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The Institute of Chartered Accountants of India

INTERMEDIATE (INTEGRATED PROFESSIONAL COMPETENCE) EXAMINATION / ACCOUNTING TECHNICIAN EXAMINATION - MAY 2013
CANDIDATE DETAILS Name of Candidate : SUKESHI AGRAWAL DOB: 09/09/1992 Registration No : CRO0387475 Applied Date: 22/02/2013 Medium Opted : English Gender : Female E Mail : sukeshi_agr@yahoo.com Control No: 4314592 Landline No: -

Exam Applied : Intermediate (IPCE) Group-II Examination Centre : Ahmedabad II Mobile No : 7303694569 Old Article Registration Number: Father's Name: SANJAY GOPAL AGRAWAL Registered with Board of Studies for: Group I and Group II of Intermediate (IPCC)

Registration date of Intermediate(IPCC)/ATC/Inter/PEE-II/PCC: 21/07/2011 PIN :2924 Physically Challenged :No

ENTRANCE/ FOUNDATION/ PEE-I/ CPT PASSING PARTICULARS Exam Passed MONTH & YEAR , Roll No.

PARTIAL INTERMEDIATE/ PEE-II/ PCE/ IPCE EXAMINATION PASSING DETAILS Exam Passed MONTH & YEAR Roll No.

EXEMPTION DETAILS OF EXEMPTION SECURED IN ERSTWHILE PCE Month & Year Roll No P1 P2 P3 P4 P5 P6

EXEMPTION DETAILS OF EXEMPTION SECURED IN IPCE/ATE Month & Year PAYMENT DETAILS Total Amount: 1000 INR Transaction Date: 22/02/2013 Bank Transaction No: EFI_CRO0387475_1381839104 Roll No. P1 P2 P3 P4 P5 P6 P7

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The Institute of Chartered Accountants of India

INTERMEDIATE (INTEGRATED PROFESSIONAL COMPETENCE) EXAMINATION / ACCOUNTING TECHNICIAN EXAMINATION - MAY 2013

Registration No :

CRO0387475

Control No:

4314592

DECLARATION BY THE STUDENT

1. I SUKESHI AGRAWAL son/daughter of SANJAY GOPAL AGRAWAL request for permission to present myself at the Intermediate (IPC) /Accounting Technician Examination to be held in MAY 2013 by the Institute of Chartered Accountants of India. 2. I declare that I am eligible to appear in the Intermediate (IPC) Examination /ATE as I have passed the PEE-I/Foundation/Entrance Examination; 3. I have passed the Common Proficiency Test (CPT) as well as Senior Secondary (10+2) Examination or an examination recognized as equivalent thereto by the Central Govt. and have registered for Intermediate (IPC) course / ATC on or before 01st September, 2012; or 4. I was already registered for the erstwhile Intermediate Examination as per syllabus under Paragraph 2 or 2A of Schedule B of Chartered Accountants Regulations 1988 or Professional Education (Course II) under sub-regulation (1) of regulation 28A or Professional Competence Course under Regulation 28 C of the Chartered Accountants Regulations , 1988 and have already converted into the Intermediate (IPCE) /Accounting Technician Course (ATC) and have completed 8 months from the date of registration in Intermediate /PE II/ PCC ; or 5. I registered for Intermediate (IPC) course/ATC and articleship on or before 30-09-2012, under the Direct Entry Scheme, under Graduate/Post Graduate category & completed/would be completing 7 months of articleship and study course, on or before 30-04-2013 and ITT and orientation course by 31-03-2013 ; or 6. I converted to Intermediate (IPC) course /ATC from Intermediate/CPT/PE-II/PCC/IPCC under the Direct Entry Scheme, under Graduate/Post Graduate category & completed/would be completing 7 months of articleship and study course, on or before 30-04-2013 and ITT and orientation course by 31-03-2013 ; or 7. I registered for Intermediate (IPC) course/ATC, under Direct Entry Scheme, under the category of Intermediate Level Pass of ICSI/Institute of Cost Accountants, on or before 30-09-2012 and completed/would be completing 7 months of study course, on or before 30-04-2013. 8. I converted to Intermediate (IPC) course /ATC, from Intermediate/CPT/PE-II/PCE or IPCE, under the Direct Entry Scheme, under the category of Intermediate Level Pass of ICSI/Institute of Cost Accountants, and completed/would be completing 7 months of study course, on or before 30-04-2013. 9. I declare that the facts and information provided in this form 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 a situation.

Name : Paste firmly with glue or adhessive like fevicol (Do not staple) a recent Signature of the candidate (Sign within the box with black pen) color photograph of size 3.5 X 4.5 cms

SUKESHI AGRAWAL
BHAGWATI HOTEL BODAKDEV AHMEDABAD,-380054 AHMEDABAD GUJARAT, Pincode:380054 INDIA

Address : B-81 CENTURY TOWER BEHIND GRAND

(I do hereby certify that the photograph affixed above is that of Mr./Ms SUKESHI AGRAWAL) 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) Date: Place: Important: Please do not fold this document while posting Name & Signature of the Member / Principal / Gazetted Officer with Membership NO.& Office seal

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The Institute of Chartered Accountants of India

INTERMEDIATE (INTEGRATED PROFESSIONAL COMPETENCE) EXAMINATION / ACCOUNTING TECHNICIAN EXAMINATION - MAY 2013

Registration No :

CRO0387475

Control No:

4314592

ELIGIBILITY DETAILS TO APPEAR IN INTERMEDIATE INTEGRATED PROFESSIONAL COMPETENCE EXAMINATION, MAY 2013 (i) Registered For Intermediate IPCC/ATC on or before 01st September, 2012 based on having passed : CPT and 10+2 exam passed CCT / ITT CERTIFICATE DETAILS Certificate Name Certificate No. Dated

Orientation Completion Details Completion Date : ************************************************** Certificate of service: For candidates who registered for/converted to Intermediate (IPC) course under the Direct Entry Scheme under the category graduates/post graduates and commenced articleship on or before 30th September 2012:

I _____________________________________ hereby certify that Mr/Ms _____________________________________ is presently serving under me as articled assistant and will be completing 7 months of articled training on or before 30th April 2013. Student Regn. No:___________________________ Date: ___________________________ Place: __________________________ Signature of the articled assistant Signature of Principal

ICAI membership No. _____________________________