ComputerBasedTestingApplicationfortheDecember2016

AdministrationofExamFM

Canadian
InstituteofActuaries

RegistrationDeadline:Monday,October31,2016

NOLATEAPPLICATIONSWILLBEACCEPTED.
Detailsforcompletingthisapplicationareonthereverseside.

ForOfficeUseOnly:

PleasePRINTallinformation.

CANDNO.

IDNO.

IhavepreviouslyregisteredforexamswiththeSOA:YesNo
Checkyourprimaryaddress:HomeWork

DateofBirth

Ifadifferentnamewasusedonapreviousapplication,printithere:

MailingAddress

LastName/FamilyName/Surname(Required)

FirstName(Required)

______
Day

____________

Year

MiddleName(Optional)

OrganizationName(onlyifacompanyaddress)

StreetorP.O.Box

City

State/Province

Zip/PostalCode

Business/Home/DayTelephone

MobileTelephone

EMail(Required)

Idonotwishtoreceiveinformationfromthirdpartyvendors.

Country

Iwishtoreceiveexamresultsviatextmessagetomymobiletelephone.
(OnlyavailableforU.S.Canadabasedmobilephonecarriers.)
Undergraduate

Printschoolnameifcurrentlyenrolled

City/State/PostalCode

Graduate

Degree/AnticipatedDegree/ExpectedYearof
Graduation

OutsideCanada:ExamFM(FMEL)byCBT:December617,2016examwindow

InCanadaExamFM(FMFL)byCBT:December617,2016examwindow

ExamFee:US$225INTLDiscountFee:US$190(QualifiedCountries)

Exam

School

______
Month

Canadianresidentsadd5%GST,PE14%,NB,NL,ON13%NS15%GST/HST

Signature
(Required)

Ihavereadtherulesandregulationsconcerningtheexamination(s)forwhichIamapplyingandagreetobeboundbythem.Iacknowledge
thatIhavereadandagreetoadheretotheSOACodeofConductforCandidates(revised11/1/15).Ialsoagreethattheresultsofany
examination(s)whichItake,andanyactiontakenasaresultofmyconduct(suchasirregularity,violationorcheating,andanyhearings
thereon)may,atthesolediscretionoftheSOA,bedisclosedtoanyotherbonafideactuarialorganizationthathasalegitimateinterestin
suchresultsand/oractions.
Signature:___________________________________________________

Payment

Ifpayingbycreditcard(IndicateOne):AmericanExpressMasterCardVisa
(Candidatespayingbycreditcardareencouragedtouseonlineregistration)

AccountNumber:__________________________________________CVV2Number(Required):________ExpDate(Required):_________
CardholdersName_____________________________________CardholdersSignature(Required):_______________________________
Cardholdersbillingaddress(ifdifferentfromapplicants):____________________________________________________________________

_________________________________________________________________________________________________________________

Mailcheckormoneyorderwithapplicationto:
PreliminaryActuarialExaminations
P.O.Box95600
Chicago,IL606945600

ALLOVERNIGHTDELIVERIES
PreliminaryActuarialExaminations
c/oSocietyofActuaries,CustomerServiceCenter
475N.MartingaleRoad,Suite600
Schaumburg,IL60173
Applicationformsmayalsobefaxedto:+18472738529

