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The Institute of Chartered Accountants of India

FOUNDATION EXAMINATION - DECEMBER 2021

Name of Candidate : ARPIT JAIN

Gender : MALE Foundation Reg. Date : 05/06/2020 Date of Birth : 25/10/2001
E Mail : jainarpit2510@gmail.com Control No: 2211172430 Registration No:CRO0687413
Converted from CPT to Foundation: No
Center Selection
Mobile No : 7231855693 Landline No : - Region : CENTRAL REGION
Father's Name : NAVEEN JAIN Centre :JAIPUR - IV
Centre State/UT :RAJASTHAN
Medium Opted : ENGLISH PIN :9211 Centre Code: 4084
2211172430
Concession Card No.: No
Address : S-10 SETHI COLONY NEAR SANMATI PUSTKALAYA
Details of Latest Previous appearances :
JAIPUR - 302004 Exam: FOUNDATION MM : 07 YYYY : 2021 Roll No.: 135487
RAJASTHAN , INDIA
ACADEMIC DETAILS OF QUALIFYING EXAMINATION (I.E., 12TH CLASS EXAMINATION) : ALREADY PASSED
Year : 2020 Roll Number : 11646977
Board of qualifying examination (i.e., 12th Class examination or equivalent) : CBSE
Payment Details Transaction Date: 27/09/2021 Amount: 1500 INR Bank Transaction No: EFFD_CRO0687413_4690451593
DECLARATION BY THE STUDENT
I ARPIT JAIN Son/Daughter of NAVEEN JAIN hereby declare that I am registered in the Foundation Course on/before 16-August-2021 or have converted to Foundation Course from CPT
course on or before 30-09-2021 and have appeared the 10+2 examination. I request for permission to appear at the Foundation examination conducted by the Institute of Chartered
Accountants of India scheduled to be held in December 2021. I hereby declare that 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 satisfied myself that I am eligible to appear in ensuing Foundation Exam to be held in December, 2021 and I shall abide by the terms and conditions
contained therein. I understand that my admission to Foundation and result thereof shall be provisional and subject to verification of my fulfilling the eligibility requirements in terms of the CA
Regulations, 1988 and decision of the Council of ICAI. 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

Date: _____________ Sign of Candidate: ______________________________ Sign of Parent / Guardian: ______________________________

Signature of the Candidate

(Sign within the box with blue/black pen
only in the same style as signed in the
Foundation course Registration Form)

Photo to be attested by same person who is attesting this form Dated : 27/09/2021 NON ATTESTED PHOTO OF CANDIDATE

I ______________________________ do hereby certify that I have verified and satisfied that the candidate named above is registered for Foundation course with the Board of Studies of
the Institute on or before 16th August,2021 / Converted to Foundation from the CPT on or before 30-09-2021 and has already appeared in 12th class examination and is eligible as per
regulation 25F (explained below) to appear in Foundation Exam. The particulars as furnished have been verified by me and found to be correct with reference to the documents produced
before me by the candidate.

Name and membership No.of the Member of ICAI /Head of

Date:
the Educational Institution /Gazzetted Officer with Seal

Place: Signature of Member of ICAI/Head of Educational Institution /Gazzetted Officer Tel No._________________________
Important: Please do not fold this document while posting

Explanation of Regulation 25 F:
1. The candidate should be registered with the Board of Studies of the Institute on or before 16th day of August 2021 for the examination to be held in the month December 2021 respectively or should have
converted from CPT to foundation on or before 30-09-2021; and
2. The candidate has appeared the Senior Secondary (10+2) examination conducted by an examining body constituted by law in India or an examination recognised by the Central Government or the State
Government as equivalent thereto for the purpose of admission to graduation course.