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The Institute of Chartered Accountants of India
INTERMEDIATE (INTEGRATED PROFESSIONAL COMPETENCE) EXAMINATION / ACCOUNTING TECHNICIAN EXAMINATION - MAY 2013
CANDIDATE DETAILS Name of Candidate : GODHULI DUTTA DOB: 25/09/1993 Registration No : ERO0182250 Applied Date: 12/02/2013 Medium Opted : English Gender : Female E Mail : biswamay@hotmail.com Control No: 4328835 Landline No: -

Exam Applied : Intermediate (IPCE) Both Groups Examination Centre : Kolkata I Mobile No : 9989477176 Old Article Registration Number: Father's Name: BISWAMAY DUTTA Registered with Board of Studies for: Group I and Group II of Intermediate (IPCC)

Registration date of Intermediate(IPCC)/ATC/Inter/PEE-II/PCC: 20/01/2012 PIN :1993 Physically Challenged :No

ENTRANCE/ FOUNDATION/ PEE-I/ CPT PASSING PARTICULARS Exam Passed CPT MONTH & YEAR 12, 2011 Roll No. 173037

PARTIAL INTERMEDIATE/ PEE-II/ PCE/ IPCE EXAMINATION PASSING DETAILS Exam Passed MONTH & YEAR Roll No.

EXEMPTION DETAILS OF EXEMPTION SECURED IN ERSTWHILE PCE Month & Year Roll No P1 P2 P3 P4 P5 P6

EXEMPTION DETAILS OF EXEMPTION SECURED IN IPCE/ATE Month & Year PAYMENT DETAILS Total Amount: 1600 INR Transaction Date: 12/02/2013 Bank Transaction No: EFI_ERO0182250_1095902909 Roll No. P1 P2 P3 P4 P5 P6 P7

I GODHULI DUTTA son/daughter of BISWAMAY DUTTA request for permission to present myself at the Intermediate (IPC) /Accounting Technician Examination to be held in MAY 2013 by the Institute of Chartered Accountants of India. I converted to Intermediate (IPC) course /ATC from Intermediate/CPT/PE-II/PCC/IPCC under the Direct Entry Scheme.5 X 4. under the Direct Entry Scheme. I am also aware that my admission shall become invalid if I make wrong declaration and undertake to abide by the decision of the Council in such a situation. I converted to Intermediate (IPC) course /ATC. 9. 2012.PO REGENT PARK KOLKATA WEST BENGAL. or 4. 1988 and have already converted into the Intermediate (IPCE) /Accounting Technician Course (ATC) and have completed 8 months from the date of registration in Intermediate /PE II/ PCC . and completed/would be completing 7 months of study course. I was already registered for the erstwhile Intermediate Examination as per syllabus under Paragraph 2 or 2A of Schedule B of Chartered Accountants Regulations 1988 or Professional Education (Course II) under sub-regulation (1) of regulation 28A or Professional Competence Course under Regulation 28 C of the Chartered Accountants Regulations . under Direct Entry Scheme. I registered for Intermediate (IPC) course/ATC and articleship on or before 30-09-2012. or 6. 8./Ms GODHULI DUTTA) who has signed in my presence. from Intermediate/CPT/PE-II/PCE or IPCE. under Graduate/Post Graduate category & completed/would be completing 7 months of articleship and study course. I declare that the facts and information provided in this form are complete and correct to the best of my knowledge and belief. I have passed the Common Proficiency Test (CPT) as well as Senior Secondary (10+2) Examination or an examination recognized as equivalent thereto by the Central Govt. on or before 30-04-2013. or 7.2/3 The Institute of Chartered Accountants of India INTERMEDIATE (INTEGRATED PROFESSIONAL COMPETENCE) EXAMINATION / ACCOUNTING TECHNICIAN EXAMINATION . under the Direct Entry Scheme. Pincode:700040 INDIA Address : CO B N PAUL (I do hereby certify that the photograph affixed above is that of Mr. under the category of Intermediate Level Pass of ICSI/Institute of Cost Accountants. I registered for Intermediate (IPC) course/ATC. on or before 30-04-2013. on or before 30-04-2013 and ITT and orientation course by 31-03-2013 .The particulars as furnished on this form have been verified by me and found correct with reference to the documents produced before me by the candidate) Date: Place: Important: Please do not fold this document while posting Name & Signature of the Member / Principal / Gazetted Officer with Membership NO. on or before 30-09-2012 and completed/would be completing 7 months of study course.5 cms GODHULI DUTTA 3/20 SURYA NAGAR. I declare that I am eligible to appear in the Intermediate (IPC) Examination /ATE as I have passed the PEE-I/Foundation/Entrance Examination. Name : Paste firmly with glue or adhessive like fevicol (Do not staple) a recent Signature of the candidate (Sign within the box with black pen) color photograph of size 3. and have registered for Intermediate (IPC) course / ATC on or before 01st September. under Graduate/Post Graduate category & completed/would be completing 7 months of articleship and study course. 3.& Office seal . under the category of Intermediate Level Pass of ICSI/Institute of Cost Accountants.MAY 2013 Registration No : ERO0182250 Control No: 4328835 DECLARATION BY THE STUDENT 1. or 5. on or before 30-04-2013 and ITT and orientation course by 31-03-2013 . 2.

Dated Orientation Completion Details Completion Date : ************************************************** Certificate of service: For candidates who registered for/converted to Intermediate (IPC) course under the Direct Entry Scheme under the category graduates/post graduates and commenced articleship on or before 30th September 2012: I _____________________________________ hereby certify that Mr/Ms _____________________________________ is presently serving under me as articled assistant and will be completing 7 months of articled training on or before 30th April 2013. No:___________________________ Date: ___________________________ Place: __________________________ Signature of the articled assistant Signature of Principal ICAI membership No. 2012 based on having passed : CPT and 10+2 exam passed CCT / ITT CERTIFICATE DETAILS Certificate Name Certificate No.3/3 The Institute of Chartered Accountants of India INTERMEDIATE (INTEGRATED PROFESSIONAL COMPETENCE) EXAMINATION / ACCOUNTING TECHNICIAN EXAMINATION .MAY 2013 Registration No : ERO0182250 Control No: 4328835 ELIGIBILITY DETAILS TO APPEAR IN INTERMEDIATE INTEGRATED PROFESSIONAL COMPETENCE EXAMINATION. MAY 2013 (i) Registered For Intermediate IPCC/ATC on or before 01st September. Student Regn. _____________________________ .