8/7/2019 Membership Application Form (Jul 2009)[1]

http://slidepdf.com/reader/full/membership-application-form-jul-20091 1/2

 The Institute of Internal AuditorsMembership Application

1. Business Data

  Please Type or Print Clearly  Check if Internal Auditor magazine is subscribed(For subscription detail, see Section 5)

  Mr. Mrs. Ms

Name (in Block)(Last) (First) (Middle)

Organization : Job Title :

Address :

City : Postal Code:

E-mail : (i) (ii)

Business Phone : Business Fax:

Do you spend more than 50 percent of your time supervising other internal auditors or directing the audit program? Yes No

Number of Internal Auditors on Staff : Industry in which you are employed :

Have you been a member of The Institute of Internal Auditors before? Yes / No

If yes : Name of The IIA’s Affiliate _____________________________________ Membership Id _______________________________ 

2. Personal Data

Home Address :

Postal Code :

Home Phone Cell :

Have you ever been convicted of afelony ?

Yes No Certified Internal Auditor ? Yes No

Qualification(s) : Academic: Professional:

Send Mail to : Home Address Business Address

3. Dues and Payment

Dues Payable :

Membership Fee per Classification applied for (Refer Section 4) US $

Subscription of Internal Auditor (Refer Section 5) US $

Total Dues Payable US $

Equivalent Rupees (Converted at Rs _______ / US dollar, See ii below) Rs.

Cheque No. dated Drawn on Amounting to Rs enclosed

i) Please make cheque payable to 'The Institute of Internal Auditors, Karachi Chapter'.

ii) US $ conversion into Pak Rupee would be at kerb rate prevalent on the date application is submitted roundedto the next higher plus Rs 1. For example, if kerb rate is at Rs. 81 to US $, dollars will be converted at Rs.85/US$.

Effective Date: July 1, 2008 Page 1 of 2

8/7/2019 Membership Application Form (Jul 2009)[1]

http://slidepdf.com/reader/full/membership-application-form-jul-20091 2/2

4. Membership Classification

Membership Classifications and Annual Fee are as follows (Please check one):

Regular (Management) : Managers and directorsengaged in internal auditing (US $ 25)

Regular (Staff) : Internal auditing staff (US $ 25)

 Associate : Corporate officers in other fields(US $ 25)

Education : Full time educators at colleges / universities(US $ 15)

Student : Engaged in full time study program(US $ 15)

Retired : Individuals who are retired and not in the employmentany more (US $ 15)

Life : (US $ 250) Honorary : Nil

5. Internal Auditor's Subscription

Annual Subscription (July to June) for 6 issues of bimonthly magazine Internal Auditor  is US $ 25. This is prorated for thosejoining during the year, as follows:

Joining Month :

Subscription Payable (US $)

 

Jul. & Aug

25

Sep. & Oct.

21

Nov. &Dec.

17

Jan.-Feb.

13

Mar. &Apr.

9

May &Jun.

5

Add applicable subscription amount to your membership fee to arrive at total dues payable (in Section 3).

6. Applicant’s Signature

I declare that all information contained in this application is true and correct. If accepted, I agree to abide by the Code of Ethics adopted by the Institute of Internal Auditors to

govern its members.

Applicant’s Signature : Date :

Name to appear on Membership Certificate :

 

(in Capital Letters)Return Completed Formand Cheque to : The Institute of Internal Auditors-Pakistan Karachi Chapter,

Room # 302, 3rd Floor,Shahwar Trade Center,72/S Block-2,Alama Iqbal Road, PECHS.Karachi.Tel : +92 (21) 4289354E.mail : contact@iiap.org.pk  

APPLICANT: PLEASE DO NOT WRITE BELOW THIS LINE.

Date Received Recommended Class of Membership :

Chapter Name and Number  K A R A C H I ( # 282 )

Job Code: Industry Code:

Chapter Membership Ref. (CMR) The IIA HQ Id.

Chair Ad. & Membership Committee (Signature) (Date)

President (Signature) (Date)

Effective Date: July 1, 2008 Page 2 of 2