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THE INSTITUTE OF CHARTERED ACCOUNTANTS OF INDIA - COMMON PROFICIENCY TEST - JUNE, 2014

Name of Candidate : MANISH KUMAR KESHRI Gender : MALE CPT Reg. Date : 08/08/2013 Revalidation Date : Nil Date Of Birth : 07/05/1994 Control No: 712404 Registration No:ERO0206599 E Mail : manishkeshri777@gmail.com

Mobile No : 8972061774 Landline No : 03461-259265 Father's Name : HARENDRA NATH KESHRI Question Paper Booklet Language : ENGLISH Address C/O- HARENDRA NATH KESHRI
LANDMARK-GOPAL MANDIR RAMPURHAT - 731224 WEST BENGAL , INDIA

Center Selection Region : EASTERN REGION Centre :KOLKATA - II Centre Code: 308 Details of Latest Previous appearances in CPT : MM : 12 YYYY : 2013 Roll No.: 162945

PIN :6276

J.L. BANARJEE ROAD, MAHAJAN PATTY,

Academic Details of Qualifying examination (i.e., 12th Class examination) : ALREADY PASSED Year : 2012 Roll No : 2301111351 % of Marks secured in 12th class Examination : 67.40 Board of qualifying examination (i.e., 12th Class examination or equivalent) : STATE BOARD Payment Details Transaction Date: 23/04/2014 Amount: 500 INR Bank Transaction No: EFC_ERO0206599_1238111604

Declaration by the student I MANISH KUMAR KESHRI Son/Daughter of HARENDRA NATH KESHRI request for permission 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 this application 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 be held in June, 2014 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 to verification 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 of suppression 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, my admission / 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 abide by the same. Date: _____________ Sign of Candidate: ______________________________ Sign of Parent / Guardian: ______________________________

Candidate's photograph Paste firmly with glue or adhessive like fevicol (Do not staple) recent color photograph of size 3.5 X 4.5 cms 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)

Candidate's photograph Paste firmly with glue or adhessive like fevicol (Do not staple) recent color photograph of size 3.5 X 4.5 cms

ATTESTED PHOTO OF CANDIDATE

Dated : 23/04/2014

NON ATTESTED PHOTO OF CANDIDATE

I do hereby certify that the photographs affixed above are that of MR./MS MANISH KUMAR KESHRI Son/Daughter of HARENDRA NATH KESHRI, who has signed in my presence. I have 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 April, 2014 and if registered on or before 1st April, 2011, he/she has already applied for revalidation and has already passed/already appeared / will be appearing in 12th class examination in April/May, 2014 and is eligible as per Regulation 25 D(as explained below). The particulars as furnished have been verified by me and found correct with reference to the documents produced before me by the candidate. Date: Place: Signature of Member of ICAI/Head of Educational Institution /Gazzetted Officer Name and membership No.of the Member of ICAI /Head of the Educational Institution /Gazzetted Officer with Seal 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 April, 2014 and if registered on or before 1st April,2011, he should have already 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 equivalent examination in April/May, 2014 will be eligible to appear in CPT exam to be held in June, 2014.