THE INSTITUTE OF CHARTERED ACCOUNTANTS OF INDIA

NORTHERN INDIA REGIONAL COUNCIL

(Joint Initiative of NIRC of ICAI and Vedanta Foundation)

APPLICATION FORM FOR GRANT OF SCHOLARSHIP

The Chairman Northern India Regional Council of The Institute of Chartered Accountants of India, ICAI Tower, “Annexe”4th & 5th Floor, Indraprastha Marg, New Delhi- 110002. Dear Sir,

I hereby apply for the grant of Merit-cum-Need Scholarship under the Vedanta Foundation. I give below the relevant particulars for your consideration. I understand that the information contained herein forms the basis for consideration of grant of scholarship and that, if the information is found to be wrong, the scholarship may be withdrawn immediately without prejudice.

PARTICULARS 1. Name in full _______________________________________ (CAPITAL LETTERS) 2. Registration No. _________________________________ 3. Date of Birth _______________________

Affix latest

Photograph here

(Passport Size)

4. Full Address (a) Correspondence _____________________________________________

______________________________________________________________

Pin Code __________________

(b) Permanent __________________________________________________ ______________________________________________________________

Pin Code ______________

Contact Number (s) _____________________________________________

Email ID ________________________________

5. (a) Father's/Guardian's Name ____________________________________

(b) Occupation (Service/Business/Other means of livelihood). Please furnish below

the name of the organization and designation of the post held, name of the firm and nature of business carried on or other relevant particulars as may be applicable.

______________________________________________________________

______________________________________________________________

6. Total yearly income of parents/guardian from all sources (Write in words also)

FORM III

7. a) Particulars of passing the HSC/University examination [enclose attested photocopy (ies)]

Sr. No. Examination Month & Aggregate of Percentage Name of the

Passed Year Marks of Marks University/

Secured Institution

1

2

3

b) Particulars of passing CPT / IPCC Course Examination of the Institute. [enclose attested photocopy (ies)]

Sr. No. Examination Month & Aggregate of Percentage Attempt Passed Year Marks of Marks Number Secured

1

2

3

8. Name, Membership Number and address of the Chartered Accountant under whom the candidate is receiving training under the Chartered Accountants Regulations. (if applicable)

______________________________________________________________________

______________________________________________________________________

Date and Year of Expected Date of Date of First eligible attempt for Commencement of Articles Completion of Articles CA Exam

9. Particulars of the Scholarship or financial assistance requested:

Financial Assistance is required for:

Sr. no. Details Please tick whichever is

applicable

1. Registration fees payable to ICAI for each

of the above mentioned streams of the CA

course. (Registration fees for each module

of CA course will be paid by the students to

ICAI first and then the same will be refunded

by NIRC to the students on the passing of

the stream.

2. Fees for coaching classes organized by

NIRC of ICAI only.

3. Orientation Programme (OP) Fees.

4. General Management and Communication

skills course (GMCS Course(I and II)) Fees 5. Information Technology Training (ITT) Fees 6. ICAI Library membership Fees 7. Subsidy for Reference Books (Up to

Rs. 5,000/- Per student) 10. Whether you belong to Scheduled Caste/Scheduled Tribe, if so, furnish

documentary evidence. Please write `OBC' in case you belong to OTHER BACKWARD CLASSES. (Yes / No)

11. Whether Physically Challenged (If Yes, enclose attested copy of certificate

issued by the Hospital under the Central/ State Government) 12. List of the attested documents attached. Tick the Certificates attached.

(i) Marksheet of SSC/ University Examination (ii) Marksheet of CPT/IPCC Examination. (iii) Caste Certificate, if applicable (iv) BPL Certificate (iv) Physically Challenged Medical Certificate, if applicable.

I hereby declare that the statements made by me in this application form are true to the best of my knowledge and belief. I further agree to abide by the terms and conditions of the award if I am selected for the Scholarship applied for.

(Signature of the student)

Place___________ Date____________.

FORM I

For students undergoing Articled Training

Certified that Shri / Ms. ____________________________________was

admitted as an articled/audit clerk in our firm from

__________________________and that he/she would be completing the

prescribed period of training under the Chartered Accountants Regulations Act

on _____________________.

Signature of the Member Membership No. ____________________________________________ Name_____________________________________________________ Name of the Firm____________________________________________ Address ___________________________________________________ Date_________

FORM II

For students not undergoing articleship

CERTIFICATE

This is to certify that Mr./Ms.______________________________________ (Reg. No.__________________________) is continuing to be a student of

CPT/IPCC/Final Course of ICAI. His/her conduct has been found to be

satisfactory.

Signature of the member of the Institute ___________________________

(Membership No.) OR Head of Educational Institution/Gazetted Officer

_______________________________________

Date: Seal Address:

FORM III

Certificate of Income to be submitted by the Parents/ Guardian of the Applicant I,Mr./Ms._________________________________________________________ father/guardian of

Mr./Ms._______________________________________________who has applied for the

grant of Merit-cum-Need/Need-Based and weaker section/Endowment

Scheme Scholarship declare that my total monthly income, including the

income of my wife and of son/ward, is Rs.__________/-(in

Words__________________________________________) and my household expenses is

approximately Rs. ___________/-per month.

(Signature)

Name___________________ Date____________________

(To be signed in the presence of a CA/Magistrate/Oath Commissioner/Notary

Public who would also affix his signature and seal).

(Signature)

Date: Seal Address: