AGN Provisional Affiliate Online Form

AGN Provisional Affiliate Membership Application

Thank you for your interest in AGN International Affiliate membership.

We will need some preliminary information to assess and ensure a good match with existing AGN members, and thus maximise mutual benefits. Please be assured that this is provided in the strictest confidence. A further more detailed due diligence will be conducted within 3 months of this application to move you out of the ‘provisional affiliate’ category to a fully endorsed AGN Affiliate member.

How much does Affiliate Membership Cost?

AGN Affiliate membership fee is $84 a month ($1,000 per annum). The fee is paid monthly via an automatic credit card debit. Detailed payment instructions are communicated as soon as this initial online application is accepted.

Not ready to apply right now, or have further questions?
Then please contact us for further discussion: Email: cwhite@agn.org or mrovira@agn.org.

Thank you in advance for taking the time to complete this initial information request. We look forward to working with you as a fully active AGN Affiliate.

Firm Name

Firm address *

Address line one

Address line two

Address line three

Country

Postal Code

Firm Website *

(Minimum requirement)

www....?

Title *

First Name *

Type name

Surname *

Type name

Email Address

Mobile Phone Number - Country code in brackets

1. What are your reasons for applying for AGN Affiliate membership?*

Please describe briefly what you would like to achieve with AGN Affiliate membership.

Type here

2. Your practices total turnover:*

(Please state your annual total turnover in Euros or USD)

Type here

3. Please state your practices main lines of service.*

Type here

4. Your future revenue expectations: *

Please state what total revenue you anticipate in the 3 next years in Euros or USD

Type here

5. Where are you current office locations?*

This will include any existing domestic and overseas locations?

Type here

6. Language *

Please note in what languages the practice is able to conduct business.

Type here

7. International business*

Please describe briefly if you have any existing international business and if so the nature of the work.

Type here

8. Your approach to quality*

Please describe briefly your approach to ensuring high technical and quality standards, including whether you are subject to any peer review or regulatory inspection regime (if so by whom). Please include your approach to professional training & development.

Type here

9. Licensing & regulators*

Please note all the official bodies that licence or regulate your professional activities, and the professional qualifications of the practice principles

Type here

10. Ethics and standards*

Please confirm that all principles of the practice are currently qualified and licensed in accordance with local requirements, have not been subject to any official adverse finding, sanction or rebuke within the last 7 years and that their business, personal & financial affairs are satisfactory so as not to reflect adversely on the practice or impede it's professional activities. Please note any material matters arising.

Type here (If none please state 'none'.)

11. Fit & Proper Status*

Is the practice AND ALL its partners/principles:

Currently licensed and qualified for all activities it/they perform in accordance with local requirements?
Free from official public/regulatory criticism or adverse findings, sanction or rebuke for at least 6 years, and from any relevant current or threatened investigation(s)?
Enjoying financial and personal affairs that do not reflect adversely on the reputation of the practice, or impede its professional activities?
Free from actual/threatened litigations (or similar enforcement actions) with a total expected value of over US$50,000?
Free from unresolved issues arising from any regulatory or peer inspections/reviews, where such unresolved issues are more than trivial?
Operating policies, procedures and training in professional independence and professional ethics to at least standards included in IFAC codes & guidance?
Operating policies, procedures and training to comply with local laws on money laundering, anti-crime/terrorism, bribery/corruption and data protection/privacy?
Otherwise “fit and proper” in all respects to carry on professional activities?

11.1 Fit & Proper status - signature

12. Confirmatory Declaration *

Yes, all matters are positively affirmed

No, there are some exceptions to be noted

12.1. Exceptional Disclosures *

If answering "NO" to the Qualifications question above, please note the circumstances of ALL exceptions here.

Type here

12.2 Confirmation Declaration - signature

I hereby declare that the information given by me in the Application is true, complete and correct to the best of my knowledge and belief and that nothing has been concealed or distorted.

13. How did you hear about us?*

1. Recommendation from an existing AGN member

2. Recommendation from another accounting industry source

3. Via search of web/LinkedIn/twitter etc,

4. References in publications/press

5. Online advertising

6. AGN marketing materials

7. AGN direct contact

Others

Write here

Thank you for your information

If you hit submit you will receive email confirmation. Payment instructions will communicated after a brief internal review. Provisional affiliate membership will be activated as soon as soon as possible, usually within few days after payment. This will also trigger us to commence with the next part of the due diligence process.

What happens next?

We will contact you with a more detailed information gathering form and also organise a zoom review discussion. Applicants are then reviewed by the AGN International Board. Successful applicants will then be accepted as an official Affiliate member eg ‘provisional’ will disappear from your listing. This process will be completed within 3 months . Unsuccessful candidates will be removed from the AGN directory listing and will receive an automatic refund of monies received.

Thanks again.

Disclaimer:
AGN International Ltd is a company limited by guarantee registered in England & Wales, number 3132548, registered office 6 Hays Lane, London Bridge, London SE1 2HB, United Kingdom.

AGN International Ltd (and its regional affiliates; together “AGN”) is a not-for-profit worldwide membership association of separate and independent accounting and advisory businesses. AGN does not provide services to the clients of its members, which are provided by Members alone. AGN and its affiliates, specialist affiliates and members are not in partnership together, they are neither agents of nor obligate one another, and they are not responsible or liable for each other’s services, actions or inactions.

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AGN Provisional Affiliate Membership Application

11.1 Fit & Proper status - signature

12.2 Confirmation Declaration - signature

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