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THE IN~TITl1n: OJ:'CHARTERED ACCOl!NTANTS OF iNDIA

Ad\', No. WKO/ICAI/Rectt.f2009

Appbcation for the positlon of MANA C;-E'dY\~r ,,(.2 A-' IN'E b

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:' ..'\ddres~for I""SIC L-t1;l." 2nd P-/Dor" l<cwnaltin\:J~1Correspondence IAp'~r-tm.e~J O\c.I pJ:iJ ra R"atA,GarPJ~

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Uni0!l Tenitory t, l-1dqY'~ t

6 Phone No. Office !02- 6"S' 2..3396'721, .J !

Residence I <14-10 }19 (;32-( !J I

Mobile94<IM~9(}3U 1 E-mail ID

I I fI PlIo 1<Y~,J 1PIco>e~~'CI)td.n1.I (7!; ,

.., ),hriul Statns. \Ja!l1ed IiL-J TJnman'iecl I ~

j No ! vJ7.1 Ifmanicd, "Nh.;thcr spouse ii.:.;mployed: Yes

If yes. demJJs ,'t employment:. .. . .. . . .. . ... .. . .....

......... .. ... ... .. . ... ... ...... ..........

........... .. ... ... .. ... .

8. Whether any relative is / \vas employed in the Institute: Yes N~

If yes, details of employment (Name, Designation, Department / Section and place ofwork.ing):

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. . . . .. ... . .. ... ... ... . .. ... . .. ... . .. ... . .. ... ... . .. '" ... ... . .. ... . .. ... . .. ... . .. ... . .. ... . . . .. ... . . . . .. ... . .. ... . .

.. .. ............. .... "'"''''

9. Whether belongto S.C./ S.T Yes Nc.....-

llf yes please enclose copy of proof certificate]

10 Df'tails of Academic and Pl"Off'ssionalQualification commend"!! from 10tl1Standard(Attach separate sheet if required)

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!Name of the Examination ! Boa~d! University Ii I Institu.e

% of Mark~! Year.~ of PassingI

I I' i11. Experience commendn!! from the pl'e.\-entposition (Attach separate sheet if required)

I Name oftiieIEmployer!(

From !To

DesignationNo. ofYearsserwd

Pel'iod Job Profile

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12. Details of task.~ handled includln~ adminIstration etc. and specIal achievl.'ments. if any(Attach senarate sheet If requh't'd)

I Details oftasks handled and the level held at relevant times:II

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I Spech.1 Achievements:jI!,

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13.1 Salal'V exnected in terms of L'TC:

14. Professional Membel'shlp Details. If any

Name ofthe Institution Membershi Since whenII

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]Write. v'

IViiLan!!U3!!eS Known I Read.

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E:\."traCurricular Acti"ities, if any

'f 17" Details of"ap~lication made earlier In the Institute f"OI'the last one veal'.

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If yes, please furllish the details as belowDate ofadvertisement:

Post applied for;Date of applicatioli:

"18 Anv other Intonnation in f"Ul1hel'ance of"candidature:

19 Minimum time required to loin. U selected:

Declaration

I declare that the above information are tme and if fmilld false, my candidature can be srunmariJyrejected and if appointed. my service will be terminated \vithout assigning any reason thereof

PI3Ce" ~Q7V J C-'

~~\L ~~)Date"

Signature