Certified Management Accountants of Ontario
25 York Street, Suite 1100
Toronto, Ontario M5J 2V5
Tel: 416 342-6382 Fax: 416 593-9082 Toll Free: 1 800-387-2991
Email: finance@cmaontario.org
www.cmaontario.org
2013 Continuing Professional Development (CPD) Declaration Form 4-5A/D
Full Name of Member:
Member No.:
In conjunction with the Annual Membership Dues process, all Members must submit a CPD Declaration Form to Certified
Management Accountants of Ontario (“CMA Ontario”). Non-retired or newly retired Members complete CPD Declaration Form 4-5A/D
declaring whether they met or are exempt from the CPD requirement. Retired Members complete CPD Declaration Form 4-5F, declaring
that they continue to meet the CPD retired exemption. Members who indicate that they did not comply with the CPD requirement MUST
also submit a CPD Plan of Action Form 4-5B. Only one plan of action will be accepted in each three-year CPD cycle.
Due Date:
All information and documentation required by this application MUST be submitted in full by the Member no later than July 1, 2014
without a late payment.
Members, who fail to provide all information and produce all documents and other materials as requested by the Registrar or, in
extraordinary circumstances where such documentation is not available, provide alternate proof satisfactory to the Registrar may be
suspended in accordance with the Bylaws and Regulations.
CPD Supporting Documentation:
Members are required to retain professional development supporting documentation (for example, the course description or outline) and
records of enrolment. It is recommended that records be kept for a total of seven years for possible review or audit.
Questions:
For questions relating to this form, please contact
x102.
cpd@cmaontario.org or by telephone during business hours, at 416 977-7741
Regular business hours: Monday - Friday, 8:30 a.m. – 4:30 p.m.
Forms:
All forms are available for printing at www.cmaontario.org/amd/forms.
Dues Remittance Options:
Online:
E-mail:
Fax:
www.cmaontario.org
cpd@cmaontario.org
Fax: 416 977-6079
Please log in using your
Member number and
password
Please ensure the subject
line contains the following:
CPD Declaration
Please retain the fax
confirmation for your
records
Regular Mail:
Certified Management AccountDQWV of Ontario
Attn: CPD
25 York Street, Suite 1100
Toronto, Ontario M5J 2V5
page 1 of 5 (Form_4_5AD) 04/2014
Certified Management Accountants of Ontario
25 York Street, Suite 1100
Toronto, Ontario M5J 2V5
Tel: 416 342-6382 Fax: 416 593-9082 Toll Free: 1 800-387-2991
Email: cpd@cmaontario.org
www.cmaontario.org
2013 Continuing Professional Development (CPD) Declaration Form 4-5A/D
Full Name of Member:
Member No.:
Please select ONE of the following:
I COMPLY with the 2013 annual CPD requirements. I have completed an annual minimum of 20 hours between January 1, 2013 – December
31, 2013, including at least 10 hours of verifiable CPD during the 12 months from January 1, 2013 – December 31, 2013.
I COMPLY with the reduced 2013 annual CPD requirements for retired Members who provide Reliance Services (see below).
I claim EXEMPTION from the 2013 CPD requirements, due to:
Retired – I am a retired M e m b e r who has ceased full-time practice, full-time employment or full-time business activity, t h e sum
of my age and the total number of years of aggregate membership in CMA Ontario or CMA Ontario and another provincial
body equals or exceeds “85” AND I do not provide any Reliance Services (activities where it is reasonable to believe that
another party is relying on my skills as a Member). See additional information below.
Maternity/Parenting/Family Care – I did not work for a total of 6 months or more between January 1, 2013 to December 31, 2013 in order to
provide full-time care to either my child(ren) who were under the age of 18 or for an elderly or ill family Member.
Unemployment – I did not work and was not involved in any activity where it was reasonable to believe that another party relied upon my skills
as a Member for a total of 6 months or more between January 1, 2013 to December 31, 2013.
