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The Institute of Chartered Accountants of India
FOUNDATION EXAMINATION - DECEMBER 2021

Name of Candidate : DILPREET KAUR

Gender : FEMALE Foundation Reg. Date : 12/04/2021 Date of Birth : 27/10/2002
E Mail : gurpreet.perfect@gmail.com Control No: 2211142230 Registration No:CRO0710287
Converted from CPT to Foundation: Yes
Center Selection
Mobile No : 9899881674 Landline No : - Region : CENTRAL REGION
Father's Name : GURPREET SINGH Centre :GHAZIABAD
Centre State/UT :UTTAR PRADESH
Medium Opted : ENGLISH PIN :2002 Centre Code: 4061
2211142230
Concession Card No.: No
Address : R 11/143 , NEW RAJNAGAR
NEW RAJ NAGAR,
Details of Latest Previous appearances :
Exam: MM : YYYY : Roll No.:
GHAZIABAD - 201002
UTTAR PRADESH , INDIA
ACADEMIC DETAILS OF QUALIFYING EXAMINATION (I.E., 12TH CLASS EXAMINATION) : ALREADY PASSED
Year : 2021 Roll Number : 21665115
Board of qualifying examination (i.e., 12th Class examination or equivalent) : CBSE
Payment Details Transaction Date: 22/09/2021 Amount: 1500 INR Bank Transaction No: EFFD_CRO0710287_6556918930
DECLARATION BY THE STUDENT
I DILPREET KAUR Son/Daughter of GURPREET SINGH hereby declare that I am registered in the Foundation Course on/before 16-August-2021 or have converted to Foundation Course
from CPT course on or before 30-09-2021 and have appeared the 10+2 examination. I request for permission to appear at the Foundation examination conducted by the Institute of Chartered
Accountants of India scheduled to be held in December 2021. I hereby declare that the particulars stated in this application form are true to the best of my knowledge and belief. I have read the
Guidance Notes for candidates and satisfied myself that I am eligible to appear in ensuing Foundation Exam to be held in December, 2021 and I shall abide by the terms and conditions
contained therein. I understand that my admission to Foundation and result thereof shall be provisional and subject to verification of my fulfilling the eligibility requirements in terms of the CA
Regulations, 1988 and decision of the Council of ICAI. In the event of suppression or distortion of any fact made in this application form, I understand that I shall be denied the opportunity to
appear in Foundation Exam and if already admitted / appeared, my admission / result acquired shall be liable for outright cancellation. I also understand that the decision of the Institute in this
regard shall be final and binding upon me and I shall abide by the same

Date: _____________ Sign of Candidate: ______________________________ Sign of Parent / Guardian: ______________________________

Candidate's photograph
Paste firmly with glue or Paste firmly with glue or
adhessive like fevicol
adhessive like fevicol
Signature of the Candidate (Do not staple) a recent
(Do not staple) recent color
(Sign within the box with blue/black pen color photograph of size 3.5
photograph of size 3.5 X 4.5 only in the same style as signed in the X 4.5 cms
cms Foundation course Registration Form)

Dated : 22/09/2021
Photo to be attested by same person who is attesting this form NON ATTESTED PHOTO OF CANDIDATE

I ______________________________ do hereby certify that I have verified and satisfied that the candidate named above is registered for Foundation course with the Board of Studies of
the Institute on or before 16th August,2021 / Converted to Foundation from the CPT on or before 30-09-2021 and has already appeared in 12th class examination and is eligible as per
regulation 25F (explained below) to appear in Foundation Exam. The particulars as furnished have been verified by me and found to be correct with reference to the documents produced
before me by the candidate.

Name and membership No.of the Member of ICAI /Head of

Date:
the Educational Institution /Gazzetted Officer with Seal

Place: Signature of Member of ICAI/Head of Educational Institution /Gazzetted Officer Tel No._________________________
Important: Please do not fold this document while posting

Explanation of Regulation 25 F:
1. The candidate should be registered with the Board of Studies of the Institute on or before 16th day of August 2021 for the examination to be held in the month December 2021 respectively or should have
converted from CPT to foundation on or before 30-09-2021; and
2. The candidate has appeared the Senior Secondary (10+2) examination conducted by an examining body constituted by law in India or an examination recognised by the Central Government or the State
Government as equivalent thereto for the purpose of admission to graduation course.