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  • 1. I I 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 1. n2.m~ I ALO I< RAT _. 0quot;quot;~. iV!Ciltquot; 0 ~ t't'Ulllie . n L..J ...' 3. D ':,',quot; v. '-'~ u.. quot;quot;~ .;-r-;.,'.. D quot;I I ~ ..., .., S I quot;u, 1 I 0quot;2- I -,-,-I/Q 83 I ''', 1 I .. quot; I I Plact' (,f Birth PATN A :' ..'ddres~ for Iquot;quot;SIC L-t1;l.quot; 2nd P-/Dorquot; l<cwnaltin:J~1 Correspondence IAp'~r-tm.e~J Oc.I pJ:iJ ra Rquot;atA,GarPJ~ I Qcrodd -39°02-0/ c;.fjqr'quot;a'f;. i tel ~ 0 2- 6,S z..:3 '3 ,,6 72. Ciry,T OVvll l?.:a cl a YD ,y f quot;3 '10 02-0 I'm! State' Uni0!l T enitory t, l-1dqY'~ t J ! 6 Phone No. Office !02- 6quot;S' 2..3396'721 . , Residence I <14-10 }1 (; 32-( I! 9 J Mobile I I f 94<IM~9(}3U 1 E-mail ID I PlIo 1<Y~,J 1PIco>e~~'CI)td.n1. I ; (7! , Ii .., ),hriul Statns. Ja!l1ed L-J TJnman'iecl I ~ 7.1 Ifmanicd, quot;Nh.;thcr spouse ii.:.;mployed: Yes j J No ! v If yes. demJJs ,'t employment: . .. . .. . . .. . ... .. . ..... ......... .. ... ... .. . ... ... ...... .......... ........... .. ... ... .. ... .
  • 2. 8. Whether any relative is / vas employed in the Institute: Yes N~ If yes, details of employment (Name, Designation, Department / Section and place of work.ing): quot;''''''''''''''''''''''''''''''''''''quot;quot;quot;,,,,,,,,,,,,,,,,,,, quot;'''''''''''''''''''''''' . . . . .. ... . .. ... ... ... . .. ... . .. ... . .. ... . .. ... ... . .. 'quot; ... ... . .. ... . .. ... . .. ... . .. ... . .. ... . . . .. ... . . . . .. ... . .. ... . . .. .. ............. .... quot;'quot;'''' 9. Whether belongto S.C./ S.T Yes Nc.....- llf yes please enclose copy of proof certificate] 10 Df'tails of Academic and Plquot;Off'ssional Qualification commendquot;!! from 10tl1Standard (Attach separate sheet if required) ,--~ ~ % of Mark~ ! Name of the Examination i ! Boa~d! University I I Institu.e ! I Year.~ of Passing , i I ' I i I 5S'C ! 5'gi' . <2:,13, / fa.a. i . l q Cf7 i I i r I I , I i i '. I i i i HSC i 4-1-1, E. C I fa a 2--0 0 0 I I ! I I i , : i 16 t ! i I b6-,l rc..NOv,1)..eI'},( ! I i I I ! i 2-oof I I i I I I -;:.t; ND) h1' i 2-@ () , J}d I 7 I i I I I' i I 11. Experience commendn!! from the pl'e.-entposition (Attach separate sheet if required) I Name oftiie No. of Pel'iod Designation Job Profile I Employer ! Years From !To serwd (
  • 3. 12. Details of task.~ handled includln~ adminIstration etc. and specIal achievl.'ments. if any (Attach senarate sheet If requh't'd) f I I Details oftasks handled and the level held at relevant times: I I I I Spech.1 Achievements: j I ! , I I I ! l 13.1 Salal'V exnected in terms of L'TC: 14. Professional Membel'shlp Details. If any Name ofthe Institution Membershi Since when I I I j i j i I 1 i 15. i . Lan!!U3!!eS Known LE~ I Read L/' ] Writev' . 1 Speak j v' ,.../ ! . l-H~d,' i . V i IV I 16. E:.quot;traCurricular Actiquot;ities, if any r f I , ,
  • 4. 'f 17quot; Details ofquot;ap~lication made earlier In the Institute fquot;OI' last one veal'. the ~ I No/quot; I If yes, please furllish the details as below Date ofadvertisement: Post applied for; Date of applicatioli: quot; 18 Anv other Intonnation in fquot;Ul1hel'ance ofquot;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 srunmariJy rejected and if appointed. my service will be terminated vithout assigning any reason thereof PI3Cequot; ~Q7V J C-' ~~L ~~) Datequot; Signature