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Application for Empanelment as Mentor for CA Aspirants
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Applicant's Photograph
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1. Applicant's Name
Full Name
2. Gender
--Select--
Male
Female
3. Date of Birth
4. Correspondance Address
5. State
-- Select State --
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chhattisgarh
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jharkhand
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
Andaman and Nicobar Islands
Chandigarh
Dadra and Nagar Haveli and Daman and Diu
Jammu and Kashmir
Ladakh
Lakshadweep
Puducherry
6. City
7. Pincode
8. Email Address
9. Mobile No.
10. Alternate Mobile No.
11. Membership Number of ICAI
12. Membership Status
13. Membership Since
14. Region
--Select--
CENTRAL
EAST
NORTH
SOUTH
WEST
15. STD Code
16. Telephone Number 1
17. Telephone Number 2
18. Telephone Number 3
19. Post Qualification Courses pursued (Conducted by ICAI)?
No
Yes
Course Name
--Select--
Computer Accounting and Auditing Techniques
Corporate Management Course
Information and Systems Audit
Insurance Risk Management
International Trade Laws and WTO
Management Accountancy Course
SAP FA and MA Module, Microsoft Dynamics NAV
Tax Management Course
Course Period (From - To)
Date of Certificate
+Add
#
Course Name
Course Period
Date of Certificate
Action
20. Certificate Courses pursued (Conducted by ICAI)?
No
Yes
Select Certificate
--Select--
Certificate Course on Business Responsibility and Sustainability Reporting
Certificate Course on Arbitration
Certificate Course on Concurrent Audit of Banks
Certificate Course on Derivatives
Certificate Course on Enterprise Risk Management
Certificate Course on Forensic Accounting and Fraud Detection
Certificate Course on Forex and Treasury Management
Certificate Course on Indian Accounting Standards
Certificate Course on Indirect Taxes
Certificate Course on Internal Audit
Certificate Course on International Financial Reporting Standards
Certificate Course on International Taxation
Certificate Course on Master in Business Finance
Certificate Course on Valuation
Course Period (From - To)
Date of Certificate
+Add
#
Certificate Name
Course Period
Date of Certificate
Action
21. Any other Post Qualification or Certificate course pursued outside ICAI with details.
22. Other Academic Qualification
23. Any major distinctions during higher studies
24. Industry working Experience: (starting from last to first)?
No
Yes
Designation
Company Name
Period From
Period To
+Add
#
Designation
Company Name
Period From
Period To
Action
25. Professional Achievements/ Significant contributions:
26. Any other association with ICAI?
No
Yes
Name of the Committee
Period of association
27. Provide Area where you may guide Students?
Subject specific Guidance
Motivation Guidance
Overall Guidance
Preferred Course of Students to Mentor?
Foundation
Intermediate
Final
Paper-1: Accounting
Paper-2: Business Laws
Paper-3: Quantitative Aptitude
Paper-4: Business Economics
Paper-1: Advanced Accounting
Paper-2: Corporate and Other Laws
Paper-3: Taxation (Section A: Income-tax Law & Section B: Goods and Services Tax)
Paper-4: Cost and Management Accounting
Paper-5: Auditing and Ethics
Paper-6: Financial Management and Strategic Management
Paper-1: Financial Reporting
Paper-2: Advanced Financial Management
Paper-3: Advanced Auditing, Assurance and Professional Ethics
Paper-4: Direct Tax Laws & International Taxation
Paper-5: Indirect Tax Laws
Paper-6: Integrated Business Solutions (Multidisciplinary Case Study with Strategic Management)
28. Mode of Mentorship Preferences?
In-Person Meeting
Online Sessions
Hybrid (Both Online & In-Person)
29. Availability for Mentoring
Weekdays (Mondayā€“Friday)
Weekends (Saturdayā€“Sunday)
30. Whether any Disciplinary action initiated and pending against you (referred to Disciplinary Committee/Board for Enquiry)?
No
Yes
Please give details (if available)
I hereby declare that
I Possess
years post qualification experience of Accounts / Audit / Taxation etc. working in Practice / industry.
I am currently active in the practice/working in Industry.
I shall guide the student to the best of my abilities.
I am not associated with any private coaching classes and will not be associated with private coaching classes.
I shall neither use this opportunity nor shall use this platform for promoting your credentials or that of any other person or institute or classes.
I shall contribute towards building a strong, vibrant, and globally competent accountancy profession by sharing my experience and insights with mentees under the ICAI mentorship framework.
The information given above is true and correct and nothing has been concealed therefrom.
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