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The Institute of Chartered Accountants of India

INTEGRATED PROFESSIONAL COMPETENCE EXAMINATION / ACCOUNTING TECHNICIAN EXAMINATION - MAY 2012
CANDIDATE DETAILS Name of Candidate : PALLAVI BUDHOLIYA DOB: 14/03/1991 Registration No : CRO0308042 Applied Date: 27/02/2012 Medium Opted : Hindi Exam Applied : IPCC-Both Groups Examination Centre : Ujjain Mobile No : 8305561425 Old Article Registration Number: Father's Name: ARUN BUDHOLIYA Registered with Board of Studies for: Group I, Group II of IPCC & ATC (All levels) Gender : Female E Mail : pllvbudholiya00@gmail.com Control No: 4715672 Landline No: -

Registration date of IPCC/ATC/Inter/PEE-II/PCC: 29/01/2010 PIN :1991 ENTRANCE/ FOUNDATION/ PEE-I/ CPT PASSING PARTICULARS Exam Passed CPT MONTH & YEAR 12, 2009 Roll No. 316798

PARTIAL INTERMEDIATE/ PEE-II/ PCE/ IPCE EXAMINATION PASSING DETAILS Exam Passed MONTH & YEAR Roll No.

EXEMPTION DETAILS OF EXEMPTION SECURED IN PE-II/PCE Month & Year Roll No P1 P2 P3 P4 P5 P6

EXEMPTION DETAILS OF EXEMPTION SECURED IN IPCE/ATE Month & Year PAYMENT DETAILS Total Amount: 1600 INR Transaction Date: 27/02/2012 Bank Transaction No: EFI_CRO0308042_1196553786 Roll No. P1 P2 P3 P4 P5 P6 P7

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The Institute of Chartered Accountants of India

INTEGRATED PROFESSIONAL COMPETENCE EXAMINATION / ACCOUNTING TECHNICIAN EXAMINATION - MAY 2012

Registration No :

CRO0308042

Control No:

4715672

DECLARATION BY THE STUDENT I request for permission to present myself at the Integrated Professional Competence Examination/Accounting Technician Examination to be conducted by the Institute of Chartered Accountants of India in MAY 2012. I declare that I am eligible to appear in the Integrated Professional Competence Examination/Accounting Technician Examination as I have passed the PEE-I/Foundation/Entrance Examination/ 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 Government and have registered for IPCC /ATC on or before 01st September, 2011/I was already registered for the erstwhile Intermediate Examination as per the syllabus under paragraph 2 or 2A of Schedule B of the Chartered Accountants Regulations, 1988 or Professional Education (Course II) under sub-regulation (1) of regulation 28A or Professional Competence Course under regulation 28C of the Chartered Accountants Regulations,1988 and have already converted into the Integrated Professional Competence Course (IPCC) / Accounting Technician Course (ATC) and have completed 9 months from the date of registration in Intermediate /PE-II/PCC. I further declare that to the best of my knowledge and belief, the information given above and on the next pages are correct and complete/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. Name Paste firmly with glue or adhessive like fevicol (Do not staple) a recent Signature of the candidate (Sign within the box with black pen) color photograph of size 3.5 X 4.5 cms : PALLAVI BUDHOLIYA
KALIDAS MARG GANESH PURA GALI NO.3 MAXI ROAD UJJAIN MADHYA PRADESH Pincode:456010 INDIA

Address : 29/3 BUDHOLIYA BHAVAN

(I do hereby certify that the photograph affixed above is that of Mr./Ms PALLAVI BUDHOLIYA) 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 / Gazetted Officer with Membership NO.& Office seal

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The Institute of Chartered Accountants of India

INTEGRATED PROFESSIONAL COMPETENCE EXAMINATION / ACCOUNTING TECHNICIAN EXAMINATION - MAY 2012

Registration No :

CRO0308042

Control No:

4715672

ELIGIBILITY DETAILS TO APPEAR IN INTEGRATED PROFESSIONAL COMPETENCE EXAMINATION, MAY 2012 Registered For IPCC/ATC on or before 01st September, 2011 based on having passed : CCT / ITT CERTIFICATE DETAILS Certificate Name Certificate No. Dated CPT and 10+2 exam passed

Orientation Completion Details Completion Date :