InstructionsforCompletingApplicationforComputerBasedTesting
RegistrationDeadlineforDecemberExamFMMonday,October31,2016
PleasePRINTallinformation.PleaseallowTENWORKINGDAYSfortheapplicationtoarrive;otherwise,theuseofanovernightcourierisstrongly
recommended.PostmarkdateswillNOTbeconsidered.ApplicationsreceivedafterthedeadlinewillNOTbeaccepted.Latecandidateswillbe
contacted regarding their registration status. Late applications will be returned to the candidate with a full refund. When using an overnight
courier,sendapplicationdirectlytotheSOAstreetaddress(seedirectionsforcreditcardpayments)asacourierwillnotdelivertoapostoffice
box.
CANDIDATENAMEandPREFERREDADDRESS
IndicateifyouhaveregisteredpreviouslyforanexamwiththeSOAbycheckingyesorno.
Ifyouusedadifferentnameonyourlastapplication(e.g.,amaidenname),printthatnameinthespaceprovided.
PrintyourfirstandlastnameasitappearsonyourvalidgovernmentissuedID(middlenameoptional),yourdateofbirth,address,daytime
telephonenumber,andvalidemailaddress.
SCHOOLINFORMATION
Ifyouarecurrentlyenrolledinacollegeoruniversityprogram,printyourschoolname,city,state,andpostalcodeinthespaceprovided.
Indicateyourstudentstatusandtheyearinwhichyouexpecttograduate.
EMPLOYERINFORMATION
Ifyouareemployedinanactuarialpositionfulltime,printthefullnameandaddressofyouremployer.
INTERNATIONALDISCOUNTPROGRAM

DetailsregardingExaminationandStudyMaterialFeeDiscountProgramcanbefoundathttp://www.soa.org/education/general
info/registration/eduexaminationfeediscount.aspx
RECEIVINGEXAMRESULTSVIATEXTMESSAGE
ThisfeatureisavailableonlyforUnitedStatesandCanadabasedmobilephonecarriers.Bycheckingthebox,youagreetoreceiveresultsfor
allexamsviatextmessage.Inordertoreceiveatextmessageyoumustenteryourmobiletelephonenumber.Pass/Failresultswillbesent
via text message after passing candidate numbers are released.Individual scores will not be delivered via text message. Standard text
messagingratesapply.

PRIVACYPOLICY

Pleasegotohttps://www.soa.org/legal/privacypolicy/toreviewtheprivacypolicy.
EXAMINATION
Registerfortheexambyplacingacheckmark()infrontoftheappropriateexam.AllexamsareadministeredinEnglishexceptinCanada.
ForalltestcentersinCanada,examsarebilingualwithquestionsviewedinEnglishwithanoptiontoswitchtoFrench.
SCHEDULEYOURAPPOINTMENTATTHETESTCENTER
After your registration has been processed, you will receive an automatic acknowledgement letter by email that includes your
candidate/eligibilitynumberforthisadministration.Thecandidate/eligibilitynumberincludedontheautomatedacknowledgementwillNOT
be activated immediately. Once the number has been activated, SOA will email you a letter of confirmation. At that time, you should
immediatelymakeanappointmentataPrometriccomputerbasedtestingcenter.Detailswillbeprovidedwiththeconfirmation.Candidates
whodonotmakeanappointmentataCBTPrometriccenteruponreceivingtheirconfirmationlettermayfindtheirlocalCBTcenterisfilled
onthedayswhentheexamisoffered.ThelatestacandidatecanscheduleaCBTappointmentis48hourspriortothestarttimeoftheexam
on the final day of the testing window. No appointments or corrections will be made after that time. Lastly, if you do not receive a
confirmation email from Prometric within 24 hours of scheduling your appointment, please contact Prometric to make sure the
appointmentwasrecordedproperly.
EXAMINATIONFEES
Examfeesmaybepaidbycheck,moneyorder,orcreditcard(AmericanExpress,MasterCard,orVisa).Checksshouldbemadepayableto
PreliminaryActuarialExams.Applicationsshouldbesenttotheappropriateaddresslistedonthefirstpage.FeesmustbeinU.S.fundsor
equivalent.LettersofConfirmationusedforschedulingappointmentsarenotreleaseduntiltheaccountispaidinfull.NOTE:Theamount
billedtoanindividualscreditcardwillbeautomaticallyadjustedforpersonswhomiscalculatetheamountdue.Feesarenottransferable
from one session to another. Candidates with a balance due will not be permitted to register for future examination sessions until
outstandingdebtsarepaidinfull.
Ifpayingbycreditcard,thecandidatemustincludetheCVV2number(seedetailsbelowunderAdditionalCreditCardInformationCVV2
Number).
A$25feewillbeassessedonanychecksreturnedduetoinsufficientfunds.