Medical Leave – I did not work and was not involved in any activity in which it was reasonable to believe that another party relied
upon my skills as a Member for a total of 6 months or more between January 1, 2013 to December 31, 2013. A letter from a
physician confirming the diagnosis and prognosis, or other such confirmation that I was not employed due to medical reasons
during that time period (e.g. letter from employer or disability claim form) is required and can be sent by mail to the address
noted above, or e-mailed to cpd@cmaontario.org.
Other – I had extraordinary circumstances between January 1, 2013 and December 31, 2013 and am requesting an exemption on
compassionate grounds. The Registrar may grant an exemption, reduction or special consideration of the continuing professional
development requirements. The Registrar shall not exercise the discretion to exempt a Member from any or all of the required hours
of the Professional Development Requirement unless the Member’s ability to practice or earn a livelihood has been interrupted or
significantly impaired. A letter is required and can be sent by mail to the address noted above, or e-mailed to cpd@cmaontario.org.
I DO NOT COMPLY with the CPD requirements and I have attached a completed Plan of Action Form 4-5B for review and approval by
the Registrar. The attached Plan of Action Form 4-5B outlines my deficiencies and details how I plan to meet the CPD
requ irem ents. The completed Plan of Action Form 4-5B MUST accompany this declaration an d cannot be filed later.
Declaration
I declare that the information contained on this form is true and complete.
Print Full Name
X
Member Signature
/
/
Date (MM/DD/YYYY)
page 2 of 5 (Form_4_5AD) 04/2014
Certified Management Accountants of Ontario
25 York Street, Suite 1100
Toronto, Ontario M5J 2V5
Tel: 416 342-6382 Fax: 416 593-9082 Toll Free: 1 800-387-2991
Email: cpd@cmaontario.org
www.cmaontario.org
2013 Continuing Professional Development (CPD) Declaration Form 4-5A/D
Full Name of Member:
Member No.:
CPD Late Filing Fee
I am filing the 2014 CPD Declaration Form 4-5A/D after July 1, 2014 and hereby remit the $25.00 late fee.
Members who fail to provide all information and produce all documents and other materials as requested by the Registrar or, in
extraordinary circumstances where such documentation is not available, provide alternate proof satisfactory to the Registrar, may be
suspended in accordance with the Bylaws and Regulations.
For an immediate payment confirmation, please remit credit card payment online at www.cmaontario.org. Receipt of payments sent by mail
cannot immediately be confirmed.
Amount Paid: $
MasterCard
Visa
HST# 123969610RT0001
Credit Card Number:
Company Cheque
Expiry Date:
Personal Cheque
/
To pay by cheque, record your Mem ber number on the cheque and
make it payable to: Certified Management Accountants of Ontario.
Electronic Bank Payment – Please use your Member number as your account number and return this form.
I authorize Certified Management Accountants of Ontario (“CMA Ontario”) to charge the above credit card as specified above.
Print Full Name of Cardholder
X
Signature of Cardholder
/
/
Date (MM/DD/YYYY)
page 3 of 5 (Form_4_5AD) 04/2014
Certified Management Accountants of Ontario
25 York Street, Suite 1100
Toronto, Ontario M5J 2V5
Tel: 416 342-6382 Fax: 416 593-9082 Toll Free: 1 800-387-2991
Email: cpd@cmaontario.org
www.cmaontario.org
2013 Continuing Professional Development (CPD) Declaration Form 4-5A/D
What Learning Qualifies as CPD
Each Member should u n d e rt ake continuing professional development relevant and appropriate to the Member’s work a n d professional
responsibilities to develop and maintain the Member’s competence necessary to provide high quality service to clients, employers, and
other stakeholders. To be recognized towards the CPD requirement the activity shall:
a.
b.
c.
d.
be quantifiable, meaning that it must be specifically identifiable and be able to be expressed in terms of a specific time
requirement;
be directly related to the competencies needed to carry on the Member’s employment or practice;
be relevant to the Member’s current professional needs and/or long-term career interests; and
contain significant intellectual or practical content.
