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Ap plication for issu e of a D uplicate P ass C ertificate

Date:
The Joint Secretary (Exam s)
The Institute of Chartered Accountants of India
Exam ination Dept
C-1, Sector-1, NOIDA 201301
Dear Sir
S ub: Issue o f duplicate p ass certificate
Kindly issue duplicate pass certificate as per details given below:
Nam e of the candidate:
Contact no

: Land line: .. Mobile:

E-mail address

Address to which the duplicate pass certificate is to be sent:


.

..
Student Registration No

Details of the duplicate pass certificate sought:


Exam ination

Month and Year

Group Passed

Details of Fees paid :DD/IPO No :


Drawn on
:

Roll No

Date:
Signature of candidate

Encl: i) Dem and Draft/IPO


ii)Affidavit in the prescribed form at

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