Application For Examination: Annexure 22 (As Per Regulation 40, Sub Rule (1) )

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Form No-1.

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Annexure 22
(As per Regulation 40, Sub Rule (1))

Application for Examination

The Executive Director


The Institute of Chartered Accountants of Nepal
Kathmandu

I have passed the Chartered Accountancy Examination from ……………………


………………………………………………………………………….. in …….………. and
am applying under Rule 41 of the Nepal Chartered Accountants Regulations, 2004 whereby I
request you to specify the subjects in which I am required to appear in the examinations for
membership in The Institute of Chartered Accountants of Nepal. The details of the
examinations that I have passed are stated and enclosed herewith in this form. I also agree to
abide by the decision of the Council in this regard.

1. Name …………………………………………………………..

2. Date of Birth ……………………………………..

3. Country of Citizenship ……………………………….……., Citizenship No. ……………

4. Address
Permanent : ………………………………………………………………………………

Contact : …………………………………………………………………………………
Telephone : ……………………………………. Post Box : ………………………
Email………………………………………………………………………………

5. Highest Academic Qualification:

Academic Qualification Year of Name of Institution Name of Board


Passing

6. Details of professional qualifications:


Qualification Year of Name of Institution Year of Name of Act under
Passing Establishment of which Institution has
Institute been Established

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7. Year of passing Foundation / PE I examinations, if applicable.

……………………… ………………… …………… ……………………..


8. Year of passing Intermediate / PE II examinations. ………………………….

S.No Subject in Intermediate Maximum Marks


Marks Secured

9. Year of passing Final Examinations.: ………………………………

S.No Subject in Final Maximum Marks


Marks Secured

10. Name, Address and Firm of Principal


Name of Principal :…………….…………………..…………………………………….
Firm's Name:……………………………………………………………………………….
Address : ………………………… …………………………………………………………

11. Membership No. ……………. COP No. …………………. of the Principal in the
concerned Institute

12. If training has been taken under more than one Principal, Name, Address, Firm's name,
Membership No and COP No. of such Principles, where applicable.

(A) Name of Principal : ………………………………………. ………………………………………...


Membership No :……………………………….COP No. ………………………………….
Firm's Name : ……………………………………………………………………………….

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Address : ………………………… ………………………………………………………….

(B) Name of Principal : ………………………………………. ………………………………………...


Membership No :……………………………….COP No. ………………………………….
Firm's Name : ……………………………………………………………………………….
Address : ………………………… ………………………………………………………….

(C) Name of Principal : ………………………………………. ………………………………………...


Membership No :……………………………….COP No. ………………………………….
Firm's Name : ……………………………………………………………………………….
Address : ………………………… ………………………………………………………….

13. Total Training Period. …………………..

From (specify DD/MM/YYYY) ……………To (specify DD/MM/YYYY) …………..

14. Mandatory Professional training period required to be entitled to qualify for Certificate of
Practice under the concerned Institute's Regulations.
…………………………………………………………………….……………… ……….

Required Documents:

Applicants shall have to submit certified copies of Membership and COP from the concerned
Accounting Institute along with required certified documents.
· Marksheet and Certificates from Foundation to Final Level,
· Academic Certificate/Transcripts of SLC to higher degree,
· Article completion Certificate,
· Citizenship Certificate / Passport and
· GMCS Certificate, where applicable.

Note: Additional papers can be attached where necessary.

-------------------------------
Applicant's Signature Date : ……………………………

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