R.
NO
S.No Batch No.
INDORE BRANCH OF CENTRAL OF INDIA REGIONA COUNCIL OF THE INSTITUTE OF CHARTERED ACCOUNTANTS OF INDIA
PLOT NO.19B, SCHEME NO.78, PART II, INDORE APPLICATION FORM FOR REGISTRATION FOR THE COURSE OF GENERAL MANAGEMENT & COMMUNICATION SKILLS
Affix a recent passport Size Photograph (Compulsory)
1. Article Registration. No. 2. Name of the Student First Name Maiden Name
CRO-
Middle Name
Surname
(In Case of Married female Students) 3. Sex (Please Tick) FEMALE 4. Date of Birth 5. Fathers Name 6. Permanent Address
City Telephone No. E-mail Pin
MALE
Day
Month
Year
Address for Communication
City Telephone No. E-mail
Pin
7. Details of Practical Training Completed (Use Additional Sheets, if Necessary & attach supporting documents) (i) Name & Address of the Principal
City
Pin
(ii) Date of Commencement of Practical Training (iii) Date of Completion of Practical Training
8. Details of Final Examination Passed/Appeared (i) Group I Roll No. (ii) Group II Roll No. 9. Details of Fees * Bank Draft /Pay Order No. For Rs. (In words) Drawn on Bank FOUR THOUSAND ONLY Branch Month Date Year Rs. Result Month Year Result
I h a v e r e a d t h e f o r m a n d d e c l a r e t h a t t h e p a r t i c u l a r s gi v e n a b o v e a r e t r u e a n d c o r r e c t t o t h e b e s t of my Knowledge and belief.
Signature of the Applicant Date Place Name
* B A N K D R AF T / P A Y O R D E R I N F A O U V R O F - I N D O R E B R A N C H O F C I R C O F I C A I ** (COMPLETION CERTIFICATE SHALL BE ISSUED ONLY TO THOSE CANDIDATES WHO REMAIN PRESENT ON ALL THE DAYS.) FOR OFFICE USE ONLY Checked and verified that the application is complete in all respect with supporting documents.
Dealing Assistant CHAIRMAN ----------------------------------------------------------------------------------------------------------------------------------------FEE RS, 4000/- BANK DRAFT OR PAY ORDER DRAWN IN FAVOUR OF
I ND OR E B R AN C H OF CI R C OF I CA I
OURSE START ON____________ R.No. (To be filled in the applicant) on S.No. General Rs. Management &
Received an application for registration for the Course Communication Skills along with Bank Draft /Pay Order. No. For Rs. (in words) Drawn on Bank From Mr./ Ms. Date Place Date
FOUR THOUSAND ONLY
Signature Name & Designation With sent of receptions officer
Instruction to Candidate: Demand draft in the name of Indore Branch of CIRC of ICAI Payable at Indore. Photograph:2 (One on application form and one for Identity card) Proof of completion of 2 years of articleship