Application form for Empanelment | Financial Reporting Review Board

ALL FIELDS ARE MANDATORY

1. Full Name

2. Gender

3. Date of Birth

4. Correspondance Address

5. State

6. City

7. Pincode

8. Email Address

9. Mobile No.

10. Alternate Mobile No.

11. Membership No. of ICAI

12. Membership Status

13. Membership Since

14. Region

UNDER POINT NO. 15 TO 19, PLEASE PROVIDE THE DETAILS OF LAST 5 YEARS, i.e. ON OR AFTER APRIL 1, 2021

15. Audit Experience of the applicant: No Yes

Firm Registration No.

Name of audit firm

Designation

Period (From)

Period (To)

Still Working

S.No.	Firm Registration No	Name of audit firm	Designation	Period From	Period To	Action

16. Details of Statutory audits conducted for companies where Ind AS was applicable?

Company Name

Listed on Stock Exchage

Office Type

Financial Year

Nature of Industry

Sub-Category of Industry

Whether you have signed the financial statement of the company Yes No

Brief description of role

upload Independent Auditor's Report

S.No.	Company Name	Listed on Stock Exchage	Office Type	Financial Year	Nature of Industry	Sub Category of Industry	Whether you have signed the financial statement of the company	Brief description of role	Audit Report	Action

17. Details of Ind AS assignments carried out in the form of consultant, preparer, Reviewers etc, not covered in 16 above?

Role

Company Name

Listed on Stock Exchange

Office Type

Financial Year

Nature of Industry

Sub-Category of Industry

Brief description of role

Upload Engagement Letter

S.NO.	Role	Company Name	Listed on Stock Exchange	Office Type	Financial Year	Nature of Industry	Sub-Category of Industry	Brief description of role	Engagement Letter	Action

18. Details of presentation made/ article authored or any other similar experience on Ind AS/ IFRS. (Maximum 5 assignments):

Role

Name of the Event

Name of Organizer

Topic of Presentation

Financial Year

upload image of CPE event detail

S.No.	Name of the Event	Name of Organizer	Topic of Presentation	Financial Year	image of CPE event detail	Topic of Article	Published In	Financial Year	Upload Image of Article	Provide a brief description	Action

19. Details of work in Industry where Ind AS was applicable
No Yes

Designation

Company Name

Listed on Stock Exchage

Nature of Industry

Sub-Category of Industry

Period From

Period To

Still Working

Key Reponsibility Area

S.No.	Designation	Company Name	Listed on Stock Exchage	Nature of Industry	Sub-Category of Industry	Period From	Period To	Key Reponsibility Area	Action

20. Preferred Industry Type (for assigning the reviews of financial statements):

(I) Category:

Sub-Category of Industry

(II) Category:

Sub-Category of Industry

(III) Category:

Sub-Category of Industry

21. Professional Achievements/ Significant contributions (any other):

I hereby declare that

I possess years of post-qualification experience in audit and/or finalization of accounts and am currently engaged in accounting, auditing practice.
I undertake to maintain strict confidentiality of all matters referred to me as well as any other information, papers, documents, etc, received by me during the course of the review, confidential, and shall maintain such confidentiality in relation to the matters of the Board.
I shall not communicate, directly or indirectly, with 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, and shall inform the Financial Reporting Review Board in cases where such conflict exists.
I shall complete my assignments within the prescribed timelines, performing the review to the best of my ability, and affirm that the information provided above is true and complete.

(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, 2013 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)

FINANCIAL REPORTING REVIEW BOARD

ALL FIELDS ARE MANDATORY

UNDER POINT NO. 15 TO 19, PLEASE PROVIDE THE DETAILS OF LAST 5 YEARS, i.e. ON OR AFTER APRIL 1, 2021