THE INSTITUTE OF CHARTERED ACCOUNTANTS OF INDIA - COMMON PROFICIENCY TEST - DECEMBER, 2015

Name of Candidate : MANISHA SUNILKUMAR MOHINANIGender : FEMALE CPT Reg. Date : 26/06/2015 Revalidation Date : Nil Date Of Birth : 23/11/1997

E Mail : priyarupraj@gmail.com Control No: 579414 Registration No:WRO0576807

Mobile No : 8087485322 Landline No : -Father's Name : SUNILKUMAR

Center Selection Region : WESTERN REGION Centre :THANE - III

Question Paper Booklet Language : ENGLISH PIN :2315 Centre Code: 149Address JAI BHAWANI TOWER

OPP BANK OF BARODA 607, ULHASNAGAR - 421002MAHARASHTRA , INDIA

Details of Latest Previous appearances in CPT :MM : YYYY : Roll No.:

ACADEMIC DETAILS OF QUALIFYING EXAMINATION (I.E., 12TH CLASS EXAMINATION) : ALREADY PASSED

Year : 2015 Roll No : M166256 % of Marks secured in 12th class Examination : 69.54

Board of qualifying examination (i.e., 12th Class examination or equivalent) : STATE BOARD

Payment Details Transaction Date: 21/10/2015 Amount: 500 INR Bank Transaction No : EFC_WRO0576807_1196814552

DECLARATION BY THE STUDENTI MANISHA SUNILKUMAR MOHINANI Son/Daughter of SUNILKUMAR hereby declare that I have not already passed CPT examination in any earlier attempt and request forpermission to present myself at the Common Proficiency Test conducted by the Institute of Chartered Accountants of India. I hereby declare that the particulars stated in thisapplication form are true to the best of my knowledge and belief. I have read the Guidance Notes for candidates and satisfied myself that I am eligible to appear in ensuing CPT to beheld in December, 2015 and I shall abide by the terms and conditions contained therein. I understand that my admission to CPT and result thereof shall be provisional and subject toverification of my fulfilling the eligibility requirements in terms of Regulation 25D (as explained below) of the CA Regulations, 1988 and decision of the Council of ICAI. In the event ofsuppression or distortion of any fact made in this application form, I understand that I shall be denied the opportunity to appear in CPT and if already admitted / appeared, myadmission / result acquired shall be liable for outright cancellation. I also understand that the decision of the Institute in this regard shall be final and binding upon me and I shall abideby the same.

Date: _____________ Sign of Candidate: ______________________________ Sign of Parent / Guardian: ______________________________

Candidate's photographPaste firmly with glue oradhessive like fevicol(Do not staple) recent colorphotograph of size 3.5 X4.5 cms

ATTESTED PHOTO OF CANDIDATE

Signature of the Candidate(Sign within the box with blue/black pen only in the same style as signed in the

CPT course Registration Form)

Dated : 21/10/2015

Candidate's photographPaste firmly with glue oradhessive like fevicol(Do not staple) recent colorphotograph of size 3.5 X4.5 cms

NON ATTESTED PHOTO OF CANDIDATE

I do hereby certify that the photographs affixed above are that of MR./MS MANISHA SUNILKUMAR MOHINANI Son/Daughter of SUNILKUMAR, who has signed in my presence. Ihave verified and satisfied that the candidate named above is registered for CPT course with the Board of Studies of the Institute on or before 1st October, 2015 and has alreadypassed/already appeared / will be appearing in 12th class examination in October/November, 2015 and is eligible as per Regulation 25 D(as explained below). The particulars asfurnished have been verified by me and found correct with reference to the documents produced before me by the candidate.

Date:Name and membership No.of the Member of ICAI /Head ofthe Educational Institution /Gazzetted Officer with Seal

Place: Signature of Member of ICAI/Head of Educational Institution /Gazzetted Officer Tel No._________________________

Important: Please do not fold this document while posting

Explanation of Regulation 25 D:

1. The candidate should be registered for CPT course with BOS of ICAI on or before 1st October, 2015 and if registered on or before 1st October, 2012, he should havealready applied for revalidation of registration in terms of Board of Studies Announcement No. BOS/Announcement/227/13 dated 22nd January,2013 hosted on www.icai.org.2. The candidate who has passed 12th class or equivalent examination or appeared in 12th class or equivalent examination or will be appearing in 12th class or equivalentexamination in October/November, 2015 will be eligible to appear in CPT exam to be held in December, 2015.

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