THE INSTITUTE OF CHARTERED ACCOUNTANTS OF INDIA

(SETUP BY AN ACT OF PARLIAMENT)

Application Details Application Print

Foundation Exam Registration Form (December, 2023)

Student Details

Application Number Name Gender Father's Name Date Of Birth Registration No

EFFD267932 ROHIT RAMJI MALE RAMJI KOTHIVAR WRO0820437
KOTHIVAR

Region Nationality Differently Abled ? Percentage Of Concessions Medical Certificate

WEST INDIAN No Disabilty Not Applicable Date
Not Applicable Not Applicable

Last Known Contact Details

Mobile Number Email Id

9099521349 rohitkothivar9573@gmail.com

Exam Details

Current Course Name Course Registration Date Course Code Course Expiry Date Examination Date
Foundation 29/Mar/2023 NEWFND 29/Mar/2026 November/2023

Provisional Flag (Yes = Reason Of Provisional ( When Flag

Provisional) = Yes)
No None

Last Known Correspondence Address

Address Line 1 Address Line 2 Address Line 3 Address Line 4

GALPADAR NEAR PITHAL MANDIR

Country State District City

 IND GUJARAT KACHCHH BHUJ

Pincode
370105

Qualification Details

Result
Month and
CGPA
Examination Roll No Board/Authority/University year of
Awaited/Passed Marks Maximum Percentage (Grade)
examination
Obtained Marks

Class X C3033269 GUJARAT SECONDARY & MAY 202 PASSED 464 600 77.33 -
HIGHER SECONDARY
EDUCATION BOARD

Class XII G178378 GUJARAT SECONDARY & MAR 2023 PASSED 592 700 84.57 A2
HIGHER SECONDARY
EDUCATION BOARD

Medium Details

Medium Opted
English

Centre Details

Region Exam State Exam City Centre Code Zone

West GUJARAT BHUJ 1016 BHUJ

Fee Details ( Based on Selections)

Examination Fees Late Fees Total Fees

1500 0 1500

Payment Transaction Details

Payment Mode Payment Date Payment Status Payment Transaction Number

 online 09/Aug/2023 S 202308090109700008961444

Payment Order Id Payment Receipt Number Payment Card Type

EFFD26793220230809211802 E20230809619592 online

Self Declaration

I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. I have read the Guidance Notes for candidates
and I shall abide by the terms and conditions contained therein. In the event of suppression or distortion of any fact made in this application form, I understand that I
shall be denied the opportunity to appear in Foundation Exam and if already admitted / appeared, my admission / result acquired shall be liable for outright
cancellation. I also understand that the decision of the Institute in this regard shall be final and binding upon me and I shall abide by the same.

Your Photograph And Signature (If Blank, Form can't Be Submitted)

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1 Photo

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Version 15.00.01