NOREFUNDS:PreliminaryActuarialExams/SOAdoesnotofferrefundsforitsexaminations.NopartofafeepaidtothePreliminaryActuarial
Exams/SOAforexaminationregistrationwillberefundedortransferredtoalaterexamperiodshouldthecandidatenotappearfortheexam
ornothavetheproperidentificationwhichprecludestakingtheexam.ThePreliminaryActuarialExams/SOAdoesrecognizethateventsmay
occur that are outside a candidates control. In those cases, there are two options that may be available:

Rescheduling Options for CBT: Because computerbased exams are administered over several days, candidates have the option to
rescheduletheirtestappointmentwithinthesametestingwindowprovidedthattherequestismademorethan48hoursbeforethe
scheduled appointment, and also provided there is a seat available. To reschedule a CBT appointment, candidates must follow the
directionsprovidedathttp://www.soa.org/Education/ExamReq/ExamDayInfo/educbtaddrules.aspx
Emergency Situations. Preliminary Actuarial Exams/SOA recognizes that unforeseen emergencies may occur that directly influence a
candidatesabilitytotakeanexamonanappointedday.Wewillconsiderthesesituationsonacasebycasebasis.Candidatesfinding
themselvesinsuchasituationshouldcontactSOACustomerServiceatcustomerservice@soa.org.

SIGNATURE
Inorderforthisapplicationtobevalid,yoursignaturemustappearonthefrontofthisapplication.

CHANGEOFADDRESSand/orEMAILADDRESS

LogintoMySOAfromourhomepage,www.soa.orgtoupdateyourrecordasneeded.IfyouexperienceanydifficultiescontacttheSOA
CustomerServiceCenteratcustomerservice@soa.orgor+18886973900forassistance.
ADDITIONALCREDITCARDINFORMATIONCVV2NUMBER
HowtofindyourcreditcardsCVV2number:
OnaVisaorMasterCard,pleaseturnyourcardoverandlookinthesignaturestrip.Youwillfind(eithertheentire16digitstringofyourcard
number,ORjustthelast4digits),followedbyaspace,followedbya3digitnumber.That3digitnumberisyourCVV2number(seebelow).
On American Express Cards, the CVV2 number is a 4digit number that appears above the end of your card number (see below).

WhatisCVV2?
CVV2isasecuritymeasurewerequireforalltransactions.SinceaCVV2numberislistedonyourcreditcard,butisnotstoredanywhere,the
onlywaytoknowthecorrectCVV2numberforyourcreditcardistophysicallyhavepossessionofthecarditself.AllVISA,MasterCardand
AmericanExpresscardsmadeintheUnitedStateshaveaCVV2number.

Visa&MasterCard:
ThisnumberisprintedonMasterCardandVisacardsinthesignatureareaofthebackof
thecard.(itisthelast3digitsAFTERthecreditcardnumberinthesignatureareaofthe
card). If you cannot read your CVV2 number, you will have to contact the issuing
institution.

AmericanExpress:

AmericanExpresscardsshowtheCVV2printedaboveandtotherightoftheimprinted
cardnumberonthefrontofthecard.

NOTE:ForEuropeanorAsiancreditcardsthatdonothaveaCVV2number,pleaseenter000asyourCVV2number.

Retainyourcandidatenumbertoaccessresultsathttp://examresults.soa.org.

Ifyouneedassistance,youmaycontacttheSOACustomerServiceCenter
+18886973900betweenthehoursof8:00a.m.and5:00p.m.centraltime.

YoumayalsoemailyourmessagetotheSOACustomerServiceCenteratcustomerService@soa.org.

September2016