APPLICATION FOR THE CERTIFIED RETIREMENT FINANCIAL ADVISOR (CRFA) CERTIFICATION EXAM

APPLICATION FOR THE CERTIFIED RETIREMENT FINANCIAL ADVISOR (CRFA) CERTIFICATION EXAM

A Note from the CRFA Board of Certification: Congratulations on starting the process of becoming a CRFA. Before completing this application, please go to our website (www.crfa.us), select the left banner tab CRFA Certification, and download the Candidate Guide and Information Handbook. This Guide provides a comprehensive explanation of the application process, eligibility requirements, examination content and development information and much more. Interested candidates MUST review the Candidate Guide in order to complete this application properly. There are six parts to the application. Part 1.Personal Information, Part 2. Eligibility, Part 3. Candidate Endorsement, Part 4. Ethics Certification and Attestation, Part 5. Certification of Accuracy, Agreement and Release Authorization and Part 6. Payment Information. Please insure all parts of the application are complete. Please call 888-880-CRFA (2732) with questions. The application information is held in strict confidence according to the CRFA Confidentiality and Document Retention/Privacy Policy. This policy may be viewed on our website under the menu tab CRFA Publications for Download, and applies to all aspects of the CRFA credential including application materials, examinations, scores and candidate records. Application Instructions 1. List your legal name as this is the name that will be submitted to the testing center. The name must agree with a government-issued picture identification card, which you will be required to present as identification at the testing center. 2. Your home contact information will be a part of your file, but all correspondence will be sent to your business address unless you note on the form that the home address is to be your address of record/contact. 3. Your business contact information should be your current employer; self-employed applicants are asked to provide personal business contact information. This will automatically become your address of record unless you make a note on this form that this is to be used for information only. 4. Once you have completed the application, you may fax the form to 405-376-1455. This is a dedicated fax line and your information will be secure. Alternately you may scan the form and e-mail it to the address posted on the form. However, this is not a secure site. We accept credit card information via fax/email but the CRFA is required to sign the form which provides authorization to charge the credit card. Candidate applications will not be considered without payment. 5. You must provide your endorsement provider with a copy of your experience documentation form. Endorsements may not be included with the application. The endorsement provider must complete the form, attach the experience form you have provided and mail it to the CRFA Certification Office independent of the application. The address is 501 N. Mustang Road, P.O. Box 453, Mustang, OK 73064.

Legal Name: P. O. Box 453 501 N Mustang Road, Suite D1 Mustang, OK 73064 Phone 405-376-9976 Fax 405-376-1455 APPLICATION FOR THE CRFA CERTIFICATION EXAMINATION: Part 1. Personal Information Last First Middle Home Contact Information: (Please address all CRFA communication using my Home info: Y N ) Address: City State Zip Phone Cell E-Mail Address Business Contact Information: (Please direct all CRFA communication using my Business info: Y N) Company Name Company Address City State Zip Phone Fax E-Mail Address

Part 2. Experience, Education/Training (Eligibility Documentation) and Certificates: Experience: Please indicate all experience in these areas below. However, all CRFA candidates must document a MINIMUM of three (3) years of Professional experience in any one of the four (4) specialties: Insurance (circle) 1 year, 2 years, 3 years, 4 or more Securities (circle) 1 year, 2 years, 3 years, 4 or more Tax Preparation (circle) 1 year, 2 years, 3 years, 4 or more Trust Preparation/Trust Administration (circle) 1 year, 2 years, 3 years, 4 years or more Education and Training: Recognizing that either education or training or a combination of the two would provide the minimum opportunity to learn the required tasks associated with competent entrylevel performance. All CRFA candidates must demonstrate a minimum of 24 Hours/Credits of Secondary Education where the curriculum is focused on professional financial services. Secondary education is focused on practical job skills that are designed to benefit employers and employees. Hours/Credits may be counted in only Education, only Training or a combination of both. Formal Education in a field/subject relevant to any/all specialties (choose the highest education achieved): Graduate Degree with an emphasis in finance (25 Credits) Bachelor s Degree with an emphasis in finance (20 Credits) Associates Degree (15 Credits) Alternative Education substituted for a degree: Successful completion of The Retirement Academy Professional Retirement Training Program (24 Hours/Credits) Formal Classroom Programming - Vo-Tech or certificate course- (3 Credits per certificate/class): _3 Credits x Classes = Formal Classroom Programming Credits Training in a field/subject relevant to any/all specialties: Training w/certificate minimum of 10 hours or more (2 Credits per certificate) _2 Credits x courses = Certificate Training Credits Training courses (no certificate) minimum of 6 hours (1 credit per course) _1 Credit x courses = Non-certificate Training Credits In-house (employer) training course (1 Credit per hour, per certificate) _1 Credit x courses = In-house Training Credits

