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Exam Passed MONTH & YEAR Roll No.

CPT 12, 2011 173037

The Institute of Chartered Accountants of India

INTERMEDIATE (INTEGRATED PROFESSIONAL COMPETENCE) EXAMINATION /

ACCOUNTING TECHNICIAN EXAMINATION - MAY 2013

CANDIDATE DETAILS

Name of Candidate : GODHULI DUTTA

DOB: 25/09/1993 Gender : Female

Registration No : ERO0182250 E Mail : [email protected]

Applied Date: 12/02/2013 Control No: 4328835

Medium Opted : English Landline No: -

Exam Applied : Intermediate (IPCE) Both Groups

Examination Centre : Kolkata I

Mobile No : 9989477176

Old Article Registration Number:

Father's Name: BISWAMAY DUTTA

Registered with Board of Studies for: Group I and Group II of Intermediate (IPCC)

Registration date of Intermediate(IPCC)/ATC/Inter/PEE-II/PCC: 20/01/2012

PIN :1993 Physically Challenged :No

ENTRANCE/ FOUNDATION/ PEE-I/ CPT PASSING PARTICULARS

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 Roll No. P1 P2 P3 P4 P5 P6 P7

PAYMENT DETAILS

Total Amount: 1600 INR Transaction Date: 12/02/2013 Bank Transaction No: EFI_ERO0182250_1095902909

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Registration No : ERO0182250 Control No: 4328835

DECLARATION BY THE STUDENT

1. I GODHULI DUTTA son/daughter of BISWAMAY DUTTA request for permission to p resent myself at the Intermediate (IPC) /Accounting Techn ician 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 o r an examination recognized as equivalent the reto 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 Inte rmediate (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 Inte rmediate (IPC) course/ATC, under Direct Entry Scheme, under the category of Intermediate Level Pass of ICSI/Institute o f 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 Inte rmediate (IPC) course /ATC, from Intermediate/CPT/PE-II/PCE or IPCE, under the Direct Entry Scheme, under the category of Inte rmediate L evel

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.

Signature of the candidate

(Sign within the box with black pen)

Paste firmly with glue or

adhessive like fevicol

(Do not staple) a recent

color photograph of size

3.5 X 4.5 cms

Name : GODHULI DUTTA

Address : CO B N PAUL

3/20 SURYA NAGAR,PO REGENT PARK

KOLKATA

WEST BENGAL, Pincode:70004 0

INDIA

(I do hereby certify that the photograph affixed above is that of Mr./Ms GODHULI DUTTA) 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 postingName & Signature of the Member / Principal / Gazetted Officer with

Membership NO.& Office seal

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Registration No : ERO0182250 Control No: 4328835

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. _____________________________

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