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ONLINE FORM
The Institute Of Chartered Accountants Of India

FINAL EXAMINATION - May, 2011

CANDIDATE DETAILS

Name of Candidate : NEERAJ PATHAK

DOB : 06/04/1982 Gender : Male

Registration No : WRO0115965 Group Applied: Second

Applied Date : 11/02/2011 Control No: 8822191

Medium Opted : English Landline No: -

Examination Centre : Mumbai IX E Mail : 200neeraj@gmail.com

Mobile No : 8080888556 Old Article Registration Number : BB104249

Father's Name: PATHAK BRIJ KISHOR

STATUS OF COMPLETION OF ARTICLE TRAINING

CAT II - PE-II : Completed/Completing 3 years of articleship training (including excess leave, if any) as on 30th April, 2011

INTERMEDIATE / PE-II / PCE / IPCE PASSING DETAILS

Group Name Exam Passed MM YYYY Roll No

Group I PE-II 5 2003 55870
Group II PE-II 5 2004 59554

LAST APPEARANCE DETAILS OF FINAL EXAM

Group Name MM YYYY Roll No Result

Second 11 2010 05196 Failed

Second 5 2010 06168 Failed

PASSING DETAILS OF FINAL (IF APPLICABLE)

Group MM YYYY Roll No.

Group I 11 2007 28496

EXEMPTION DETAILS

Month & Year Roll No. P1 P2 P3 P4 P5 P6 P7 P8

ELIGIBILITY CERTIFICATE DETAILS

Eligibility Certificate No. Dated:

PAYMENT DETAILS

Total Amount: 1250 INR Transaction Date: 11/02/2011 Bank Transaction No: EFN_WRO0115965_1108611255
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The Institute Of Chartered Accountants Of India

FINAL EXAMINATION - May, 2011

Registration No : WRO0115965 Control No: 8822191

DECLARATION BY THE STUDENT

I request for permission to present myself at the Final Examination to be held in May, 2011 conducted by the Institute of Chartered
Accountants of India. I declare the facts and information provided above 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
situation.

Name : NEERAJ PATHAK

Address : A-501 TRISHUL B APPARTMENT

NEAR GYMKHANA CLUB, SINDHI
Paste firmly with glue or
SOCIETY
adhessive like fevicol
CHEMBUR (E)
(Do not staple) at recent
MUMBAI
Signature of the candidate color photograph of size 3.5
X 4.5 cms MAHARASHTRA
(Sign within the box with black
Pincode: 400071
pen)
INDIA

Name and Signature of the

Date:
Principal with

Place: Membership No

(I do hereby certify that the photograph affixed above is that of Mr./Ms NEERAJ PATHAK) who has signed in my presence.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)

Enclosures: Certificate of service

Important: Please do not fold this document while posting

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ONLINE FORM
The Institute Of Chartered Accountants Of India

FINAL EXAMINATION - May, 2011

Registration No : WRO0115965 Control No: 8822191

CERTIFICATE OF SERVICE

Old Article Reg No :

1. Article Ship Completion Declaration
New Unique Regn. No:

I -----------------------------------hereby declare that I have completed the prescribed period of 3 years / 3 1/2 Years of practical training
(including excess leave, if any) on ------------------ as an Articled / Audit assistant. A certified true copy of the confirmation later dated ---------
-------issued by the Institute's office in this regards is enclosed

Date: ---------------------- -----------------------------

Place :---------------------- Signature of the Candidate

2. For candidates who are presently in service and due to complete 3 years / 3 1/2 years of training (including excess leave if any) on

or before 30th April, 2011.

I -----------------------------------------------hereby certify that Shri/Ms----------------------------------------------is presently serving under me as an

articled assistant /audit assistant and his/her due date of completion (including excess leave if any) will be -----------------------------------------
-------on or before 30th April, 2011,as per deed of articles.

Old Article Regn.No.--------------------------

New Unique Regn.No.-------------------------- -------------------------------------- -------------------------------

Date:---------------------- Signature of the articled/audit assistant Signature of Principal/Member

Place:---------------------- ICAI Membership No---------------------

3 For candidates who are presently in service, serving the last twelve months of training as on 1st May, 2011 and due to complete 3

years / 3 1/2 years of training (including excess leave, if any)on or before 30th April, 2012.

I ----------------------------------------------------hereby certify that Shri/Ms--------------------------------------------presently serving under me as an

articled assistant/audit assistant, will be in service as on 1st May, 2011 serving the last twelve months of training and his/her due date of
completion (including excess leave,if any)will be ---------------------------------------------i.e. on or before 30th April, 2012 as per deed of
articles.

Old Article Regn.No.--------------------------

New Unique Regn.No.-------------------------- -------------------------------------- -------------------------------

Date:---------------------- Signature of the articled/audit assistant Signature of Principal/Member

Place:---------------------- Membership No--------------------------
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ONLINE FORM
The Institute Of Chartered Accountants Of India

FINAL EXAMINATION - May, 2011

Registration No : WRO0115965 Control No: 8822191

CERTIFICATE OF SERVICE

4
For candidates who are presently in service, serving the last six months of training as on 1st May, 2011 and due to complete 3 1/2
years of training (including excess leave, if any) on or before 31st October, 2011.

I ----------------------------------------------------hereby certify that Shri/Ms--------------------------------------------presently serving under me as an articled

assistant/audit assistant, will be in service as on 1st May , 2011 serving the last six months of training and his/her due date of completion
(including excess leave, if any)will be ---------------------------------------------i.e. on or before 31st October, 2011 as per deed of articles.

Old Article Regn.No.--------------------------

New Unique Regn.No.-------------------------- -------------------------------------- -------------------------------

Date.-------------------------- Signature of the articled/audit assistant Signature of Principal/Member

Place:------------------------ ICAI Membership No--------------------------

5 For candidates who are presently in service, serving the last six months of training as on 1st May, 2011 and due to complete 3 years
of training (including excess leave,if any)on or before 31st October, 2011.

I ----------------------------------------------------hereby certify that Shri/Ms--------------------------------------------presently serving under me as an articled

assistant/audit assistant, will be in service as on 1st May, 2011 serving the last six months of training and his/her due date of completion
(including excess leave, if any)will be ---------------------------------------------i.e. on or before 31st October, 2011 as per deed of articles.

Old Article Regn.No.--------------------------

New Unique Regn.No.-------------------------- -------------------------------------- -------------------------------

Date.-------------------------- Signature of the articled/audit assistant Signature of Principal/Member

Place:------------------------ ICAI Membership No--------------------------

ATTENTION STUDENTS

Candidates who have already completed 2 or 3 years of training and have taken termination due to any reason are advised, in their own
interest to register their balance period of training with the Institute well before the commencement of examination i.e 1st May, 2011 so that
they are in service as on 1st May, 2011 failing which admission to the examination will not be granted.
A candidate who is otherwise eligible (i.e passed PE-II examination, registered for final course, completed 2 years of articles training
without any excess leave as on 1.05.2011 and to appear in final examination may not be insisted upon to be in service of articles/audit
training as on 1st May, 2011 provided his permissible appearance for the first time in the Final Examination is for May, 2011 (and not
thereafter in subsequent appearance)