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APPLICATION FORM FOR ADMISSION TO INTERMEDIATE (INTEGRATED PROFESSIONAL COMPETENCE) COURSE UNDER DIRECT ENTRY SCHEME

1.Name in full (in Capital Letters)(As mentioned in SSC/10th Standard Marks Statement)
First Name*:
Middle Name:
Last Name*:
2.Gender*:      
3. (i)Date of Birth*:(enclose proof)
(ii)Place of Birth*:
(iii)State*:
(iv)Country*:
4.(a)Mother's Name*:
4.(b)Father's Name*:
5.(a) Nationality     
(# In case of foreign nationals intending to pursue studies in India, an attested copy of student visa or study permit, as the case may be, issued by appropriate authorities for the duration of the Chartered Accountancy Course must be enclosed)
    (b) Category:         (enclose Proof thereof)
    (c) Annual Income of Parents(in Rs.): INR
6. Option for level(s) of Intermediate (IPC) Course (please refer registration requirement at Annexure A)*
Registeration No:(if registered earlier) eg:-NROxxxxxx Registeration Year:
7.(a) Entry Educational Qualification:
Course/Stream University/
Authority
Subjects*
Studied
Month
& Year
Result
Marks/
CGPA/
Grade/
Obtained
Max.
Marks
Awaited/
Passed
Graduation*

(Course)
1.
2.
3.
Post-Graduation*

(Course)
1.
2.
3.
Passed Intermediate
Examination of The
Institute of Cost
Accountants of
India / Company
Secretary of India
1.
2.
3.
  
Equivalent Foreign
Qualification
1.
2.
3.
  
* Graduate or Post graduate in commerce required to secure aggregate marks of 55% or above of the total marks or its equivalent grade in the examination conducted by any recognized University (including Open University) by studying any three papers of 100 marks each out of Accounting, Auditing, Mercantile Laws, Corporate Laws, Economics, Management (including Financial Management), Taxation (including Direct Tax Laws and Indirect Tax Laws), Costing, Business Administration or Management Accounting. or
Graduate or Post graduate other than those referred above, required to secure aggregate marks of 60% or above of the total marks or its equivalent grade in the examination conducted by any recognized University (including Open University).
    (b) Whether applying for Provisional Registration (please tick)     
Students pursuing the final year of Graduation shall be eligible for provisional registration for Intermediate (IPC) Course*. Please attach a proof obtained from the University/ College.
* For details please refer instructions for Provisional Registration attached at Annexure A.
Expected month of Final Year Examination: Month: Year:
8.(a)Address For Communication:
Address Line 1*:
Address Line 2:
Address Line 3:
Address Line 4:
City*:         State Code*:
Pin*:         Phone No. with STD Code:
Country*:
Email id*:         Mobile No.:
    (b)Permanent Address Same As Communication Address given in 5(a) above:    Yes     No  
Address Line 1*:
Address Line 2:
Address Line 3:
Address Line 4:
City*:         State Code*:
Pin*:         Country*:
9. Please indicate whether you need study material in 'Hindi' or 'English':     
10. Fee and other details (refer Annexure A):
    (a) I (name) hereby deposit fee towards registration for Intermediate (IPC) Course including fee of


Date: 01-11-2014
Place*:
Total payable amount:
Select a payment gateway:
ICICI Bank
Credit/Debit Card












 
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