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Chartered Institute for Securities & Investment (CISI) Examination
Verification Form for Securities Industry Essentials (SIE) Exam Exemption
Complete this form in full. Please note that by submitting this form, you are authorizing CISI to release
your exam results to FINRA. Per FINRA Rule 1210.01
, this information will be used to determine your
eligibility for an SIE exemption. Failure to accurately complete this verification form will delay the
exemption process and may result in a denial.
Please email this form to CISI at (datarelease.enquiries@cisi.org) and FINRA (waivers@finra.org
).
Candidate Information (to be completed by candidate)
Full Name ____________________________________________________________________
CISI Reference Number _________________________________________________________
Date of Birth ___________________________________________________________________
Street Address _________________________________________________________________
City __________________________________________________________________________
State _________________________________________________________________________
Zip Code / Postal Code ___________________________________________________________
Country _______________________________________________________________________
Email Address __________________________________________________________________
Current Employer’s Name and Address ______________________________________________
______________________________________________________________________________
Name and address of employer(s) when you sat for the CISI examinations. (Please provide name of
exam unit taken and employer’s name and address if more than one employer.)
_____________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Candidate’s Signature and Date____________________________________________________
CISI will send a report directly to FINRA
and to you at the email address you have provided above.
