How to Register and Application Forms Summit Finuas Network Registration Form 2013/2014 How to Register STEP 1 – EMPLOYER PREREQUISITES: 1. Ensure that your company is a member of Summit Finuas Network - see www.summitfinuasnetwork.com. In order to register for a programme and avail of funding offered by the Summit Finuas Network your company must be a member of the Network. You can check if your company is a member online at www.summitfinuasnetwork.com and go to the Network Membership section. Membership is free and if your company is not a member it can join by visiting the Summit Finuas website and filling in the Network Membership form online. 2. Ensure your employer is willing to pay for your programme fees or reimburse you where payment is made by you personally. Summit Finuas Network funding is only available to private sector companies. Private individuals are not eligible for funding. STEP 2 – COMPLETE THE FOLLOWING SECTIONS OF THE REGISTRATION FORM: A. Personal Information B. Programme Selection C.Authorisation D. Trainee Profile Completion of all details is required. Please use block capitals. FINAL STEP Collate the Registration Form (Sections A,B,C,D) and cheque made payable to Summit Finuas Network and send in advance of the closing date to The Institute of Banking, IFSC, 1 North Wall Quay, Dublin 1, or email to [email protected] PLEASE NOTE THAT INCOMPLETE REGISTRATIONS MAY RESULT IN DELAYS IN PROCESSING YOUR REGISTRATION Summit Finuas Network Registration Form 2013/2014 2013/2014 EXECUTIVE MASTERS IN RISK MANAGEMENT (EXMRM) - REGISTRATION FORM A. Personal Information PERSONAL DETAILS ALL FIELDS ARE MANDATORY Membership Number qqqqqqq Surname qqqqqqqqqqqqqqqqqqqqqqqqq First Name qqqqqqqqqqqqqqqqqqqqqqqqq Date of Birth (dd/mm/yyyy) qq / qq / qqqqq County of Birth e.g. Dublin (if born outside of Ireland, country of birth) qqqqqqqqqqqqqqqqqqqqqqqqq Employer Name qqqqqqqqqqqqqqqqqqqqqqqqq Mobile Phone Number* qqqqqqqqqqqqqqqqqqqqqqqqq Email Address* qqqqqqqqqqqqqqqqqqqqqqqqq qqqqqqqqqqqqqqqqqqqqqqqqq Mother’s Maiden Name qqqqqqqqqqqqqqqqqqqqqqqqq Have you been a UCD student before? E.g. attained a degree, studied a postgraduate programme or attained an award from The Institute of Banking If yes, state dates of attendance From (mm/yyyy) qq / Staff Numberqqqqqqqqqq (if applicable) qqqq q Mr Mrs q Yes To (mm/yyyy) Ms q q No q qq / qqqq *We will send you alerts when new correspondence is posted online to My Institute WORK DETAILS Note that all correspondence is sent to your work address unless requested otherwise. The Institute of Banking does not accept responsibility for correspondence sent to home addresses Employer Name qqqqqqqqqqqqqqqqqqqqqqqqq Department qqqqqqqqqqqqqqqqqqqqqqqqq Address qqqqqqqqqqqqqqqqqqqqqqqqq County qqqqqqqqqqqqqq Work Phone Number qqqqqqqqqqqqqqqqqqqqqqqqq Postcode qqqqqqqq HOME DETAILS Address qqqqqqqqqqqqqqqqqqqqqqqqq County qqqqqqqqqqqqqq Postcode qqqqqqqq EXECUTIVE MASTERS IN RISK MANAGEMENT (EXMRM) - REGISTRATION FORM 2013/2014 B. Programme Selection Module Semester Fee €6,250 per semester Summit Finuas Network fee €4,000 per semester Quantitative Methods I 1 q q Derivative Securities 1 q q Bank Asset & Liability Management I 1 q q LECTURE VENUE Dublin q P EXAM VENUES Athlone q Venues available subject to demand Cork q Dublin q Galway q Letterkenny q Limerick q Waterford q DATA PROTECTION NOTICE DECLARATION The information provided by you on this registration form and generated as a result of your participation in programme(s) may be used and disclosed by the Institute of Banking for all purposes which are reasonably incidental to your participation in the programme(s). I wish to register for the programme(s) selected above. By submitting this Institute of Banking registration form, I acknowledge that I have read in full, understood and agree to be bound by the terms and conditions set out and referred to online at www.iob.ie/terms. I further confirm that I have read and understood the contents of the data protection notice and consent to the uses and disclosures of my personal data as set out therein. Those purposes may include the disclosure of examination results and other information