a The Institute of Chartered Accountants of India APPLICATION FOR ENROLMENT FOR INTEGRATED PROFESSIONAL COMPETENCE COURSE (IPCC) / ACCOUNTING TECHNICIAN COURSE (ATC) lo 95 IN sl pace Yor Official Stamp 1. Name in full lin Capital Lettersi(As per Institute's Record/10+2/Graduate Certificate) (First Name) (idle Name} (Sur Name] ‘Maiden Name (in care ot marned remare stucert) 2.Gender Male © Female O 3. Date of Birth 4[a) Mother's Name (da/mmyyy) (b) Father's Name 5. Option for level{s) of Course Group of PCC CQ) Group of IPCC (with/without articles) CQ Accounting Technician Course Group 1of IPCC and ATC CQ) Group of PCC (with/without articies) and ATC OQ) Group | and Group ll of IPCC (with/without articles) (C) Group I, Group ll of IPCC and ATC (All Levels) O) 6. Residential Address a) Permanent Address O° a state Code Pin Mobile No. Email id by correspondence cy LTT TT TI LLU BEaSee8) re LL Sp'eeae IO [Eh stent Form ince.page 1 ofa emanid | | | | CLT [TTT LITTTITTT TT tT) mobiieno. [1111 TIL 7. Please indicate whether you need study material in Hind! or’English’ — C) Hindi English 8a) Nationality O indian © Foreign {in cese of foreign nationals intending to pursue studies in Idia, an attested copy of student visa or study permit, as the case may be from appropriate authorities forthe duration of the Chartered Accountancy Course must be enclosed) (b) whether Physically challenged (if yes, proof for nature of deformity to be enclosed) C) ves. ©. No 9. Educational Qualifications (Starting from 10th examination) Result Examination| —Board/ Authorty/University ver Tacomamea) man mana ] awanca x x Degree O Yes Diploma O Yes 10[a} Date of joining Entrance/ Foundation / PE-1/CPT with Registration number aS ete CLO regsvaton, (b) particulars regarding passing the Entrance/Foundation/ PE-1/CPT, wherever applicable (year, month and roll number) FC Exam Year| | | | |Montn| | |Rounumber [| | | ||] JIM | mn) arse a Student Form IPCC Page 2 of 4«(TT TTTTTTT TTT ttt ttt hereby deposit towards Registration fee for Integrated PCC [choose one} Without Articles) Group | of IPCC Rs.8,000/$500 Group Il of IPCC Rs.5,000/$300 atc Rs.10,000/$600 Both Groups of IPCC R.9,000/$550 Group | of IPCC and ATC Group Il of IPCC and ATC Rs.10,000/$600 Group I,Group Il of IPCC and ATC Rs.10,000/$600 (i) * Articted training starts only after passing Group I of IPCC or ATC. (ii) Fees of Rs.1,000/- meant for Student's Activities is to be paid only once. (it) Detailed chart of Fees is enclosed herewith. Rs.10,000/$600 Rs 7,000/$400 * Rs 11,000/$650 * Rs 12,000/$700 * Rs 12,000/$700 * (b) O Rs. 400/- or $150 for the annual subscription of Journal - The Chartered Accountant (optional) Detais of Payment OD Date: |_| Detais of Payment if paid through online pone. [| | ] ‘Acknowledgement Number © Amountin ks. Q Amount in § Name of the Bank Amount | | The amount of | Chel [-1_[_ shout be pata by way of Demand Draft drawn in favour ot “The Secretary, The Institute of Chartered ‘Accountants of India" payable at Mumbai / Chennai /Kolkata / Kanpur / New Delhi in accordance with the address of the student. |, undertake to abide by all the Rules of the Board of Studies, as may be in force from time to time during the period 1 am undergoing tuition. I further agree not to pass, or sell or ‘gift away any study paper or any other material provided to me by the Board of Studies/institute. Please affix Recent Colour Photograph es | qa7ls2749 (Within te frame ony) Signature of the Applicant (For office use only) Study sets Bruedicolected Q Yes Q No Wes Inperson trom regional/pranch office datewanomeesea! [TTT] [=f] [|] oncesea By Post Applied inthe Region Q Western © Southern © Eastern © Central O Northern Signature of Signature of Dealing Assistant ‘Otter InChorge ACKNOWLEDGEMENT ‘We acknowledge with thenks receipt of| FS or[5 byway ofdemanadrattne. [T | | | | 9 Registration Fee for IPCC subject to realization oft student Form IPCC. Page 3.0f 4 the Demand Draft Tae toe anti