Application for Change Of Email and Mobile

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Ref. No : UEM0000096182
Space for official
Date 04/Mar/2020
Stamp
Registration Number 185436

1. Name in Full ANKITA PRADEEP RAKA

2. Professional Address 12 B/12 TAKSHILAMAHAKALI CAVES ROAD

City MUMBAI

Pincode 400093

3. Email Address ankita.p.raka@gmail.com

4. Mobile Number 9320567297

Declaration
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1. I hereby declare that all the information above is true to the best of my knowledge.
2. Since we are in the process of digitization and committed to provide paperless and seamless
services, we wish to inform you.
Your updated mobile number and email id will be used for all future correspondence and
authentication purposes as in lieu of your signature, where ever it is required to approve or
authenticate any form/transaction with ICAI.

Signature of Member

Place: _______________________________________________
Date: ______________________________

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