to your employer and the Summit Finuas Network. The Institute of Banking may also provide you with information in relation to other services which they offer. If you do not wish to receive information or offers in relation to such other services please tick this box. q You are entitled to ask for a copy of the personal data which The Institute of Banking holds about you and to have any inaccuracies in such personal data amended or erased. You may do so by writing to: The Registrar, The Institute of Banking, IFSC, 1 North Wall Quay, Dublin 1. Signature qqqqqqqqqqqqqqqq Date d q d / q mq m / q y q y q y q y q 2013/2014 MSC/GRADUATE DIPLOMA IN COMPLIANCE - REGISTRATION FORM A. Personal Information PERSONAL DETAILS ALL FIELDS ARE MANDATORY Membership Number+ qqqqqqq Surname qqqqqqqqqqqqqqqqqqqqqqqqq First Name qqqqqqqqqqqqqqqqqqqqqqqqq Date of Birth (dd/mm/yyyy) qq / qq / qqqqq County of Birth e.g. Dublin (if born outside of Ireland, country of birth) qqqqqqqqqqqqqqqqqqqqqqqqq Employer Name qqqqqqqqqqqqqqqqqqqqqqqqq Mobile Phone Number* qqqqqqqqqqqqqqqqqqqqqqqqq Email Address* qqqqqqqqqqqqqqqqqqqqqqqqq qqqqqqqqqqqqqqqqqqqqqqqqq Mother’s Maiden Name qqqqqqqqqqqqqqqqqqqqqqqqq Have you been a UCD student before? E.g. attained a degree, studied a postgraduate programme or attained an award from The Institute of Banking If yes, state dates of attendance From (mm/yyyy) qq / Staff Numberqqqqqqqqqq (if applicable) qqqq q Mr Mrs q Yes To (mm/yyyy) Ms q q No q qq / qqqq *We will send you alerts when new correspondence is posted online to My Institute + YOU MUST BE A CURRENT ACOI MEMBER IN ORDER TO REGISTER IF YOU WISH TO BECOME AN ACOI MEMBER GO TO WWW.ACOI.IE WORK DETAILS Note that all correspondence is sent to your work address unless requested otherwise. The Institute of Banking does not accept responsibility for correspondence sent to home addresses Employer Name qqqqqqqqqqqqqqqqqqqqqqqqq Department qqqqqqqqqqqqqqqqqqqqqqqqq Address qqqqqqqqqqqqqqqqqqqqqqqqq County qqqqqqqqqqqqqq Work Phone Number qqqqqqqqqqqqqqqqqqqqqqqqq Postcode qqqqqqqq HOME DETAILS Address qqqqqqqqqqqqqqqqqqqqqqqqq County qqqqqqqqqqqqqq Postcode qqqqqqqq MSC/GRADUATE DIPLOMA IN COMPLIANCE - REGISTRATION FORM 2013/2014 B. Programme Selection Module Semester Fee €2,050 per semester Summit Finuas Network fee €1,500 per semester Ethics and Corporate Governance 1 q q Managing for Compliance 1 q q LECTURE VENUE Dublin q P EXAM VENUES Athlone q Venues are available subject to demand Cork q Dublin q Galway q Letterkenny q Limerick q Waterford q DATA PROTECTION NOTICE DECLARATION The information provided by you on this registration form and generated as a result of your participation in programme(s) may be used and disclosed by the Institute of Banking for all purposes which are reasonably incidental to your participation in the programme(s). I wish to register for the programme(s) selected above. By submitting this Institute of Banking registration form, I acknowledge that I have read in full, understood and agree to be bound by the terms and conditions set out and referred to online at www.iob.ie/terms. I further confirm that I have read and understood the contents of the data protection notice and consent to the uses and disclosures of my personal data as set out therein. Those purposes may include the disclosure of examination results and other information to your employer and the Summit Finuas Network. The Institute of Banking may also provide you with information in relation to other services which they offer. If you do not wish to receive information or offers in relation to such other services please tick this box. q You are entitled to ask for a copy of the personal data which The Institute of Banking holds about you and to have any inaccuracies in such personal data amended or erased. You may do so by writing to: The Registrar, The Institute of Banking, IFSC, 1 North Wall Quay, Dublin 1. Signature qqqqqqqqqqqqqqqq Date d q d / q mq m / q y q y q y q y q C. Authorisation COMPLETION OF ALL DETAILS IS REQUIRED. PLEASE USE BLOCK CAPITALS. PAYMENT ADVICE Purchase Order Number (if applicable) Select one of the options below: qqqqqqqqqqqqqqqqqq Company Name (to