Empanelment Form for ICAI Examination - January 2025
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1
Member Information
2
Declaration
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Membership No.
Date of Birth
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Personal Information
Member Name *
Date of Birth*
Date of Enrollment *
Address *
Region *
State *
City *
Pin Code *
Mobile 1: (self) *
Mobile 2: (Optional) (self) *
E-mail ID: (self) *
E-mail ID - 2: (Optional) self
Phone (Office with Std Code)
Phone (Residence with Std Code)
GST (Optional)
Select duty Slot
All Exam Days
Exam Days - Group I
Exam Days - Group II
Select Zone Preferences *
Areas:
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Upload Photograph and Signature
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Signature (upto 50KB)*
Account Information
Name of the Bank *
Bank Branch with Address *
Account Number *
Account Type
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Current
IFSC CODE *
PAN NO. *
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I hereby declare that;
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Eligibility Criteria for ICAI Examination January 2025
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