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April 2015
Retirement Provision Certificate
(RPC)
Student Membership Application
Personal Information
PIN (if known)
Title
Forename(s)
Surname
Date of Birth
Home Address
Town
County
Post Code
***PLEASE PROVIDE A CLEAR AND ACCURATE EMAIL ADDRESS AS ALL STUDY MATERIAL IS SENT VIA EMAIL***
Email
Work phone
Mobile Number
Employment Details
Name of Employer
Address
Town
County
Post Code
Current Job Title
Address you would like to be used for correspondence (PMI News etc)
Home
Work
Do you wish to receive communication from the PMI Regional Groups?
Yes
No
If yes, please select the Regional Group(s) you wish to be contacted by
Eastern
London
Midlands
North East
North West
Scotland
Southern
South West
Do NOT wish to receive a monthly copy of PMI News?
Do NOT wish to receive a monthly copy of Pensions Age?
Do NOT wish to receive fortnightly PMI TV emails?
Do NOT wish to receive emails about PMI activities?
Education
Please indicate your education attainments (please tick all that apply):
Secondary (GCSE, A Level)
Vocational Qualifications
University (Degree)
Professional Qualifications
Online Learning Materials
Please tick appropriate box(es) below
2015 RPC Online Learning Access Key
Updated 2015 RPC Online Learning Access Key (for
those who purchased a 2014 Access Key)
PLEASE SEE NOTES AND FEES PAGE FOR RELEVANT FEES
Data Protection Statement
The PMI is registered under the Data Protection Act and maintains a membership database to: enable information to be exchanged as
required between you, the PMI, its subsidiaries, your qualification centre and individuals involved in assessment and regional groups;
relevant regulators; your employer (see below) administer any examinations or qualifications you enter and courses you undertake; billing
and accounts; distribute publications and information about other PMI services; distribute mailings from 3rd parties which we believe may be
of interest; confirm your membership status and PMI qualifications.
Declaration
I hereby apply for membership of the Pensions Management Institute and declare that all the information given in this form is correct and that I consent to it being
held in accordance with the Data Protection and Privacy Statement. I hereby undertake, if admitted to the Pensions Management Institute duly to observe the
Articles of Association, Code of Professional Conduct, Rules and Regulations for the time being in force for the duration of my membership. The Code of
Professional Conduct and other relevant documents are published on the PMI website.
Signed
Date
FOR OFFICE USE ONLY
PIN Number
Entered By
Amount
Date Received
Checked By
Qualifications April 2015
Examination Entry Form
PMI House
4 -10 Artillery Lane
London E1 7LS
T: 020 7247 1452
F: 020 7375 0603
W : www.pensions-pmi.org.uk
The form and payment must be received by the
PMI by Friday 23 January 2015
PIN:
Full Name:
Home Address:
If permanent change please tick
Work Address:
If permanent change please tick
Phone Number:
Email:
Please circle the module(s) that you wish to sit – (Examination Entries are £155.00 for 200/300 level exams, £150.00 for RPC)
Retirement Provision Certificate
101
Providing for Retirement
201
Legal Issues Relating to UK Pension Arrangements
202
Defined Benefit Schemes
203
Defined Contribution Arrangements
204
Investment
205
Employee Compensation and Benefits
301
Management, Risk and Governance
302
Explaining Pension and Benefit Matters
304
International 2: Managing International Employee
Benefits
305
Retail Investment Advice and Regulation
306
Total Fee
Please indicate your choice of examination centre:
£
1st Choice
2nd Choice
Declaration: I declare I have read the April 2015 Examination Regulations and that this exam entry is in accordance with them.
RPC Payment Form and
Fees Page
2014 – 2015
All fees are given in Sterling (£)
Full Name
PIN Number (if known)
Retirement Provision Certificate (RPC) Student Fees (Please tick appropriate box(es) below)
2015 Online Learning Access Key
180
2015 Updated Online Learning Access Key
85
April 2015 Examination
150
October 2015 Examination
150
Revision Course
105
Total Amount:
£
NOTE: When you order the RPC access key you automatically become a Student Member and you will be asked to
pay an annual subscription in future years if you wish to remain a student.
The deadline for examination entries are detailed in the Handbook and on the PMI website.
Please note there is now no VAT due on RPC learning material
Payment Type:
I enclose a cheque made payable to PMI
I would like to pay by debit/credit card
I have made a BACS payment to PMI
BACS:
The payment has been made from:
A personal account
My Employer
Employer:
PMI Bank details:
HSBC Bank Plc, 100 Old Broad Street, London, EC2N 1BG
Sort Code:
40-07-31
Account Number:
61146203
Please ensure your surname and membership number is given as a reference on the BACS payment to prevent the
payment being returned.
Credit/Debit Card:
Type of card:
Mastercard
Visa
Debit Card
Switch
Maestro
American Express
Card Number:
Start Date:
Issue Number:
Security Code:
Name on Card:
Signature:
/
End Date:
Switch/Maestro only
Last 3 digits on the back of the card
/