Doc. No.
_______________
Received Rs._________________
Temp. Ref. No. ________________
Receipt No.________________
Date _____________________
The Institute of Chartered Accountants of India
Application Form for Registration to Common Proficiency Test Course
(To be filled in capital Letters)
Affix recent
passport size
Photograph
1. Name in full (As per SSC X certificates) ______________________________
2. Sex ________ Male ___________ Female
3. Date of Birth ___________________________________
4. (a) Mother’s Name _________________________________
(b) Father’s Name _________________________________
5. (a) Permanent Address ______________________________________________
______________________________________________
______________________________________________
(b) Address for communication __________________________________________
______________________________________________
_______________________________ Pin Code_________
( c) Phone No. with STD Code ---------------------------------------------
(d ) Mobile No. ----------------------------------------------
(e ) Email id -----------------------------------------------
6. Special category ___ Gen
(Enclose proof thereof) ___ ___SC/ST Backward Class __ OBC ___ Disabled
7. Nationality ____________ Indian
____________ Foreign National
8. (a) Indian National Residing in India Rs.1500/-
(b) Indian National residing in Bangladesh,
Bhutan, Nepal, Pakistan, Sri Lanka Rs. 1500/-
(c) Indian National residing in a place other
than (a) & (b) US$ 200
(d) Foreign National belonging to Bangladesh,
Bhutan, Nepal, Pakistan, Sri Lanka Rs. 1500/-
(e) For other than stated in (d) above US$ 200
9. Medium of study _____ English _________ Hindi
10. Details of Education Qualifications: Starting from 10th standard
Examination Board/ Authority Year Result
Passed Awaited
(Percentage of marks
obtained)
X Not applicable
XII
Degree
Diploma
11. Annual income of parents ----------------------
12. In case an existing student of Professional Education (Course-I/II) wants to switch over
to CPT, please provide your Unique Registration No.(i.e., WRO/SRO/NRO……)
____________________.
13. (a) Details of Course Fee for new registrants:
Tuition and Registration Fee Rs.1500 for students stated in 8 (a), (b) & (d)
US$ 200 for Students stated in 8 (b), (c) & (e)
Subscription for Journal Rs. 300 (for one year)
(Optional but recommended)
(b) Registration fee for an existing student of Professional Education (Course-I/II):
Rs.100
Bank Draft / Pay order No. __________ dated ________ For Rs. ______________ (in words)
Drawn on Bank ______________________________ Branch _________________________
Payment made online using credit card / debit card _______ Yes / No
If yes, Acknowledge Number. _________ & date of transaction ___________________
Date ________________
Place _____________ Name ________________ Signature of applicant
FOR OFFICE USE ONLY
Checked and verified that the application for Common Proficiency Test Course is complete in
all respects with supporting documents.
Dealing Assistant Officer-in-charge
INSTRUCTIONS TO CANDIDATES
DOCUEMNTS TO BE ATTACHED
1. Amount payable :
a) In respect of fresh candidate registering CPT course after passing 10th Standard or
any other higher courses – Rs. 1500/- course fee + Rs. 300/- CA journal
subscription (optional)
b) In respect of those students who have registered for PE-I course (upto 31st August ,
2006) but have not passed PE-I examination and have opted CPT course - Rs. 100/-
c ) Rs. 100 /- for Prospectus including application form. Existing students of PE-I do not
have to pay separately for Prospectus.
2. Demand Draft / Pay Order of requisite amount drawn in favour of “The Secretary, The
Institute of Chartered Accountants of India” payable at New Delhi /Kanpur / Mumbai/
Chennai / Kolkata in accordance with the postal address given in Column 5 (b) of the
application and appropriate office of the Institute mentioned in the Point 4 below.
3. A copy of each of (i) Date of Birth Certificate as per SSC/ Matriculation examination, (ii)
Marks-sheets/ Certificate for 10th pass duly attested by a Chartered Accountant/
Gazetted Officer/ Head of the Institut
4. In case a student applies online, he should take a print out of the application affix a
photograph, sign the application and dispatch to the appropriate office of the Institute
within 15 days from the date of online registration.
5. The filled in application be sent to the appropriate office of the Institute as stated below:
Students belonging to Despatch address
Gujarat, Maharashtra, Goa and the Western India Regional Council, The Institute of
Union Territories of Daman & Diu and Chartered Accountants of India, ICAI Bhawan
Dadra & Nagar Haveli 27 Cuffe Parade, Colaba, Mumbai – 400 005.
Tel.: 022- 39893989 email: wro@[Link]
Andhra Pradesh, Kerala, Karnataka, Southern Indian Regional Council, The Institute of
Tamil Nadu, Pondicherry and the Chartered Accountants of India, ICAI Bhawan 122,
Union Territory of Lakshadweep M.G. Road, Post Box No. 3314, Nungambakkam,
Chennai – 600 034.
Tel.: 044- 39893989 email: sro@[Link]
Assam, Meghalaya, Nagaland, Orissa, Eastern Indian Regional Council, The Institute of
West Bengal, Manipur, Tripura, Chartered Accountants of India, ICAI Bhawan 7,
Sikkim, Arunachal Pradesh, Mizoram Anandilal Poddar Sarani, (Russell Street) Kolkata –
and the Union Territory of Andaman & 700 071.
Nicobar Tel.: 033- 39893989 email: ero@[Link]
Uttar Pradesh, Bihar, Madhya Pradesh, Central India Regional council, The Institute of
Rajasthan, Uttaranchal, Chattisgarh & Chartered Accountants of India, ICAI Bhawan, Post
Jharkhand Box No. 314, 16/77-B Civil Lines, Kanpur – 208 001
Tel.: 0512- 3989398 email: cro@[Link]
Delhi, Haryana, Himachal Pradesh, The Institute of Chartered Accountants of India,
Jammu & Kashmir, Punjab and the ICAI Bhawan,52, 53, 54, Vishwas Nagar,
Union Territory of Chandigarh Delhi – 110 032.
Tel.: 011- 39893990 email: nro@[Link]
------------------------------------------------------------------------------------------------------------------
THE INSTITUTE OF CHARTERED ACCOUNTANTS OF INDIA
(To be filled in by the applicant)
[Link].
(to be assigned by office)
Received an application for registration for Common Proficiency Test Course along with
Demand Draft/ Pay Order No. _________________
for Rs. (in words) _________________________________________
drawn on (Bank) _________________________________________
from Mr./ Ms. _________________________________________
Date
Place Signature, Name &
Designation
with seal of receiving office
