Application form for Empanelment | Financial Reporting Review Board

Membership Number of ICAI

Date of Birth

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Membership Since

Membership Status

Please confirm, have you done course in Ind AS / IFRS or do you have experience in Ind AS / IFRS?
No Yes

Verify your Email ID

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Applicant's Photograph

(size : 100 KB | jpg, jpeg, png)

1. Applicant's Name

Title

Full Name

2. Gender

3. Father's / Husband's Name

4. Mother's Name

5. Date of Birth

6. Correspondance Address

State

City

Pincode

7. Email Address

8. STD Code

Telephone Number 1

Telephone Number 2

Telephone Number 3

9. Mobile No.

Alternate Mobile No.

10 (A). Membership Number of ICAI

10 (B). Membership Status

11. Membership Since

Region

12. Post Qualification Courses pursued (Conducted by ICAI)? No Yes

Course Name

Course Period (From - To)

Date of Certificate

#	Course Name	Course Period	Date of Certificate	Action

13. Certificate Courses pursued (Conducted by ICAI)? No Yes

Select Certificate

Course Period (From - To)

Date of Certificate

#	Certificate Name	Course Period	Date of Certificate	Action

14. Any other Post Qualification or Certificate course pursued outside ICAI with details.

15. Other Academic Qualification

16. Any major distinctions during higher studies

17. Audit Experience of the applicant: (starting from last to first) No Yes

Firm's Name

FRN

Full Address

No. of Partners

Designation

Period (From - To)

Nature of Audit

#	Firm Name	FRN	Full Address	No. of Partners	Designation	Period From - To	Nature of audit i.e Statutory/Internal	Action

18. Whether you are empanelled reviewer of Peer Review Board of ICAI? No Yes

Year of appointment as peer reviewer

Please give brief details of assignments performed as reviewer

19. Whether the firm has been peer reviewed by ICAI? No Yes

Certificate No.

20. Whether you are an empanelled reviewer on Quality Review Board? No Yes

Year of appointment as Quality Reviewer

Please give brief detail of assignments performed as reviewer

21. Whether the firm has been quality reviewed by ICAI? No Yes

Period of the Quality Review

Company for which firm was Quality Reviewed

22. Any experience regarding forensic audit/Information systems Audit or other special audits (specify)

23. Have you done course in Ind AS/ IFRS or do you have experience in Ind AS/ IFRS?
No Yes

Year

Month

uploads Ind AS/ IFRS Certificate

Please give brief detail of assignments performed as reviewer

24. Details of Major Attestation Work handled by the applicant (During last five years)*?
a. IndAS Specific Experience No Yes

Company Name

Company Class

Listed in Stock Exchage

Audit Type

Office Type

Level of Reponsibility

Financial Year

#	Company Name	Company Class	Listed in Stock Exchage	Audit Type	Audit of Head Office/ Branch	Level of Reponsibility	Financial Year	Action

b. Other than IndAS Specific Experience No Yes

Company Name

Company Class

Listed in Stock Exchag

Turnover (In Lakhs)

Total Assests (In Lakhs)

Audit Type

Audit From

Level of Reponsibility

Financial Year

#	Company Name	Class	Stock Exchange	Turnover (In Lakhs)	Total Assets (In Lakhs)	Audit Type	Audit of head office/ branch	Level of Responsibility	Financial Year	Action

25. Industry working Experience: (starting from last to first)? No Yes

Designation

Company Name

Nature of Industry

Period From

Period To

Company Class

Listed in Stock Exchage

Turnover

Gross Assets

Key Reponsibility Area

#	Designation	Company Name	Nature of Industry	Period From	Period To	Company Class	Listed in Stock Exchage	Turnover	Gross Assets	Key Reponsibility Area	Action

26. Professional Achievements/ Significant contributions:

27. Please specify your area of Expertise against the relevant category:

I. Manufacturing and Trading enterprises (Food and Beverages, Textiles, Chemicals, Non-metallic mineral products, Metals and metals products, Machinery, Transport Equipment, Processing, Mining, Plantation, Oil and Gas enterprises etc.) Yes

II. Banking Services Yes

III. Financial Services and Stock Broking Yes

IV. Insurance Services Yes

V. Information Technology, Telecommunication, Media and Entertainment Yes

VI. Service Sector (other than those covered under (II) to (V) above) (including Hotels, Consultancy, Transport, Stock Exchanges, R&D, Hospitals, Retail, Courier etc.) Yes

VII. Infrastructure & Construction sector (including Power generation and supply, Port Trusts, Metro, Roads, and Real Estate etc.) Yes

VIII. Others (any enterprises not covered above) Yes

28. Whether any Disciplinary action initiated and pending against you (referred to Disciplinary Committee/Board for Enquiry)? No Yes

Please give details

29. Please specify your contribution in ICAI

(a) Technical contributions, if any, made including paper presentation, publication of articles/columns, preparation of back ground papers/discussion drafts, etc.

(b) Authorship /Co-authorship

(c) Drafting of Technical Standards for Accounting , Auditing and Internal auditing

(d) Substantive review and redrafting of study materials or new study materials /e-learning modules

(e) CA class room lectures /Virtual classes

(f) Lectures in Seminars, Conferences and workshops/webinars for members

(g) Lectures in students Conferences and workshops

30. Any other association with ICAI? No Yes

Name of the Committee

Period of association

31. Whether member of management committee of any branch or regional? No Yes

Position held

Period

32. Directorship in any enterprise during last five years? No Yes

Name of the enterprise

Period

Nature of Directorship

#	Name of the enterprise	Period	Nature of Directorship	Action

I hereby declare that

I Possess years post qualification experience of audit and / finalisation of accounts working in industry.
I am currently active in the practice of accounting and auditing or I am currently working in industry.
I shall keep all the matters referred to me as well as any other information, papers, documents, etc, received by me during the course of the review, confidential.
I shall not make or cause to be made any communication between myself and the auditor of the enterprise whose financial statements are under review.
I shall consider conflict of interest*, if any, on each occasion I have to conduct a review or am asked to advice on a case.
I shall inform the Chairman of the Financial Reporting Review Board (hereinafter referred to as “the Board”) in case where a conflict of interest exists.
I shall maintain the confidentiality in relation to the matters of the Board.
I shall complete my assignment within the time frame given by the Board.
I shall perform the quality review to the best of my abilities.
The information given above is true and correct and nothing has been concealed therefrom.

(Conflict of interest include following: When you/ your partner/firm has acted in the capacity of statutory auditor/ internal auditor/ tax auditor or have rendered any other professional services as a consultant or otherwise or any of your partner/ close relatives as defined under Companies Act is a Key Managerial Personnel/ Director in such Companies (either the Company or its wholly owned subsidiaries) in the last 5 years at the time of taking the assignment)