WRO0293312-IPC-NOV 2015

Exam Passed MONTH & YEAR Roll No.CPT 12, 2008 114295

The Institute of Chartered Accountants of IndiaINTERMEDIATE (INTEGRATED PROFESSIONAL COMPETENCE) EXAMINATION /

ACCOUNTING TECHNICIAN EXAMINATION - NOVEMBER 2015

CANDIDATE DETAILS

Name of Candidate : PRATIK DHANSUKHLAL PARAKH

DOB: 27/02/1990 Gender : Male

Registration No : WRO0293312 E Mail : [email protected]

Applied Date: 12/08/2015 Control No: 2154159365

Medium Opted : English Landline No: -

Exam Applied : Intermediate (IPCE) Group-II

Examination Centre : NashikCenter Code: 137

Mobile No : 9595550651

Father's Name: DHANSUKHLAL JUGRAJ PARAKH

Conversion / Registration date of Intermediate(IPCC)/ATC: 13/02/2013 Revalidation Date: -

PIN :2790 Differently Abled :No

ENTRANCE/ FOUNDATION/ PEE-I/ CPT PASSING PARTICULARS (IF APPLICABLE)

PARTIAL INTERMEDIATE (PASSED ON OR AFTER NOVEMBER 1994)/ PEE-II/ PCE/ I(IPC)E EXAMINATION PASSING DETAILS

Exam Passed MONTH & YEAR Roll No.

Group I IPCE 11, 2014 437911

EXEMPTION DETAILS OF EXEMPTION SECURED IN I(IPC)E/ATE

Month & Year Roll No. P1 P2 P3 P4 P5 P6 P7

PAYMENT DETAILS

Total Amount: 1200 INR Transaction Date: 12/08/2015 Bank Transaction No: EFI_WRO0293312_1334784840

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Registration No : WRO0293312 Control No: 2154159365

DECLARATION BY THE STUDENT1. I PRATIK DHANSUKHLAL PARAKH son/daughter of DHANSUKHLAL JUGRAJ PARAKH request for permission to present myself at the Intermediate (IPC)

/Accounting Technician Examination to be held in NOVEMBER 2015 by the Institute of Chartered Accountants of India and hold valid registration for appearing inIntermediate(IPC) Examination to be held in NOVEMBER 2015.2. I declare that I am eligible to appear in the Intermediate (IPC) Examination /ATE as I have passed the PEE-I/Foundation/Entrance Examination and have completedeight months study course in IPCC.3. I have passed the Common Proficiency Test (CPT) as well as Senior Secondary (10+2) Examination or an examination recognized as equivalent thereto by theCentral Govt. and have registered for Intermediate (IPC) course / ATC on or before 01st March, 2015 as per registration letter received from the Regional Office; 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 Regulations1988 or Professional Education (Course II) under sub-regulation (1) of regulation 28A or Professional Competence Course under Regulation 28 C of the CharteredAccountants Regulations , 1988 and have already converted into the Intermediate (IPC) Course/Accounting Technician Course (ATC).5. I registered for Intermediate (IPC) course/ATC under the Direct Entry Scheme, under the Graduate/Post Graduate category and commenced articled training on orbefore 01st February, 2015 & completed/would be completing 9 months of articled training (including 8 months of study course) as on 01st Nov, 2015 as per articleregistration letter received from the Regional office.6. I converted to Intermediate (IPC) course /ATC from erstwhile Intermediate or CPT or PE-II or PCC or IPCC,under Direct Entry Scheme, under the Graduate/PostGraduate category and commenced articled trainging on or before 01st February, 2015 & completed/would be completing 9 months of articled training (including 8months of study course) as on 01st Nov, 2015 as per article registration letter received from the Regional office.7. I registered for Intermediate (IPC) course/ATC, under Direct Entry Scheme, having passed the Intermediate level examination of the Institute of Cost Accountants ofIndia/The Institute of Company Secretaries of India, on or before 01st March, 2015 and completed or would be completing 8 months study course as on 01st Nov, 2015as per registration letter issued by Regional Office.8. I converted to Intermediate (IPC) course /ATC, from erstwhile Intermediate/CPT/PE-II/PCC or IPCC, under the Direct Entry Scheme, having passed the IntermediateLevel examination of The Institute of Company Secretaries of India/Institute of Cost Accountants of India, and completed/would be completing 8 months of study course,as on 01st Nov, 2015 as per article registration letter received from the Regional office.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 shallbecome 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 oradhessive like fevicol

(Do not staple) a recentcolor photograph of size

3.5 X 4.5 cms

Name : PRATIK DHANSUKHLAL PARAKH

Address : FLAT NO 7 RAM VAIBHAV CO OP HSG STYB WING VRUNDAVAN COLONYMAKHMALABAD, ROAD PANCHAVATINASHIKMAHARASHTRA, Pincode:422003INDIA

I do hereby certify that the photograph affixed above is that of Mr./Ms PRATIK DHANSUKHLAL PARAKH 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 of ICAI/ Principal / Gazetted Officerwith Membership NO.& Office seal

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Registration No : WRO0293312 Control No: 2154159365

DETAILS FOR DETERMINING ELIGIBILITY

(ii)Converted to Intermediate (IPCC)/ATC from one of the following courses : PCC

**************************************************

Certificate of service:

For candidates who registered for/converted to Intermediate (IPC) course under the Direct Entry Scheme under the categorygraduates/post graduates and commenced articleship on or before 01st February, 2015

I _____________________________________ hereby certify that Mr/Ms _____________________________________ is presently servingunder me as an articled assistant and completed or will be completing 9 months of articled training as 01st Nov, 2015.

Student Regn. No:___________________________

Date: ___________________________

Place: __________________________ Signature of the articled assistant Signature of Principal

ICAI membership No. _____________________________

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Documents

WRO0293312-IPC-NOV 2015