THE INSTITUTE OF CHARTERED ACCOUNTANTS OF INDIA

(SETUP BY AN ACT OF PARLIAMENT)

Application Details Application Print

Foundation Exam Registration Form (June, 2024)

Student Details

Application Number Name

EFFD511377 ANISH KUMAR ROUT

Gender Father's Name

MALE PRAMOD KUMAR ROUT

Date Of Birth Registration No

NRO0572563

Region Nationality
NORTH 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

8287002070 kumaranish57846@gmail.com

Exam Details

Current Course Name Course Registration Date

Foundation 21/Jan/2024

Course Code Course Expiry Date

 NEWFND23 21/Jan/2028

Examination Date
June/2024

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

No None

Last Known Correspondence Address

Address Line 1 Address Line 2

Z 44 OKHLA PHASE 2 HARKESH NAGAR NEW DELHI 110020 Z 44 OKHLA PHASE 2 HARKESH NAGAR NEW DELHI 110020

Address Line 3 Address Line 4

Country State
IND DELHI

District City

SOUTH DELHI NEW DELHI

Pincode
110020

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 14282294 CENTRAL BOARD OF APR 2021 PASSED 352 500 70.40 -
SECONDARY EDUCATION
(CBSE)

Class XII 14766679 CENTRAL BOARD OF APR 2023 PASSED 413 500 82.60 -
SECONDARY EDUCATION
(CBSE)

Medium Details
 Medium Opted
English

Centre Details

Region Exam State

North DELHI / NEW DELHI

Exam City Centre Code

DELHI / NEW DELHI - IV 5010

Zone
Nizamuddin, Lajpat Nagar, Lodi Road, Kalkaji

Fee Details ( Based on Selections)

Examination Fees Late Fees

1500 0

Total Fees
1500

Payment Transaction Details

Payment Mode Payment Date

online 23/Feb/2024

Payment Status Payment Transaction Number

S 20240223010850000967597960136135904

Payment Order Id Payment Receipt Number

EFFD51137720240223012850688 E20240223593285

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 15.01.01