Application for Change Of Email and Mobile

_________________________________________________________________________

Ref. No : UEM0000096182
Space for official
Date 23/Sep/2022
Stamp
Registration Number 552600

1. Name in Full TARUN KUMAR BANSAL

2. Professional Address C/O SHRI HARBANS LAL BANSALSCF 38

City BHATINDA

Pincode 151002

3. Email Address TARUNBANSALHB@GMAIL.COM

4. Mobile Number 8010404167

Declaration
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1. I hereby declare that all the information above is true to the best of my knowledge.
2. Since we are in the process of digitization and committed to provide paperless and seamless
services, we wish to inform you.
Your updated mobile number and email id will be used for all future correspondence and
authentication purposes as in lieu of your signature, where ever it is required to approve or
authenticate any form/transaction with ICAI.

Signature of Member

Place: _______________________________________________
Date: ______________________________

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