appear on Invoice) q Option 1 - I attach Employer cheque (made payable to Summit Finuas Network) q Option 2 - I attach Personal cheque (made payable to Summit Finuas Network) plus letter from my employer confirming I will be reimbursed for these programme fees q Option 3 - Invoice my employer, details and Company Authorisation below: qqqqqqqqqqqqqqqqqq Company Address (to appear on Invoice) qqqqqqqqqqqqqqqqqq qqqqqqqqqqqqqqqqqq Authorised Signatory (the person in your company who has responsibility for authorising invoices for training programme fees.) I authorise Summit Finuas Network to issue an invoice in respect of programmes selected overleaf for fees €_______________________ (insert total amount). I confirm that payment will be made on receipt of invoice. Name qqqqqqqqqqqqqqqqqq Email address qqqqqqqqqqqqqqqqqq Phone qqqqqqqqqqqqqqqqqq Summit Finuas Network Registration Form Signature q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q q Date d q d / q mq m / q y q y q y q y q 2013/2014 SF09 - F5 D. Trainee Profile COMPLETION OF ALL DETAILS IS REQUIRED. PLEASE USE BLOCK CAPITALS. The purpose of this form is to gather profile information about participants on programmes funded by Finuas/Skillnets Ltd from the National Training fund through the Department of Education and Skills (DES). Only aggregated data will be reported to the Department of Social Protection (DSP). Summit Finuas Network will comply with all applicable data protection legislation in respect of the information and personal data provided by you in this form. You have the right of access to the data by means of a written request and you can request Summit Finuas Network to correct any inaccuracies in the data. If you do not want to receive any further information regarding programmes managed or administered by Skillnets Limited, please tick this box q Signature: ______________________________________________________Date: __________________________________________________________ SECTION A First Name: ____________________ Surname: _____________________________ Age: _____ Gender: Male q Female q Phone Number:___________________________________________________ E-mail Address: ________________________________________________ What is your current level of employment (please select one box only): Full-time q Part-time q Short-time q Seasonally employed q Temporarily employed q Unemployed q What is your highest attainment level on the National Framework of Qualifications (NFQ)? NFQ 1 q NFQ 2 q NFQ 3 q NFQ 4 q NFQ 5 q NFQ 6 q NFQ 7 q NFQ 8 q NFQ 9 q NFQ 10 q Other (please specify): ______________________________________________________________________________________________________________ (Note Level 5 = Leaving Certificate; Level 6 = Advanced/Higher Certificate; Level 7 = Ordinary Bachelors Degree; Level 8 = Honours Degree/Higher Diploma; Level 9 = MSc; Level 10 = Phd) In what year did you receive your highest educational qualification? _________________ SECTION B Company Name: ___________________________________________________________________________________________________________________ Job Title/Position in Company: _______________________________________________________________________________________________________ Work address of employee: __________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ Employees Supervisor/Manager Name:_________________________________________________________________________________________________ Work Address of Supervisor/Manager: _________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ Email Address of Supervisor/Manager:_________________________________________________________________________________________________ Phone Number of Supervisor/Manager:________________________________________________________________________________________________ What is your occupation category? Owner Manager q Technician/Technical q The Summit Finuas Network is funded by member companies and the Finuas Networks Programme, managed by Skillnets Ltd. funded from the National Training Fund through the Department of Education and Skills. Managerial/Supervisor q Skilled Manual q Professional q Non-Manual q Semi Skilled q