Exam Passed MONTH & YEAR Roll No.

CPT 07, 2010 118312

The Institute of Chartered Accountants of India
INTERMEDIATE (INTEGRATED PROFESSIONAL COMPETENCE) EXAMINATION /
ACCOUNTING TECHNICIAN EXAMINATION - NOV 2013

CANDIDATE DETAILS
Name of Candidate : POOJA SURENDRA RATHI
DOB: 11/02/1993 Gender : Female
Registration No : WRO0356179 E Mail : pooja11.rathi@gmail.com
Applied Date: 10/08/2013 Control No: 4533497
Medium Opted : English Landline No: -
Exam Applied : Intermediate (IPCE) Group-II
Examination Centre : Mumbai X
Mobile No : 8976345837
Father's Name: SURENDRA RATHI
Registration date of Intermediate(IPCC)/ATC/Inter/PEE-II/PCC: 04/07/2011
PIN :1234 Differently Abled :No
ENTRANCE/ FOUNDATION/ PEE-I/ CPT PASSING PARTICULARS
PARTIAL INTERMEDIATE/ PEE-II/ PCE/ IPCE EXAMINATION PASSING DETAILS
Exam Passed MONTH & YEAR Roll No.
Group I IPCE 08, 2012 293516
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: 1000 INR Transaction Date: 10/08/2013 Bank Transaction No: EFI_WRO0356179_1024944591
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The Institute of Chartered Accountants of India
INTERMEDIATE (INTEGRATED PROFESSIONAL COMPETENCE) EXAMINATION /
ACCOUNTING TECHNICIAN EXAMINATION - NOV 2013

Registration No : WRO0356179 Control No: 4533497
DECLARATION BY THE STUDENT
1. I POOJA SURENDRA RATHI son/daughter of SURENDRA RATHI request for permission to present myself at the Intermediate (IPC) /Accounting Technician
Examination to be held in NOV 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 or an examination recognized as equivalent thereto by the
Central Govt. and have registered for Intermediate (IPC) course / ATC on or before 01st March, 2013; 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 (IPC) /Accounting Technician Course (ATC) and have completed 8 months from the
date of registration in Intermediate /PE II/ PCC.
5. I registered for Intermediate (IPC) course/ATC under the Direct Entry Scheme, under Graduate/Post Graduate category and commenced articled training on or before
01st February, 2013 & completed/would be completing 9 months of articled training (including 8 months of study course) as on 01st November, 2013
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 Graduate/Post
Graduate category and commenced articled trainging on or before 01st February, 2013 & completed/would be completing 9 months of articled training (including 8
months of study course) as on 01st November, 2013
7. I registered for Intermediate (IPC) course/ATC, under Direct Entry Scheme, having passed the Intermediate level examination of the Institute of Cost Accountants of
India/The Institute of Company Secretaries of India, on or before 01st March, 2013.
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 Intermediate
Level 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 November, 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 : POOJA SURENDRA RATHI
Address :
601 6TH FLOOR BUILDING NO A 3
GAGANGIRI ENCLAVE BARAVE
ROAD,KHADAKPADA KALYAN WEST
KALYAN
MAHARASHTRA, Pincode:421301
INDIA
(I do hereby certify that the photograph affixed above is that of Mr./Ms POOJA SURENDRA RATHI) 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 posting
Name & Signature of the Member of ICAI/ Principal / Gazetted Officer
with Membership NO.& Office seal
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The Institute of Chartered Accountants of India
INTERMEDIATE (INTEGRATED PROFESSIONAL COMPETENCE) EXAMINATION /
ACCOUNTING TECHNICIAN EXAMINATION - NOV 2013

Registration No : WRO0356179 Control No: 4533497
DETAILS FOR DETERMINING ELIGIBILITY
(i) Registered For Intermediate (IPCC)/ATC on or before 01st March, 2013 based on having passed : CPT and 10+2 exam passed
CCT / ITT CERTIFICATE DETAILS
Certificate Name Certificate No. Dated
ITT 005572 12/09/2012
Orientation Completion Details
Completion Date : 18/06/2012
**************************************************
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 1st February, 2013
I _____________________________________ hereby certify that Mr/Ms _____________________________________ is presently serving
under me as articled assistant and completed or will be completing 9 months of articled training as 01st November, 2013.
Student Regn. No:___________________________
Date: ___________________________
Place: __________________________ Signature of the articled assistant Signature of Principal



ICAI membership No. _____________________________



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