In Regulatory Notice 11-52 issued by FINRA it is suggested that Designation Standards and Supervision include rigorous curriculum for any certification. All applicants are encouraged to research courses approved by their firm. SCRFA offers curriculum that meets FINRA standards through The Retirement Academy. Successful completion of an education-based program that meets FINRA standards 24 Hours/Credits. Total Education/Training Hours/Credits: Hours/Credits to qualify). (Must be 24 or more Certificates: (indicate all that apply) Resident Insurance License State: License Number: Non-Resident Insurance License State: License Number: Current Broker/Dealer: Part 3. Endorsement: Please provide the attached endorsement form, with a copy of your experience documentation to a CRFA in good standing or your employment supervisor who can attest to the veracity of the information on the application and your suitability for certification. The CRFA or employer is required to return the document to the CRFA office under a separate cover; do not include this document in the application. Part 4. Ethics Certification and Attestation: To qualify for the CRFA examination you must respond to the following 6 questions and sign the Certification of Accuracy, Agreement and Release Authorization: 1.) Have you received a regulatory reprimand? Yes No If Yes, please provide details concerning the facts related to the reprimand. 2.) Have you been charged with a misdemeanor or felony? Yes No If Yes, please describe details concerning the facts related to the criminal charges. 3.) Have you ever filed for personal or corporate bankruptcy? Yes No

If Yes, please describe in detail the dates and facts related to the bankruptcy. 4. I hereby attest to, and certify that, the following statements are true, correct, and accurate to the best of my knowledge, and I further agree to fulfill the obligations set forth as follows: a. Y N I agree to give the CRFA timely notice of any contact or address change in writing. b. Y N Having read the SCRFA Code of Ethics on the CRFA website, I hereby confirm that I have not violated any of its provision in the past, and will comply with all tenants in the future. I agree to act and conduct my practice in accordance with the currently adopted Code and Policies. c. Y N I understand and agree that I am obligated to report, in writing, in a timely manner any changes concerning my responses to this application to the CRFA Certification Board. d. Y N I have never been the subject of any professional or occupational credentialing, license, certification or registration, ethics or other disciplinary matter(s) or proceeding(s). e. Y N I understand that any intentional or unintentional failure to provide true and complete responses to this application may result in sanctions by the CRFA Board of Directors. If you answer "NO" to any statement(s) above, please provide a written explanation on a separate page. Attach the page to this application. 5. I am requesting special testing accommodations. Yes No (If Yes, please attach documentation as required by the Candidate Guide.) 6. PRIVACY POLICY: I understand that a condition of certification is acceptance from the CRFA Certification Board of all official correspondence. I understand that refusal to accept official correspondence or issuance of a demand to have my personal information removed from the CRFA data base will cause revocation of certification status. I further understand that a benefit of CRFA Certification is that limited information concerning CRFA Certificants is posted on the CRFA online Registry, and that information concerning my certification status will be shared with outside agents with my approval. I also understand that the CRFA at times may share my contact information with outside agents promoting education and programs of interest to

