Google+
Search: Search
 
Follow us
   
Home  |  e-Services  |  Feedback  |  Contact Us  |  Web Mail 

APPLICATION FOR EMPANELMENT AS CHECKER FOR THE CHARTERED ACCOUNTANTS EXAMINATIONS
[in response to Announcement Dated 1st October , 2014]

(This form is an application for empanelment only, making an application will not be construed as appointment as a checker)

I hereby give below my particulars for empanelment of my name to act as a Checker, in response to Announcement dated 1st October 2014, which I declare that have gone through the requirements and shall abide by them.
(Please Affix a recent Passport size photograph.)
Fields marked with * are mandatory.
1. Name and Address for Communication of the Member (IN CAPITAL LETTERS)
 
a. * Name:
b. Address 1:
c. Address 2:
d. Address 3:
e. Address 4:
f. Place/Town/City (Please provide full name; do not provide short name):
g. District:
h. State:
i. * Pin Code:
2. * ICAI Membership Number:
3. * Date of Birth(dd-mm-yyyy):
4. * Date of Enrollment as an associate Member:
5. Date of Admission as a Fellow Member (if applicable):
6. Other Communication Details:
 
a. * E-mail ID:
b. * Mobile:
c. Phone (Office) (with STD Code):
d. Phone (Residence) (with STD Code):
7. * PAN (attach self attested copy):
8. Banking details for payment purpose (a cancelled leaf of unsigned cheque may be enclosed)
 
a. * Name of the Bank:
b. * Branch of the Bank with complete Address:
c. * Bank Account Number (12/16 digit account no. as applicable):
d. * IFSC Code:
e. * MICR Code:
9. Whether your membership is LIVE as on date
(i.e. membership fee paid for the current financial year):
DECLARATION
I hereby declare that:
1. Above information is true and complete to the best of my knowledge and belief. I undertake to keep the information/data/records/documents etc that might come to my knowledge/ possession as always confidential and secret and shall not divulge to anyone under any circumstance. I have read and understood the Eligibility requirement(s) to become a checker, functions of checker, terms and conditions, etc. I understand that this assignment is of secret nature and I shall not divulge to anyone, not include such association in any manner in my bio-data or make public under any circumstances.
2. None of my relatives* or dependants* is / will be appearing in the CA [Final or Intermediate (IPC)] Examinations in November, 2014. [The term “relative” or “dependants” for the purpose of examination shall include in relation to an individual, the wife, husband, son, daughter-in-law, daughter, son-in-law, grandson, granddaughter, brother, brother’s wife, brother’s son, brother’s daughter, sister, sister’s husband, sister’s son, sister’s daughter, wife’s brother, wife’s sister and husband’s brother and husband’s sister”]
3. I am not an examiner for evaluation of answer books of CA Final and / or Intermediate (IPC) Examinations in November, 2014.
4. I am not coaching students for any of the examinations conducted by the Council of the Institute, in any Institute, in any institution / organization including Regional Councils / branches of the Institute and also private coaching, and
5. I am not associated with the Institute as an elected member of the Council / Regional Council / Branch managing Committee.
6. I have not been convicted by any court of law and that no disciplinary proceedings are pending against me either by the ICAI or by any other organization both in India and abroad.
7. A sample of my hand-writing in words as well as numerals is given below for reference and record purposes:
In word:
In numerals:
Station:__________ Signature:_________ Membership No. _________
Date:__________  Name: _________
Please send the print out with necessary enclosures to the following address: Shri G Somasekhar,
Additional Secretary (Exams)
Examination Department,
The Institute of Chartered Accountants of India,
'ICAI Bhawan'
C-1,Sector:1,
NOIDA-201301
Uttar Pradesh.
 
Students
BoS Knowledge Portal
BoS Announcements
Become an Accounting Technician
e-Sahaayataa
100 hours IT Training
Examinations
e-Services
Career Counselling Presentation - 2013
 
Members
Know Rules & Regulations
Post-Qualification Courses
Generously Contribute to CABF
Know the CPE Hours credit status
Trace a Member
e-Sahaayataa
Examinations
Empanelment
e-Services
Become Examiner with ICAI
Other Imp. Links
 
Employers
Understand benefits that you get
Register as an employer
Upload Jobs & Training Assignments
Review CVs
Shortlist Applications
Search for Professional Assistance
 
Resources
Download Standards
View Notifications
Look up Guidance Notes & Interpretations
Find Publications
Free Download - Publications
Publications
Visit the e-library
Committee Pages
 
Events
View Committee Events
Look up CPE Events in my location
Sign up for an Event
View Archived Webcasts & Webinars
Report on an Event
Photo Gallery
 
Official Directory  |  Web Mail  |  Feedback  |  Contact Us
Best viewed on screen resolution 1024x768 pixels
Web Counter: web counter