“The Sceretary to the Councl of “THE INSTITUTE OF COST 12, Sudder Street, Kolkata-700 016 Si, {beg to apply fora Registration asa Student ofthe (Ceriiat 2. Father's / Husband's Name Mr/De. 3. Permanent Address iy Pin Code: cemallié 4. Date of Binh (DDIMMIYYY: THE INSTITU Registration No... REGISTRATION FORM (FORM 1) tobe ied by the cana in CAPITAL LETTERS. On carat in each box avd box Putin appropriate bo. Delete whichever snot ppb) blank between to parts ofthe name, ITE OF COST AND WORKS ACCOUNTANTS OF INDIA ASfix recent Scheduled Caste [_] Scheduled Tribe o | 3sx2sem | o won ncourars ort | LU. se of ont ard Works Accountants of Ida, The required partelars are furshed below C11 TL I LTT LIT | C1 TIT I TLITT CITT [elas LLITTI tit O [ LIT CLIT I I [=leie I aan eles] sa [ C1 I LT) fe Phone ed beeen es) ee mobile no{ [| [ OwIwti ] atonaors — [ [eeielelelale) 0 s.Caste General [__] Other Backward Cass 6. Occupation 7. Educational Qualification: ‘University / institute / Board Degree Yearoffas | %oiMars | | 8. Profesional Qualification: rivers /rsiune / Board Degree Yeroffan | soot tars || remit herewith a sum of Rs, 500/- as student Registration foe, (Details of payment) Demand Draft no. for Re Date. Draven on Bank. | do hereby declare thatthe particulars furnished above are true to the best of my knowledge and belief and should it any time be proved thatthe said particulars were untrue | agree to my Registration being cancelled without any obligation on the part ofthe Insitute to refund any fee paid by me to the Institue, | also hereby undertake that if enrolled asa Registered Student ofthe Insitute, | willbe bound by the provisions ofthe Cost and Werks Accountants Act 1959 (as amended in 2006) and the Regulations framed there under cor that may hereafter from time to time be made pursuant to the said Act : Yours Place Date: Signature Instruction: Xerox copies of testimonials towards oge and qualifications, duly attested by any Member of ICWAT, ICAI or ICS/Member of Porlioment] State Legilatve Assembly or @ Gazetted Officer or a Principal of a College. to be attached alongwith Registration Form. Fees shall be paid through Demand Droft drawn on any scheduled Bank favouring tof Cost and Werks Accountants of Indio” payable at Kolkata ony. The application form sto be submited tothe respective Regional Couneil only. FOR OFFICE USE ONLY Exemption Records Subject ‘Term of Examination or Qualification Date of granting Signature of granting officer Record of Coaching Completion and Examination Results Group Coaching Completion Examination Result Date Source ‘Term of Examination Roll No, Signature Date