2014 Designation Promotional Campaign Participation Compliance Form

This signed compliance form indicates that you have obtained permission to be included in the 2014 promotional campaign

representing the _________________________ designation. You will be featured in various forms of media – including print,

online, and out of home advertising. Being a part of the promotional campaign could include the following:

Interviews - in print and online

Profiles in magazines

Live Q&A sessions

Webinar panel of different designation holders to the public on what your designations mean

Media interviews as a spokesperson

Video gallery

These advertisements are intended to build the profile of designation holders as trusted and experienced financial professionals.

By featuring successful designation holders in the ads, we demonstrate the value of your credential. The advertisements will

include (please fill out below):

1. A photograph of you – see sample advertisement

2. Your full name:__________________________________

3. Your current title: ______________________________________________

4. Current company:________________________________________________

If you grant us permission to feature you in the campaign, please sign below. We also require compliance sign-off from your

company allowing us to feature you in the ad, including your title and the name of your current employer. Please sign off and

return to amy.umpleby@moodys.com or fax back to 1-866-866-2660 Attn: Amy Umpleby.

_________________________ _________________________ _________________________

Designation Holder: Full Name (Printed)

Signature Date

_________________________ _________________________ _________________________

Compliance Officer: Name (Printed) Signature Date

csi.ca/ciwm

Credentials That Matter.CANADIAN SECURITIES INSTITUTE

do better with a

CERTIFIED INTERNATIONAL WEALTH MANAGER

FPO

“The keys to successful client-advisor relationships are communication and trust.”I am passionate about helping my clients build

their financial futures and working with them to

address their challenges and opportunities at

each life stage.

Excellent communication skills, expert knowledge

and understanding my clients’ unique needs are

the keys to strong and successful relationships.

My credentials give me the professional

foundation and personal confidence that

empower me to change lives.

Ramandeep Banga, CIWMFinancial Advisor Portfolio Strategies Corp.