CGA Mutual Recognition Agreement Initial
Application for CPA Ireland Members
PERSONAL INFORMATION
Date of Birth: M__________ D__________ Y__________ Gender: Male Female
Mr. Mrs. Miss Ms. CPA FCPA
First Name: __________________________________________ Initial: ________ Surname: __________________________________
Preferred Name: ______________________________________
Home Address: ______________________________________________________________ City: ________________________________
Province: ____________________________ Country: ____________________________ Postal Code: __________________________
Home Phone: ( ) ______________________________ Home E-mail Address: ________________________________________
This is my preferred mailing address (please tick)
CPA Ireland Membership Number: __________________________________ Date Admitted by CPA Ireland: ____________________
Date Admitted as FCPA: __________________________
(if applicable)
Degrees or designations (other than CPA): ____________________________________________________________________________
Institution: ________________________________________________________________________________ Date: __________________
Degrees or designations (other than CPA): ____________________________________________________________________________
Institution: ________________________________________________________________________________ Date: __________________
Citizenship status for applicants residing in Canada:
Canadian Citizen Permanent Resident Visa Applicant (attach supporting documents) Other
EMPLOYMENT INFORMATION
Your Employer’s Name: ______________________________________________________________________________________________
Your Job Title: ______________________________________________________________________________________________________
Your Employer’s Address: ____________________________________________________ City: ________________________________
Province: ____________________________ Country: ____________________________ Postal Code: __________________________
Work Phone: ( ) ______________________________ Work E-mail Address: __________________________________________
This is my preferred mailing address (please tick)
Are you offering any public accounting services in Canada? Yes No
Page 1 of 3
CGA Mutual Recognition Agreement Initial
Application for CPA Ireland Members
DECLARATION
In providing personal information on this form (and any other information collected and maintained in the course of the
application process) and signing the document I consent to its use for the purposes of:
1) regulating applicants in accordance with the provisions of the provincial or national Act incorporating the CGA association,
association by-laws, and the Code of Ethical Principles and Rules of Conduct;
2) admission to membership;
3) processing payments; and
4) exchanging membership status information, including the disclosure of confidential disciplinary investigation and
sanctions with CPA Ireland.
Have you ever been convicted of any criminal offence(s) in any jurisdiction? Yes No (if yes, please attach details)
At present, do you have any criminal charges outstanding in any jurisdiction? Yes No (if yes, please attach details)
made against you by any professional organization?
Have you ever had a finding of unprofessional conduct or similar finding
Yes No (if yes, please attach details)
Are you presently the subject of any outstanding complaints or discipline
matters with any professional organization with which you are or ever Yes No (if yes, please attach details)
have been registered?
Have you ever been found guilty of contravening a section of securities
regulatory or taxation authority legislation in any jurisdiction? Yes No (if yes, please attach details)
Have you ever been declared bankrupt or are you currently the subject
of a bankruptcy proceeding? Yes No (if yes, please attach details)
The applicant is responsible for ensuring the accuracy of the information contained in this application. Failure to comply with
this requirement may lead to termination of membership in the Association.
I acknowledge that under the terms of the MRA, admission to the Association requires that I continue to be a member
in good standing with CPA Ireland.
I also acknowledge that I am required to meet the Association’s Entry to Public Practice requirements in the jurisdiction
of residence or practice in order to offer public accounting services.
I certify that all statements on this application are true and correct.
Signature: ______________________________________________________________ Date: __________________________________
Page 2 of 3
CGA Mutual Recognition Agreement Initial
Application for CPA Ireland Members
CHECKLIST FOR SUBMITTING APPLICATIONS
Attachments to the Initial Application Form
• Membership Status Letter from CPA Ireland
Documentation to be provided after submission of the initial application:
1) Certificate of completion of the CGA Overview of Canadian Income Tax and Law course available on completion of the
online course. This is to be provided directly by the applicant. Applicants claiming a transfer credit from the course are
required to provide an official sealed transcript showing completion of an acceptable equivalent course from a Canadian
post-secondary institution. Transcript to be provided directly by the post-secondary institution to the appropriate
Association office.
2) Official sealed transcript of your degree sent directly to the Association by your post-secondary institution.
(Note: These documents may be submitted with the initial application form.)
Page 3 of 3
CGA Contact Information
FOR INTERNATIONAL RESIDENTS
CPA Ireland Members who are CPA Ireland Members who are
NOT residents of Canada residents of Hong Kong
or Hong Kong CGA-Hong Kong
CGA-Canada International Unit A, 10/F
100 – 4200 North Fraser Way 211 Johnston Road
Burnaby, BC V5J 5K7 Wanchai HK
mracga@cga-canada.org info@cgahk.org.hk
FOR RESIDENTS OF CANADA
CPA Ireland Members who are CGA-New Brunswick CGA-Ontario
residents of Canada Commerce Building 240 Eglinton Avenue East
Contact the provincial office P.O. Box 1395 Toronto ON M4P 1K8
where you reside 10-236 St. George Street T (416) 322-6520
CGA-Alberta
Moncton NB E1C 1W1 F (416) 322-6481
T (506) 857-0939 info@cga-ontario.org
Ordre des CGA du Québec
Suite 100, 325 Manning Road NE, F (506) 855-0887
CGA-Newfoundland & Labrador
Calgary, AB, T2E 2P5
T (403) 299-1300 500, Place d’Armes
F (403) 299-1339 294 Freshwater Road, Suite 201 Bureau 1800
MemberService@cga-alberta.org St. John’s NL A1B 1C1 Montréal (Québec) H2Y 2W2
CGA-British Columbia
T (709) 579-1863 Tél. : 514 861-1823
F (709) 579-0838 Téléc. : 514 861-7661
CGA-NWT/Nunavut CGA-Prince Edward Island
300-1867 West Broadway
Vancouver BC V6J 5L4
T (604) 732-1211 P.O. Box 128, 3rd Floor P18 Queen Street, Suite 105
F (604) 732-1252 5016 50th Avenue Charlottetown PEI C1A 4A1
CGA-Manitoba
Yellowknife NT X1A 2N1 T (902) 368-7237
T (867) 873-5620 F (902) 368-3627
CGA-Saskatchewan
4 Donald Street South F (867) 873-4469
CGA-Nova Scotia
Winnipeg MB R3L 2T7
T (204) 477-1256 114-3502 Taylor Street East
F (204) 453-7176 1801 Hollis Street, Suite 230 Saskatoon SK S7H 5H9
info@cga-manitoba.org Halifax NS B3J 3N4 T (306) 955-4622
T (902) 425-4923 F (306) 373-9219
CGA-Yukon Territory
F (902) 425-4983
P.O. Box 31536
Whitehorse YT Y1A 6K8
T (867) 668-4461
F (867) 667-5790
Page ii