Verifiable CPD (Regulation 4-5, s. 1.6)
Verifiable continuing professional development means that the learning can be objectively verified by a competent source and may
include:
•
participation in courses, conferences and seminars;
•
organized employer-based in-house training sessions;
research or study projects in areas that expand the professional knowledge of the Member and that result in presentations,
•
reports or similar documentation;
•
research, including reading professional literature or journals for specific application in a professional role;
•
participation and work on technical committees;
•
published professional writing or academic work;
•
writing technical articles, papers or books;
•
teaching a course or a continuing professional development session in an area that is relevant to a professional role;
•
participation as a speaker in conferences, briefing sessions or discussion groups;
•
formal study such as leading to a degree or diploma;
•
pre-professional re-examination or formal testing;
•
self-study involving successful completion of an examination or leading to a designation.
Unverifiable CPD (Regulation 4-5, s. 1.5)
Unverifiable continuing professional development means independent and informal learning activities and may include:
•
on-the-job training for new software, systems, procedures or techniques for application in a professional role;
self-study that does not involve an examination or other objective certification of completion, such as conference reference
•
material or self-study by electronic media or device;
•
casual reading of professional journals or magazines that is not part of research for a specific application in a professional role.
Retired Members Exempt from CPD Requirements
Retired M e m b e r s who do not provide any Reliance Services are exempt from the continuing professional development requirements.
page 4 of 5 (Form_4_5AD) 04/2014
Certified Management Accountants of Ontario
25 York Street, Suite 1100
Toronto, Ontario M5J 2V5
Tel: 416 342-6382 Fax: 416 593-9082 Toll Free: 1 800-387-2991
Email: cpd@cmaontario.org
www.cmaontario.org
2013 Continuing Professional Development (CPD) Declaration Form 4-5A/D
Retired Members Providing Reliance Services
There are continuing professional development requirements for retired M e m b e r s who are providing Reliance Services. “Reliance
Services” means activity undertaken by a Member where it is reasonable to believe that another party is relying on the Member’s s k i l l s
as a Member and includes, but is not limited, to:
•
serving on the board or governing body of a reporting issuer as defined in Rule of Professional Conduct 204;
•
serving on the board or governing body of a public interest entity;
•
providing accounting services to the public; an d
•
providing other professional service(s) for which the Member is remunerated and the gross annual revenue from such service(s)
exceeds $25,000.
Minimum Continuing Professional Development Requirement
Retired Members Providing Reliance Services
Retired Member must meet the Continuing Professional
Development Requirements set out in section 4 of Regulation
4-5.
•
•
Retired Member must meet the following:
•
•
•
•
10 hours annually of continuing professional development
and 60 hours in each three ye ar reporting period.
At least 50 percent of these hours shall be Verifiable
continuing professional development. The remaining hours
may consist of Unverifiable professional development.
Serving on the board or governing body of a reporting issuer
as defined in Rule of Professional Conduct 204 (subsection
17.2 and clause 1.3.1)
Providing accounting services to the public or other
professional services and the aggregate gross annual
revenue from such services exceeds $75,000 (subsection
17.2, clauses 1.3.3 and 1.3.4)
Serving on the board or governing body of a public interest
entity (subsection 17.2 and clause 1.3.2)
Providing accounting services to the public or other
professional services and the aggregate gross annual
revenue from such services exceeds $25,000 but not
$75,000 (subsection 17.2, clauses 1.3.3 and 1.3.4)
Privacy Statement
A Member of CMA Ontario has the right to privacy in respect of information of a personal nature known to CMA Ontario that is unrelated to
Membership status or not required to be disclosed in respect of the fulfillment of CMA Ontario’s self-regulatory responsibilities. CMA
Ontario may disclose your personal information to CP A O nt a ri o provincial accounting bodies and the Public Accountants Council for the
purposes of regulation or providing services to Firms, Members, Students and Applicants and to third party service providers, for the
purpose of providing Member benefits.
page 5 of 5 (Form_4_5AD) 04/2014