THE INSTITUTE OF CHARTERED ACCOUNTANTS OF INDIA

(SETUP BY AN ACT OF PARLIAMENT)

Application Details

Foundation Exam Registration Form (December, 2023)

Student Details

Application Number Name

EFFD285601 MD AZIMUL HAQUE

Gender Father's Name

MALE MD NASIMUL HAQUE

Date Of Birth Registration No

ERO0284212

Region Nationality
EAST INDIAN

Differently Abled ? Percentage Of Disabilty

No Not Applicable

Concessions Medical Certificate Date

Not Applicable Not Applicable

Last Known Contact Details

Mobile Number Email Id

8984032475 azim0000047@gmail.com

Exam Details

Current Course Name Course Registration Date

Foundation 07/Apr/2023

Course Code Course Expiry Date

NEWFND 09/Aug/2026
 Examination Date
November/2023

Provisional Flag (Yes = Provisional) Reason Of Provisional ( When Flag = Yes)

No None

Last Known Correspondence Address

Address Line 1 Address Line 2

AT-6TH LANE GOUTAM NAGAR KORAPUT PO/PS-KORAPUT

Address Line 3 Address Line 4

Country State
IND ODISHA

District City
KORAPUT KORAPUT

Pincode
764020

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 176AC0154 ORISSA BOARD OF MAR 2021 PASSED 441 600 73.50 -
SECONDARY EDUCATION

Class XII 202HA001 COUNCIL OF HIGHER MAR 2023 PASSED 479 600 79.83 -
SECONDARY EDUCATION
ORISSA

Medium Details

Medium Opted
 English

Centre Details

Region Exam State

East ODISHA

Exam City Centre Code

ROURKELA 3024

Zone
ROURKELA

Fee Details ( Based on Selections)

Examination Fees Late Fees

1500 0

Total Fees
1500

Payment Transaction Details

Payment Mode Payment Date

online 10/Aug/2023

Payment Status Payment Transaction Number

S 20230810010910000896324907255126170

Payment Order Id Payment Receipt Number

EFFD28560120230810091510623 E20230810620553

Payment Card Type

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)

Sr.
Description Documents
No.

1 Photo

2 Signature

Print
Version 15.00.01