REFERENCE

FORM
Applicant to Complete
CFA INSTITUTE IDENTIFICATION # SOCIETY APPLYING TO

APPLICANT NAME
PREFIX (CHECK ONE) Mr. Miss Ms.
Mrs. Dr. Prof. Rev. Hon. FIRST (GIVEN) NAME MIDDLE NAME OR INITIAL LAST NAME (SURNAME OR FAMILY NAME)

Reference to Complete
EMPLOYMENT STATUS OF REFERENCE

Employed part time Employed full time Student Unemployed Retired

EMPLOYER NAME EMPLOYER NAME
CFA INSTITUTE IDENTIFICATION # (IF APPLICABLE) PREFIX (CHECK ONE)
Mr. Miss Ms. Mrs. Dr. Prof. Rev. Hon.
REFERENCE NAME

FIRST (GIVEN) NAME MIDDLE NAME OR INITIAL LAST NAME (SURNAME OR FAMILY NAME)

BUSINESS NAME (IF APPLICABLE)

MAILING ADDRESS LINE 1 ADDRESS LINE 2

CITY STATE/PROVINCE COUNTRY ZIP+4/POSTAL CODE

TELEPHONE FAX

COUNTRY CODE AREA/CITY CODE LOCAL NUMBER EXTENSION COUNTRY CODE AREA/CITY CODE LOCAL NUMBER

E-MAIL ADDRESS

Based on your knowledge of the applicant, complete the following:

1. Does the applicants primary full-time professional occupation meet the requirements of the work experience guidelines?
Yes No

2. Does the applicant spend at least 50 percent of their time directly involved in the investment decision-making process or in responsibilities that inform or add
value to that process?
Yes No

3. Describe the applicants role in the investment decision-making process. The details you provide will help us understand the applicants qualifications.

4. Do you know of any reason why the applicant should not be considered for membership due to professional character or conduct issues?
No, this applicant should be considered for membership. Yes, I know of issues.

5. Relationship to applicant: Colleague Supervisor Other Professional Reference

References Agreement
By signing below, I certify that the information provided is true and correct to the best of my knowledge.

SIGNATURE DATE (DAY/MONTH/YEAR)

Please allow up to 3 business days for processing.

CFA INSTITUTE 915 EAST HIGH STREET CHARLOTTESVILLE, VA 22902, USA

FAX: +1 (434) 951 5290 PHONE: +1 (434) 951 5499 USA AND CANADA: (800) 247 8132 E-MAIL: MEMBERSHIP@CFAINSTITUTE.ORG