retirement financial advisors. I have indicated my willingness/unwillingness to be included in the CRFA database, the CRFA published registry and to receive additional information related to the profession as indicated below: I give my permission for the CRFA Certification Board to include my information in the CRFA internal database and to send me all official communication. I give my permission for the CRFA Certification Board to post my name, state/province of residence, and certification title(s) information on the CRFA Registry. I give my permission for the CRFA Certification Board to share USPS mail and email contact information with outside organizations promoting programs that may be of interest to retirement financial advisor certificants and registrants. Part 5. Certification of Accuracy, Agreement and Release Authorization: By signing this document, I hereby certify that the information provided in and attached to this application is true, accurate, and complete to the best of my knowledge and belief. I understand and agree that the CRFA Certification Board has the right to contact any person, agency/entity, or organization to review or confirm any information provided in this application. I further agree to authorize the release of any information requested by the CRFA Certification Board with respect to the review of this application. I further understand and agree that the CRFA Certification Board has the right to notify pertinent credentialing and professional organizations if it is determined that this application contains false information. I understand and agree that CRFA certification and recertification depends upon my fulfillment of all required criteria, and obligations including compliance with the SCRFA Code of Ethics, Standards of Practice and Policies and Procedures. I further agree to inform the CRFA Certification Board, in a timely manner, if I become the subject of any ethics, disciplinary, criminal, or lesser offenses, complaints, or charges. I understand that all material included in this application becomes the property of CRFA Certification Board upon receipt and that neither originals nor photocopies will be returned to me. In the event that my certification is suspended or revoked, I agree to comply with all directives or orders of the CRFA Certification Board, including the return of all CRFA credentialing documents. I agree to comply with such directives and orders in a timely manner and at my own expense. Signature Date Part 6. Payment I am applying to sit for the examination. Please charge my credit card $595. I am forwarding or enclosing a check in the amount of $595. I understand my application will be held until the check clears. Mail to: CRFA PO Box 453

Mustang, OK 73064 Credit Card: (Please circle one) Visa Master Card American Express Account # Expiration Date # Billing Zip/Security # for Card Signature Fax to 405-376-1455 or Scan and e-mail to certification@crfa.us Application Checklist: Complete Part 1. Personal Information Complete Part 2. Eligibility Rubric, Certificates and supporting documents Complete Part 3. Endorsement: provide an endorsement form to a CRFA or employer with a copy of your experience document form: The endorsement provider must send a copy of your experience document along with the endorsement document form to the CRFA home office in a separate mailing. Endorsements included in this application will not be accepted. Complete Part 4. Ethics Certification and Attestation (6 questions and signature) Complete Part 5. Certification of Accuracy, Agreement & Release Authorization: Complete Part 6. Payment Information

CRFA Experience Documentation Form Note: this form is to be used to document the Three Year Experience requirement: The original must be included with your application. A COPY must be provided to the endorsement provider, and included in the separate endorsement mailing. Candidate Name: Date Submitted: Dates of Employment Employer s Name and Address Name and Title of Supervisor Narrative Description of Roles and Responsibilities Related to Retirement Financial Planning

CRFA Education & Training Documentation Form Note: this form may be used to document Both Education and Training requirements. Candidate Name: Date Submitted: Dates of Education/ Training Name and Address of Educational Facility Name and Title of Program (e.g., College Major, XYZ Training, XYZ Certificate) Narrative Description Courses of Study/Training and Applicability to the role of the Retirement Financial Advisor CRFA Experience/Training Documentation Form 5/2012

APPLICANT ENDORSEMENT FORM (Present this form to Endorser with copy of training and experience documentation) Please type or legibly print all information in black or blue ink: sign and mail this form in a separate envelope to: P. O. Box 453 501 N Mustang Road, Mustang, OK 73064 Phone: 405-376-9976 Fax: 405-376-1455 Certified Retirement Financial Advisor Candidate Information: Last Name/Surname: First Name/Given Middle Initial: Endorser s Information : Last Name/Surname: First Name/Given Middle Initial: Mailing Address: _ street address,,, City State/Province Country Zip/postal Code Email Address: Phone: Fax: Endorsement: I,, hereby state that I am ( select all that apply) A CRFA in good standing Certification #, Licensed, Commissioned and/or Certified as a : License/Certificate #s Licensing Body(ies): An officer of the Candidate s Employer. Position/Title: and am know ledgeable of, and in good standing w ithin, the Retirement Financial Advisory profession. I hereby affirm that I personally know, or have researched and review ed to the best of my ability, the w ork history and experience, reputation, and criminal history of the above-referenced candidate and find that s/he meets the requirement of a Certified Retirement Financial Advisor as prescribed by the CRFA. In support of my findings, I have attached a copy of the candidate s statement of experience as presented to me by the candidate. Based upon my findings, I hereby endorse the above referenced candidate for consideration as a Candidate for the Certified Retirement Financial Advisor program. Submitted this day of, 20. Endorsers Signature: CRFA Candidate Application 5.2012

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