34t5/3ict-3/197/2021/1s y ryx, frhttay,/03/2021
TRANSCRIPT
HT 2511920, $ i 2511918, - [email protected]
34T5/3icT-3/197/2021/1S y Ryx, fRHTTAY,/03/2021
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Chartered Accountant Firms
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A
. AA 2021/1
APPLICATION FOR EMPANELMENT OF CHARTERED ACCOUNTANTS FOR
AUDIT OF COOPERATIVE SOCIETIES UNDER SECTION 58 (3) and (4) (11)OF
C.G. COOPERATIVE SOCIETIES ACT, 1960
Application Form No..
EXPRESSION OF INTEREST(Particulars as on 1t January 2021)
Status of Firm Individual/Proprietorship/ Partnership
01 (a Name of the Firm (in Capital letters)
(b-1 Address of the Head office
(Please also give telephone no. and e-mail
Address) ************ *****************************************************************
****"**************°*****.*********************************
(b-2) Address of the Branch office *************************.******************* ** **
(Please also give telephone no. and e-mail
Address) *** *********************************************************************
************************************"*********.**********************"******
(c) PAN NO. of the firm
ICAI Registration No Region Name. .. ...Region Code No. ******* 02. *******.
03.
(a) Date of constitution of the firm ***********************************************. . ... .
(b) Date since the firm has a full time FCA ****************************************************** ***********
04. Full-Time Partners of the firm as on 1.1.2021 (Please fill up Annex A-1)
S.No. Years of continuous association in the firm Number of FCA Number of ACA
(a) Less than one Year
(b) 1 Year or more but less than 5 Years
(c) 5 Years or more but less than 10 Years
(d) 10 Years or more but less than 15 Years
(e) 16 Years or more
05. Number of Part Time Partners if any, as on 1.1.2021 *********"****
(Please fill up Annex A-2)
06 Number of Full Time Chartered Accountant Employees . *.************************* **
(As on 01-01-2021) (Please fill up Annex A-3)
T.y. iA 2021/12
07. Number of full- time audit staff employed with the firm
(a) Articleship/ Audit Clerk s *************************' **********'
Other Audit Staff (with knowledge of book
Keeping and accountancy) Other Proffessional Staff (Please specify)
(b **************'***'®*******°**°*'************
(c) **********°** ****** ****.********************s**
08. Number of Branches (Please fill up Annex -B) ******************** ****' *********************.
Yes/No Whether the firm is engaged in any Internal/ Concurrent audit / Statutory Audit of any Co-operative Society in Chhattisgarh State. If Yes, details may be given Annexure C
09
Yes/No Whether the firm is engaged in any Internal/ Concurrent audit/ Statutory Audit of any Govt. Companies /
Corporations/Bank's etc. If Yes, details may be given Annexure 'D'
10.
11. Whether there are any court/ arbitration / any other legal cases against
the firm (lf yes, give a brief note of the case indicating its present status) Yes/ No
*** ******************************************************************************************************|
*************e*** *****************n********************.****°**********************************""* **********'
**********************************.**************************e********************** ********************** *****************
12. Any other information can be mentioned as per Annexure 'E
Enclosed 1. Annexure A-1 (Details of Full Time Partners of the firm)
2. Annexure A-2 (Details of Part- Time Partners of the firm)
3. Annexure A-3 (Details of full time Chartered Accountant Employees)
4. Annexure B (Particulars of Branch)
5. Annexure C (Details of Internal audit work/ Statutory audit /Concurrent Audit of
Co-operative Societies undertaken by the firm)
6. Annexure D (Details of Internal audit work/ Statutory audit /Concurrent Audit of any
Government Companies/ Corporations/ Banks, etc undertaken by the firm) 7. Annexure E (Other Information)
8. Annexure F (Signed and certified copy of Terms and conditions for Empanelment)
9. Appendix A (ffne-s) (Qualification & Experience of the Auditor and Auditing firm)
10. Appendix C (RfRIE-7) (Detailed terms and conditions of audit)
**************************************** Name), the authorized partner of the ********* *********************** *** (Name of Firm)
Certify that the information provided in this application form and attached with this application is Correct
and true to the best of my knowledge.
