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

EFFD349569 DEEPAK DHARMENDRA VISHWAKARMA

Gender Father's Name

MALE DHARMENDRA SHIVPRASAD VISHWAKARMA

Date Of Birth Registration No

WRO0804470

Region Nationality
WEST 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

8767859656 31deepvish@gmail.com

Exam Details

Current Course Name Course Registration Date

Foundation 03/Jul/2022

Course Code Course Expiry Date

 NEWFND 03/Jul/2025

Examination Date
December/2023

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

No None

Last Known Correspondence Address

Address Line 1 Address Line 2

44/45-10, RAMRAJYA APT, RAMKRISHNA NAGAR SATPUR-AMBAD LINK ROAD, NASHIK -422010

Address Line 3 Address Line 4

Country State
IND MAHARASHTRA

District City
NASHIK NASHIK

Pincode
422010

Qualification Details

Month and Result

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

Class X D015910 MAHARASHTRA STATE MAR 2020 PASSED 365 500 73.00 -
BOARD OF SEC & HIGH.
SEC. EDUCATION

Class XII S139825 MAHARASHTRA STATE MAR 2022 PASSED 333 600 55.50 -
BOARD OF SEC & HIGH.
SEC. EDUCATION
Medium Details

Medium Opted
English

Centre Details

Region Exam State

West MAHARASHTRA

Exam City Centre Code

NASHIK - I 1049

Zone
Nashik City, Pimpalgaon, Panchvati, Meri, Mhasarul, Gangapur Road, Cidco, Ambad
and Satpur

Fee Details ( Based on Selections)

Examination Fees Late Fees

1500 0

Total Fees
1500

Payment Transaction Details

Payment Mode Payment Date

online 20/Aug/2023

Payment Status Payment Transaction Number

S 20230820010830000899982657021164150

Payment Order Id Payment Receipt Number

EFFD34956920230820112945989 E20230820683357

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

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Version 15.00.01