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ONLINE FORM
The Institute Of Chartered Accountants Of India PROFESSIONAL COMPETENCE EXAMINATION - NOVEMBER 2011
CANDIDATE DETAILS Name of Candidate :ALANCE Registration Number : NRO0195120 Applied Date: 14/08/2011 Medium Opted : Hindi Examination Centre : Ghaziabad Mobile No : 9997854426 Father's Name: DHANPAL DOB : 15/09/1989 Control No: 9909345 Group Applied: Second Landline No: E Mail : jitesh195252@gmail.com Old Article Registration Number : Gender : Male

Date of Registration to PCE : 15/04/2008 FOUNDATION/ PEE-I/CPT - STREAM CANDIDATE PASSING PARTICULARS Exam Passed CPT MM 11 YYYY 2007 Roll No. 052315

ELIGIBILITY DETAILS TO APPEAR IN PROFESSIONAL COMPETENCE EXAMINATION NOVEMBER, 2011

Passed the Common Proficiency Test (CPT) Conducted by ICAI and Senior Secondary Examination (10+2 examination) conducted by an examining body constituted by Law in India or an examination recognized by the Central government as equivalent thereto and have worked for not less than 15 months as an articled assistant or as an audit assistant or partly as an articled assistant and partly as a audit assistant as on 1st August, 2011.

Exam name

CBSE

Roll No.

05673703

Month & Year of Exam

3 2006

Shall be completing 100 Hours Information Technology Training Programme on or before commencement of the exam PARTIAL INTERMEDIATE /PEE-II/PCE EXAMINATION PASSING DETAILS Group Name EXEMPTION DETAILS Month & Year Roll No. P1 P2 P3 P4 P5 P6 Exam Passed MM YYYY Roll No

ELIGIBILITY CERTIFICATE DETAILS Certificate Name Articleship Training Certificate (15 Months as on 1st February, 2011) IIT/CCT Certificate on or before 2 nd Nov, 2011 OTHER ELIGIBILITY CERTIFICATE DETAILS Certificate Name PAYMENT DETAILS Total Amount: 1000 INR Transaction Date: 21/08/2011 Bank Transaction No: EPC_NRO0195120_1056051617 Certificate No Month Year Certificate No Date

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The Institute Of Chartered Accountants Of India

PROFESSIONAL COMPETENCE EXAMINATION - NOVEMBER 2011

Registration Number :

NRO0195120

Control No:

9909345

DECLARATION BY THE STUDENT: I request for permission to present myself at the Professional Competence Examination to be conducted by the Institute of Chartered Accountants of India in November, 2011. I declare that I am eligible to appear in the Professional Competence Examination as I have obtained Eligibility Certificate for Both Groups of Intermediate/PE-II/I have Passed the PEE-I/Foundation Examination/ I have passed the Common Proficiency Test (CPT) as well as Senior Secondary (10+2 Examination) or an examination recognized as equivalent thereto by the Central Government and thereafter completed 15 months practical training as an articled assistant or as an audit assistant on 1st August, 2011/ I am a PEE-I passed candidate directly admitted to Professional Competence Course(PCC) and thereafter completed 15 months practical training as an articled assistant or as an audit assistant as on 1st August, 2011. I further declare that I have completed 250 hours Compulsory Computer Training/100 Hours Information Technology Training as specified by the Institute/I shall be completing 100 hours Information Technology training Programme on or before 2nd November, 2011. CCT / ITT Certificate No.................................Dated......................enclosed / I shall be sending a copy of the CCT / ITT Certificate to the Additional Secretary (Exams.), ICAI, C-I, Sector-1, Noida-201301 (U.P.) by 30th November, 2011. I declare that the facts and information provided by me are complete and correct to the best of my knowledge and belief. I am also aware that my admission shall become invalid if I make wrong declaration and undertake to abide by the decision of the Council in such a situation. Name Paste firmly with glue or adhessive like fevicol (Do not staple) a recent Signature of the candidate (Sign within the box with black pen) color photograph of size 3.5 X 4.5 cms Address : : ALANCE B-160, NEW PANCHWATI OPP: PAWAN CINEMA G.T.ROAD GHAZIABAD UTTAR PRADESH Pincode: 201001 INDIA 1. I do hereby certify that the photograph affixed above is that of Mr./Ms. ALANCE who has signed in my presence. The particulars as furnished on this form have been verified by me and found correct with reference to the documents produced before me by the candidate. 2. For candidates who are presently in practical training as an articled assistant or as an audit assistant or partly as an articled assistant and partly as an audit assistant. I hereby certify that he/she is presently serving under me as an articled assistant / audit assistant, and has completed more than 15 months of articled training as on 1st August, 2011. Date: Place: Important: Please do not fold this document while posting Name & Signature of the Member / Principal with Membership No.& Office seal