Authorized Signature with Seal ***********************
Name of Partner **********s** ***
For and on behalf .. ********************
(Name of the firm)
g. Yaa 2021/13
Annexure A-1 1. Firm's name. **** ********************
Details of Full Time Partners/ of the firm **************************************°********* ************ ************** **°"
(Please refer to SI. No. 4 of the Expression of Interest format)
S.No Name Member- Whether Date Whether has of Date of Station Whether
becoming & Region
of the ship No. FCA/ Joining acknowledgement DISA
ACA the firm FCA of Income Tax (Information Partner
(full time) where Return for the systems Audit
residing relevant Year CISA Or any
at Attached other
present Yes /No equivalent
qualification
(specify the
qualification)
Annexure A-2 Details of Part - Time Partners of the firm
(Please refer to SI. NO. 5 of the Expression of Interest format)
of No. Name of Member
partners ship No. ther Whe Date Date of Wheth Whether Whether has DiISA
of Joining other employed (Information systems er
FCA becom partnersh firm in practic elsewhere Audit CISA or any
ing ip which he ing in (Y/N) other equivalent ACA FCA is his qualification (specify
the qualification) * If yes, please attach a
partner own
name
also copy of the certificate
(Y/N)
F T 2021/14
Annexure A-3 Details of full time Chartered Accountant Employees
(Please refer to Sl. No. 6 of the Expression of Interest format) Membership Whether FCA Date of Joining Whether has DISA (Information
systems Audit CISA or any
S.NO. Name
NO. ACA the firm as full
time employee other equivalent qualification *If
yes, please attach a copy of the
(specify certificate the
qualification)
(Annex B) Particulars of Branch (including foreign branches, if any)
(Please refer to SI. No. 8 of the Expression of Interest format) Complete S. Station address Name of the Date of Region Whether included
NO. at which with PIN Code & partner in opening in last year
located Telephone No. charge of the of the application yes branch branch /No)
Annexure C) Details of Internal audit work/ Statutory audit /Concurrent Audit of Co-operative Societies undertaken by the firm.
(please refer to Sl. No. 9 of the Expression of Interest format) Name of the Co-operative Societies Nature S. NO. of Year for which appointed
assignment
Fit . a 2021/15
(Annexure D)
Details of Internal audit work/Statutory audit /Concurrent Audit of any Government Companies/
Corporations/ Banks, etc undertaken by the firm. (please refer to SI. No. 10 of the Expression of Interest format)
of the govt. Nature of Year for which appointed S. NO. Name
Companies/Corporations/ Bank etc. assignment
(Annexure E) Any other information
S. NO. Particular Remark
---- --
T.Y. ïHA 2021/16
NOTES - (Annexure F)
1. The Chartered Accountant Firms must be registered with ICAI, New Delhi and registration
letter from the Institute shall be attached.
In case of Partnership firm, partnership deed must be attached.
Certified copy of DISA (Diploma in Information System Audit) certificate should be
2 3.
attached. Copy of experience/ appointment letter should be attached with respect to annexure C & D.
The applicant shall ensure that the Chartered Accountant's associated with such firm are not
associated with other firms.
The following changes in the particulars if any should be intimated (within 30 days by
Registered post or by hand) to this office:- i) There is a reduction in the number of full time Partners or part time Partners or paid
Chartered Accountants employed full time with the firm. ii) The firm is left without any FCA. The pro-forma should be signed by a full time Partner on behalf of the firm.
Any change in the information given in the form should immediately be intimated to
6.
7. 8.
this Office.
If any information the candidate wishes to furnish, he/she or the firm may do on a separate
annexure Enclosed with the application form. (Annexure E)
The fim should not have any disciplinary action initiated by ICAI or any other concerned
relevant authority.
Qualification & Experience of the Auditor and Auditing firm are enclosed as per appendix "A" (ufRfrE-3)
9.
10.
11.
Detailed terms and conditions of audit are enclosed as per appendix "C" (ufRATE-T) and it is
mandatory to follow the terms and conditions mentioned in appendix "C"
The Expression of Interest must be received by Email ([email protected])
along with delivered by post or by hand in a sealed envelope which must be addressed to
12
13
The Registrar.
Co-operative Societies Chhattisgarh
Block "B", Second & Third Floor,
Indravati Bhavan, Nava Raipur, Atal Nagar, Raipur (C.G.).
..(Name), the authorized partner of the
(Name of Firm) Certify that the information provided in this
application form and attached with this application is Correct and true to the best of my knowledge.
Authorized Signature with Seal
Name of Partner
For and on behalf
(Name of the firm)
Ny. ù7a 2021/17
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********************************************* Name), the authorized partner of the
******************** ************* (Name of Firm) Certify that, on behalf of the firm, I accept the
above rules, terms and conditions.
Authorized Signature with Seal
Name of Partner
For and on behalf ***** **
(Name of the firm)
(oftr aTRT 377Hf
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