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The Institute of Chartered Accountants of India


INTERMEDIATE(INTEGRATED PROFESSIONAL COMPETENCE)
EXAMINATION/ACCOUNTING TECHNICIAN EXAMINATION - NOVEMBER 2016

CANDIDATE DETAILS
Name of Candidate : KANCHAN DHAKA
DOB: 28/07/1993 Gender : Female
Registration No : CRO0353507 E Mail : kanchan_dhaka@yahoo.in
Applied Date: 08/08/2016 Control No: 2164313356
Medium Opted : English Landline No: -
Exam Applied : Intermediate (IPCE) Group-II
Examination Centre : JAIPUR
Center Code: 427
Mobile No : 8875845478
Father's Name: HITENDER DHAKA
Date of commencement of articleship
Conversion / Registration date of Intermediate(IPCC)/ATC: 29/07/2010
training: 22/04/2013
PIN : 1234 Differently Abled : NO

ENTRANCE/ FOUNDATION/ PEE-I/ CPT PASSING PARTICULARS (IF APPLICABLE)

Exam Passed MONTH & YEAR Roll No.


CPT 06, 2010 192192

PARTIAL INTERMEDIATE (PASSED ON OR AFTER NOVEMBER 1994)/ PEE-II/ PCE/ I(IPC)E EXAMINATION PASSING DETAILS
Exam Passed MONTH & YEAR Roll No.
Group I IPCE November, 2012 322198
EXEMPTION SECURED IN I(IPC)E/ATE
Month & Year Roll No. P1 P2 P3 P4 P5 P6 P7
PAYMENT DETAILS

Total Amount: 1200 INR Transaction Date: 19/08/2016 Bank Transaction No: EFI_CRO0353507_6936112747
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The Institute of Chartered Accountants of India


INTERMEDIATE(INTEGRATED PROFESSIONAL COMPETENCE)
EXAMINATION/ACCOUNTING TECHNICIAN EXAMINATION - NOVEMBER 2016

Registration No : CRO0353507 Control No: 2164313356

DECLARATION BY THE STUDENT


1. I KANCHAN DHAKA son/daughter of HITENDER DHAKA request for permission to present myself at the Intermediate (IPC) /Accounting Technician Examination to be held in NOV 2016 by the Institute of Chartered Accountants

of India and hold valid registration for appearing in Intermediate(IPC) Examination to be held in NOV 2016.

2. I declare that I am eligible to appear in the Intermediate (IPC) Examination /ATE as I have passed the PEE-I/Foundation/Entrance Examination and have completed eight months study course in Intermediate(IPCC).

3. 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. and have registered for Intermediate (IPC) course / ATC

on or before 01st March, 2016 as per registration letter received from the Regional Office; or

4. 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 , 1988 and have already converted into the Intermediate (IPC) Course/Accounting Technician Course (ATC).

5. I registered for Intermediate (IPC) course/ATC under the Direct Entry Scheme, under the Graduate/Post Graduate category and commenced articled training on or before 01st February, 2016 & completed/would be completing 9

months of articled training (including 8 months of study course) as on 01st Nov, 2016 as per article registration letter received from the Regional office.

6. I converted to Intermediate (IPC) course /ATC from erstwhile Intermediate or CPT or PE-II or PCC or IPCC,under Direct Entry Scheme, under the Graduate/Post Graduate category and commenced articled trainging on or before

01st February, 2016 & completed/would be completing 9 months of articled training (including 8 months of study course) as on 01st Nov, 2016 as per article registration letter received from the Regional office.

7. I registered for Intermediate (IPC) course/ATC, under Direct Entry Scheme, having passed the Intermediate level examination of the Institute of Cost Accountants of India/The Institute of Company Secretaries of India, on or before

01st March, 2016 and completed or would be completing 8 months study course as on 01st Nov, 2016 as per registration letter issued by Regional Office.

8. I converted to Intermediate (IPC) course /ATC, from erstwhile Intermediate/CPT/PE-II/PCC or IPCC, under the Direct Entry Scheme, having passed the Intermediate Level examination of The Institute of Company Secretaries of

India/Institute of Cost Accountants of India, and completed/would be completing 8 months of study course, as on 01st Nov, 2016 as per article registration letter received from the Regional office.

9. I register for Intermediate(IPC) through CPT route and appeared in the Intermediate(IPC) examination in one or both groups but did not pass any of the groups and converted to Intermediate(IPC) course under the Direct Entry

Scheme and commence practical training on or before 31st October, 2016

10. I declare that the facts and information provided in this form are complete and correct to the best of my knowledge and belief. 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.

Name : KANCHAN DHAKA


Address : C/O RAKESH GUPTA
70/146, PATEL MARG, MANSAROVER
JAIPUR
RAJASTHAN, Pincode: 302020
INDIA
Signature of the candidate
(Sign within the box with black pen)

I do hereby certify that the photograph and signature appearing above are that of Mr./Ms KANCHAN DHAKA. 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:

Name & Signature of the Member of ICAI/ Principal / Gazetted Officer


Important: Please do not fold this document while posting
with Membership NO.& Office seal
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The Institute of Chartered Accountants of India


INTERMEDIATE(INTEGRATED PROFESSIONAL COMPETENCE)
EXAMINATION/ACCOUNTING TECHNICIAN EXAMINATION - NOVEMBER 2016

Registration No : CRO0353507 Control No: 2164313356

DETAILS FOR DETERMINING ELIGIBILITY

(i) Registered For Intermediate (IPCC)/ATC on or before 01st March, 2016 based on having passed : CPT & 10+2 exam passed

**************************************************
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 01st February, 2016

I _____________________________________ hereby certify that Mr/Ms _____________________________________ is presently serving


under me as an articled assistant and completed or will be completing 9 months of articled training as 01st Nov, 2016.

Student Regn. No:___________________________

Date: ___________________________

Place: __________________________ Signature of the articled assistant Signature of Principal

ICAI membership No. _____________________________