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To,

Sea&ry
In<tlie (f cf
Delhi.

I appb' Oance of Certifntefor d;


CIJrpose
(( (Lao
I I am oontinuirvmy nunbetship as on date wth ICAI aM paki arrmrt rrernbershipfee / would
nemberS1ip fee <ipulated date.

I abo de&re I haveattendedCPE syograne/<n.dured/tn<ruduredOE Ear@ tte IråMe ard have


requiredCPE tuns. (Pbase see CPE turs &bils menthredm Iräjüfe M/±site
bww.cpeiai.o«q)

I also dedare that no disciplinary adion/enquir,/ is pending again< me at ICAI and I am not omvded ebeohere fT
profesbnal misoondud.

I am assodated witl LOGI of ICAI at (Phoe and Courüy).

Kindly issue my GoodstandingCertifiate at my current address as given below. A copy of the sarre rnay also be
endorsed to the ooncerned Institute/ organizatjm/ Employer for tie above purpose ard be sert on t-e auræs given
tere urxier;

g —309 Yousfatifily
(-4 ye.ø-.P•e-A

(SgraWre)

Address of the applicant : Me •201/ Name:


ACA/FCA M No:
t / t 00 Email
+3750 753/ g
t*10bikNo:
Date :

Endosure:
(i) Ifany
( i i ) CopßDedaratjon form(availableon tEIn<itute'swebsiteabrvwith
mernbers residing abroad onty).

: rnay also apty for goodsbnding oettifiates online, pleaæ see ICAI be
Isuaroe Good±nding Certifiate requiresfulfillmentof QE mm*tion, payrnertof fæ
disdplinary dearanæ at our erd Phase oonbd us after 10 days if Goodstanding S received b/ on

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