Application for CIPFA membership

This form of membership of CIPFA is open to people from the United Kingdom who work as senior executives, with management responsibility for multiple corporate services, and/or who directly line manage the organisation’s finance function, with a direct reporting line to the Chief Executive or equivalent role.

PLEASE USE BLOCK CAPITALS

Title * Other Title Forename(s) * Surname * Home Address Line 1 * Home Address Line 2 Home Address Line 3 Town * Country * Post Code/Zip Code Telephone Number * Email Address * Mobile

COMPETENCE AND FITNESS

1 I HEREBY APPLY for Affiliate Membership of the Chartered Institute of Public Finance & Accountancy and undertake to;

(a) Observe the provisions of the Supplemental Charter and of the Bye-Laws and Regulations of CIPFA
(b) Observe the ethical and technical guides to conduct, principles or rules established or approved by CIPFA
(c) Promptly and willingly provide cooperation and assistance, as I am able, if asked to do so by CIPFA in pursuance of its duties

2 Pay the annual subscription due in respect of my membership of CIPFA to the extent that this is not a paid on my behalf by a third party

I hereby certify that: A. I manage multiple corporate services in a public service B. I line manage the Finance function in a public service C. I report directly to the Chief Executive D. I manage a service/professional discipline with significant finances E. I have been recommended to CIPFA and my role is deemed relevant Are there any matters reflecting your competence or fitness of which the Institute ought to be aware? Yes No

CURRENT EMPLOYMENT DETAILS

Job Title * Department * Organisation * Work Address Line 1 * Work Address Line 2 Work Address Line 3 Work Address Line 4 Town * Country * Post Code/Zip Code Work Telephone Number * Work Email Address *

EDUCATION, EMPLOYMENT, PROFESSIONAL DETAILS AND CURRICULUM VITAE

Please attach a Curriculum Vitae (CV) including where relevant details of