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EXAMINATION FORM
THE INSTITUTE OF CHARTERED ACCOUNTANTS OF INDIA
CERTIFICATE COURSE ON IND AS EXAMINATION – Sept, 2019
(To be filled in with black/blue pen)
Date: September 15, 2019
(Time: 10.00 A.M. – 1.00 P.M.)
Signature of Candidate
Centre Opted*: ______________________ ____________________________

1) Name of the Candidate (Mr./Ms.) : _____________________________________________

(as per ICAI record)
2) Father’s Name : _____________________________________________

3) Membership No. : _____________________________________________

4) E-mail : _____________________________________________

5) Mobile No. : _____________________________________________

6) Correspondence address : _____________________________________________

(in BLOCK LETTERS) _____________________________________________
___________________________ PIN _____________
7) Centre of the Course attended : _____________________________________________

8) Batch No. : _____________________________________________

9) Course (Class room training) : _____________________________________________

commencement Date
10) Course (Class room training) : _____________________________________________
completion Date
11) Whether appeared earlier in : Yes/ No
Certification Course on Ind AS Exam
 ATTENTION CANDIDATES

 List of Centre: (a) Ahmedabad (b) Bengaluru (c) Chennai (d) Delhi (e) Hyderabad (f) Indore
(g) Kolkata (h) Mangalore (i) Mumbai (j) Nagpur

 The Ind AS Implementation Committee reserves the rights to merge any examination centre
with the nearby centre in case the numbers of applicants at the given centre are not
adequate.

 No examination Fee is required to be paid after the completion of classroom training, in

case the participant is appearing for the first time out of two immediate scheduled Certificate
Course on Ind AS examination.

 Examination fee of Rs 1,180/- (Examination Fee Rs 1,000 + GST@ 18% Rs 180=Rs

1,180) can be paid under the following link as per the location of the exam centre:-

(a)Ahmedabad (b)Bengaluru (c)Chennai

http://ccm.icai.org/?progi http://ccm.icai.org/?progid http://ccm.icai.org/?progid
d=2465 =2464 =2466
(d)Delhi (e) Hyderabad (f)Indore
http://ccm.icai.org/?progi http://ccm.icai.org/?progid http://ccm.icai.org/?progid
d=2467 =2468 =2469
(g)Kolkata (h)Mangalore (i)Mumbai
http://ccm.icai.org/?progi http://ccm.icai.org/?progid http://ccm.icai.org/?progid
d=2470 =2464 =2471
(j)Nagpur
http://ccm.icai.org/?progi
d=2471

 The Soft copy of the examination form duly filled & signed after affixing photograph should be
sent through email at indascourse@icai.in on or before August 30, 2019.

 Admit card will be sent by e-mail by September 09, 2019. In case of non receipt of the
same by the said date, kindly contact us at indascourse@icai.in or 0120-3045928/3876875. All
such request for non receipt of Admit card received by September 13, 2019 till 5 P.M. will be
considered.

 Only a member of the Institute (membership status must be active) is eligible to appear
in the exam after successfully completing the class room training.

 To qualify in the course, candidate has to secure 50% in aggregate.

 The use of calculator is allowed in the examination.