10/3/2019

SYLLABUS - 2016
The Institute of Cost Accountants of India
(Statutory body under an Act of Parliament)
APPLICATION FOR INTERMEDIATE EXAMINATION OF DECEMBER-2019

Application No : 244091
Registration No : 01191058085
Old Registration No :

Name : DEEPALI CHANDRASEKHARAN Gender : Female

Address : Line 1: RAJU NIWAS
Line 2 : NR NANDADEEP BLDG
Line 3 : KASARVADAVALI THANE WEST
City : THANE Pin : 400615
Mobile No. : 9004469729 Email : deepalic1997@gmail.com
Phone No. : 0 Group : GR I
Physically Challenged : No Date Of Birth: 19/12/1997
Qualification: GRADUATION Medium : English
Exam Center Code: 136 Center Opted : MUMBAI-THANE
Mode Of Coaching : Oral

Payment Details :

I have made payment through card/Net banking with transaction no. 201927647749387 dated 03/10/2019 for Rs. 1213 to The Institute of Cost Accountants Of India

I declare that to the best of my knowledge and belief the information given above are correct and complete in all respect. In the event of being found otherwise, I shall
be abide by the decision of the Institute to summarily reject my application/ withhold my result. I also undertake to make the payment, which is non refundable and
agree to abide by the rules and regulations framed by the council for the guidence to the candidates appearing for the examination.

Candidate's Signature :

Date: 03/10/2019 Registration No : 01191058085

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