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ONLINE FORM
The Institute Of Chartered Accountants Of India

PROFESSIONAL COMPETENCE EXAMINATION - May, 2011

CANDIDATE DETAILS

Name of Candidate :DASARI ASHOK CHETTY

Registration Number : SRO0234271 Control No: 4614030

Applied Date: 18/02/2011 Group Applied: Both

Medium Opted : English Landline No: 0657 - 2213207

Examination Centre : Chennai I E Mail : dasariashokchetty@gmail.com

Mobile No : 9790730756 Old Article Registration Number :

Father's Name: DASARI DEMULLU CHETTY DOB : 12/08/1987 Gender : Male

FOUNDATION/ PEE-I/CPT - STREAM CANDIDATE PASSING PARTICULARS

Exam Passed MM YYYY Roll No.

CPT 6 2008 45819

ELIGIBILITY DETAILS TO APPEAR IN PROFESSIONAL COMPETENCE EXAMINATION MAY, 2011

Passed the Common Proficiency Test (CPT) Conducted by ICAI and Senior Secondary Examination (10+2 examination) conducted by an examining body
constituted by Law in India or an examination recognized by the Central government as equivalent thereto and have worked for not less than 15 months as an
articled assistant or as an audit assistant or partly as an articled assistant and partly as a audit assistant as on 1st February, 2011.

BOARD OF
Exam name INTERMEDIATE Roll No. 70267891 Month & Year of Exam 3 2007
EDUCATION A P

Has successfully completed 250 Hours Compulsory Computer Training Programme/100 Hours Information Technology Training Programme
on or before commencement of the exam.

PARTIAL INTERMEDIATE /PEE-II/PCE EXAMINATION PASSING DETAILS

Group Name Exam Passed MM YYYY Roll No

EXEMPTION DETAILS

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

ELIGIBILITY CERTIFICATE DETAILS

Certificate Name Certificate No Date

Articleship Training Certificate (15 Months as on 1st February, 2011)
IIT/CCT Certificate as before commencement of exam ITT/S/34/38169 15/02/2010

OTHER ELIGIBILITY CERTIFICATE DETAILS

Certificate Name Certificate No Month Year

PAYMENT DETAILS

Total Amount: 1600 INR Transaction Date: 18/02/2011 Bank Transaction No: EPC_SRO0234271_1092214206
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The Institute Of Chartered Accountants Of India

PROFESSIONAL COMPETENCE EXAMINATION - May, 2011

Registration Number : SRO0234271 Control No: 4614030

DECLARATION BY THE STUDENT:

I request for permission to present myself at the Professional Competence Examination to be conducted by the Institute of Chartered
Accountants of India. I declare that I am eligible to appear in the Professional Competence Examination as I have obtained Eligibility
Certificate for Both Groups of Intermediate/PE-II/I have Passed the PEE-I/Foundation 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 thereafter completed 15 months practical training as an articled assistant or as an audit assistant on 1st February, 2011/ I am a PEE-I
passed candidate directly admitted to Professional Competence Course(PCC) and thereafter completed 15 months practical training as an
articled assistant or as an audit assistant as on 1st February, 2011. I further declare that I have completed 250 hours Compulsory Computer
Training/100 Hours Information Technology Training as specified by the Institute/I shall be completing 100 hours information Technology
training Programme on or before 3rd May, 2011. CCT / ITT Certificate No.................................Dated......................enclosed / I shall be sending a
copy of the CCT / ITT Certificate to the Sr.Dy.Dir (Exams.), ICAI, C-I, Sector-1, Noida-201301 (U.P.) by 31st May, 2011. I declare that the facts
and information provided by me 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.

Name : DASARI ASHOK CHETTY

Address : S K P D VYSYA STUDENTS HOME

Paste firmly with glue or
26 HARRINGTON ROAD
adhessive like fevicol
SHENOY NAGAR CHETPET
(Do not staple) at recent
color photograph of size 3.5 CHENNAI
Signature of the candidate X 4.5 cms TAMILNADU
(Sign within the box with black pen) Pincode: 600030
INDIA

1. I do hereby certify that the photograph affixed above is that of Mr./Ms. DASARI ASHOK CHETTY 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.

2. For candidates who are presently in practical training as an articled assistant or as an audit assistant or partly as an articled assistant and
partly as an audit assistant. I hereby certify that he/she is presently serving under me as an articled assistant / audit assistant, and has
completed more than 15 months of articled training as on 1st February, 2011.

Date:

Place:

Name & Signature of the Member / Gazetted Officer with

Important: Please do not fold this document while posting
Membership NO.& Office seal