APPLICATION FOR APPOINTMENT /ENROLLMENT OF CHARTERED ACCOUNTANT ON THE PANEL OF AUDITOR. To, The Registrar, Cooperative societies, Government of Goa, Mala, Panaji-Goa. Paste coloured photograph (Do not staple) Sir, I/We, the undersigned practicing Chartered Accountant would like to convey my/our willingness to enroll my/our name on the panel of certified Auditors to conduct the Audit of the Mutually aided, Notified and State Aided Cooperative Societies in the State of Goa for the Coop. year 2009-10 & 2010-11 alongwith the arrears if any. The Bio-data and other testimonials are as under:- 2. FIRMS/COMPANY NAME: 3. NAME OF THE PARTERNERS IF ANY? 4. PERMANENT OFFICE ADDRESS WITH PIN CODE AND TELE NO. E-MAIL ID IF ANY:- 5. MOBILE NO. 6. EDUCATIONAL QUALIFICATION:- .2. 7. PERIOD OF ARTICALSHIP:- 8. NAME OF CHARTERED ACCOUNTANT WITH WHOM ARTICALSHIP IS COMPLETED:- 9. DATE SINCE WHEN PRACTICING AS A CHARTERED ACCOUNTANT:- 10. WHETHER ANY COOPERATIVE INSTITUTION AUDITED? a) Name of the Institutions:- PIN E-MAIL TELE 12. REGISTRATION NO. IF ANY 13. PAN NO. IF ANY:- DECLARATION:- 1. I hereby declare that all the statements made in the application are true to the best of my knowledge and belief and the application has been filled up by me. 2. I have never been debarred from the fellow members of the Institute of Chartered Accountants of India. 3. I will abide by the directives /instructions issued by the Registrar and duties and powers of the Auditors as specified under sub-section (1),(2) and (3) of Section 75 of the Goa Cooperative Societies Act, 2001. 4. Any willful misrepresentation of facts and concealment of information will results in the cancellation of my name from the panel of Auditors. 5. The application alongwith duly attested copies of relevant documents such as Educational Qualification, other certificates etc. should reach to the Department, on or before the stipulated date at 'Sahkar Sankul' , 4th & 5th Floor , Patto- Panaji, Goa. I hereby accept all the terms and conditions inserted in the Annexure appended to this application and also paid prescribed fees of Rs.50/- vide Receipt No. ___________ dated___________ . Place:- Date:- (Signature of the Applicant or Authorised person.)
