Account Number
Signature
Deferral Fee $450
Account Name
Date
CFP 1 – CFP 4 only
28 March
CFP 1 – CFP 4 only
22 August
CFP 1 & CFP 4 only
12 December
Student Declaration: I have read and agree to all the policies and procedures as stated on this form and in the FPA Student Handbook and on the FPA
website www.fpa.asn.au. I confirm that all the statements made by me in this form are complete and true and I consent to the collection, use and
disclosure of any information provided in this form and otherwise held or acquired by the FPA in accordance with and for the purposes outlined in the FPA
Privacy Statement. The FPA Privacy Statement is available on the FPA website www.fpa.asn.au.
Signature
 I hereby authorise the FPA to debit my credit card for
Date
Deferral Fee $450
Card Type (please circle): Visa or MasterCard only
Card Number
CCV Number
Expiry Date
Cardholder’s Name
Cardholder’s Signature
SEND FORM TO:
Financial Planning Association of Australia– Professional Designations
GPO Box 4285, Sydney NSW 2001 | Fax: 02 9220 4580 | Email: [email protected]
Or call us on 1300 337 301 for further assistance.
Date
Wdl/Def Form 1/2014

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