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The Institute of Chartered Accountants of India


INTERMEDIATE (INTEGRATED PROFESSIONAL COMPETENCE) EXAMINATION /
ACCOUNTING TECHNICIAN EXAMINATION - MAY 2016
CANDIDATE DETAILS
Name of Candidate : PIYUSH AGARWAL
DOB: 18/06/1993

Gender : Male

Registration No : CRO0430750

E Mail : piyushmonu001@gmail.com

Applied Date: 22/02/2016

Control No: 1164244807

Medium Opted : English

Landline No: -

Exam Applied : Intermediate (IPCE) Group-II


Examination Centre : Varanasi
Center Code: 449
Mobile No : 8604101054
Father's Name: PAWAN KUMAR AGARWAL
Date of commencement of articleship

Conversion / Registration date of Intermediate(IPCC)/ATC: 08/08/2012


PIN :1993

training: 07/03/2014

Differently Abled :No

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


Exam Passed

MONTH & YEAR

Roll No.

CPT

06, 2012

212867

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

MONTH & YEAR

Roll No.

IPCE

11, 2013

344761

Group I

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: 22/02/2016

Bank Transaction No:

EFI_CRO0430750_1314932748

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The Institute of Chartered Accountants of India


INTERMEDIATE (INTEGRATED PROFESSIONAL COMPETENCE) EXAMINATION /
ACCOUNTING TECHNICIAN EXAMINATION - MAY 2016

Registration No :

CRO0430750

Control No:

1164244807

DECLARATION BY THE STUDENT


1. I PIYUSH AGARWAL son/daughter of PAWAN KUMAR AGARWAL request for permission to present myself at the Intermediate (IPC) /Accounting Technician Examination to be held in MAY 2016 by the Institute of Chartered
Accountants of India and hold valid registration for appearing in Intermediate(IPC) Examination to be held in MAY 2016.
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 completed eight months study course in Intermediate(IPC).
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 September, 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 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) 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 or before 01st August, 2015 & completed/would be completing 9
months of articled training (including 8 months of study course) as on 01st May, 2016 as per article registration 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/Post Graduate category and commenced articled trainging on or before
01st August, 2015 & completed/would be completing 9 months of articled training (including 8 months of study course) as on 01st May, 2016 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 of India/The Institute of Company Secretaries of India, on or before
01st September, 2015 and completed or would be completing 8 months study course as on 01st May, 2016 as 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 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 May, 2016 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 shall become invalid if I make wrong declaration and undertake to
abide by the decision of the Council in such a situation.
10. I registered for Intermediate(IPC) through CPT route and appeared in the Intermediate(IPC) examination in one or both groups but did not pass any of the group/s and converted to Intermediate(IPC) under the direct entry scheme
& commenced practical training on or before 30th April, 2016

Name :

PIYUSH AGARWAL

Address : C/O PAWAN KUMAR AGARWAL

B - 36 / 8 A SANKAT MOCHAN MARG

Paste firmly with glue or


adhessive like fevicol
Signature of the candidate
(Sign within the box with black pen)

(Do not staple) a recent

VARANASI
UTTAR PRADESH, Pincode:221010
INDIA

color photograph of size


3.5 X 4.5 cms

I do hereby certify that the photograph affixed above is that of Mr./Ms PIYUSH AGARWAL 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 - MAY 2016

Registration No :

CRO0430750

Control No:

1164244807

DETAILS FOR DETERMINING ELIGIBILITY


(i) Registered For Intermediate (IPCC)/ATC on or before 01st September, 2015 based on having passed : CPT and 10+2 exam passed

**************************************************
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 01st August, 2015

I _____________________________________ hereby certify that Mr/Ms _____________________________________ is presently serving


under me as an articled assistant and completed or will be completing 9 months of articled training as 01st May, 2016.
Student Regn. No:___________________________
Date: ___________________________
Place: __________________________

Signature of the articled assistant

Signature of Principal

ICAI membership No. _____________________________