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Application form for DIRM Technical Examination - June, 2014
February, 04th 2014
                       The Institute of Chartered Accountants of India
            POST QUALIFICATION COURSE IN INSURANCE AND RISK MANAGEMENT
                                        Technical Examination, June, 2014
                          (Under Regulation 204 of the Chartered Accountants Regulations, 1988)
                                   Last Date : 24th February, 2014 (Without late fee)
Cost of Application Form : Rs100/- 3rd March, 2014 (With late fee of ` 500/-)
            NOTES FOR INFORMATION AND GUIDANCE OF APPLICANTS
                               Candidates are advised to carefully read, understand and follow the

(1)    Dates of Examination               3rd, 5th, 7th and 9th June, 2014
(2)    Timings of Examination             2.00 p.m. to 5.00 p.m. (IST)
(3)    Subject :                          1
       Module - I                         Principles and Practice of Insurance
       Module - II                        Technical Aspects of Insurance
       Module - III                       Risk Management and Reinsurance
       Module - IV                        Business Strategic Planning & Information Technology
(4)    Last date for receipt of              24th February, 2014 (Without late fee)
       application at the Institute's        3rd March, 2014 (With late fee)
       Headquarters at New Delhi.         (Application received after 3rd March, 2014 will not be entertained under any circumstances.
                                          Therefore, candidates sending their application by Post must send the same at least 3-4 days in
                                          advance of the last date and avoid sending it on the last date for receipt of application forms).
(5)    Examination Fee                      1000/- (Rupees One Thousand Only) without Late Fee
       (Note : Candidates are advised       1500/ (Rupees One Thousand Five Hundred Only) with Late Fee
       not to send any fee other than       100/- (Rupees One Hundred Only) extra if the examination form is downloaded
       examination fee along with the     from Institute's website.
       Examination Application Form)
(6)    Mode of Payment of Fee                 The Examination Fee should be paid only by way of Demand Draft which may be of any
                                              Scheduled Bank.
                                              Drawn in favour of "The Secretary, The Institute of Chartered Accountants of India" and
                                              should be payable at New Delhi only.
                                              Candidates are advised to furnish the following details on the reverse of the Demand Draft in
                                              their own interest.
                                                     Name
                                                     IRM Registration No.
                                                     Examination Application form No.
                                                     Centre Opted
(7)    Filling up of Admit Card
                                          the Examination Department alongwith the examination form.
(8)    Examination Centres                1. Agra          27. Bhiwani           53. Guwahati     79. Kollam          105. Palghat             131. Sirsa
                                          2. Ahmedabad     28. Bhopal            54. Gwalior      80. Kota            106. Pali Marwar         132. Sivakasi
                                          3. Ahmednagar    29. Bhubaneswar       55. Hisar        81. Kottayam        107. Panipat             133. Solapur
                                          4. Ajmer         30. Bhuj              56. Hubli        82. Kozhikode       108. Panvel              134. Sonepat
                                          5. Akola         31. Bikaner           57. Hyderabad    83. Kumbakonam      109. Patna               135. Sri Ganganagar
                                          6. Alappuzha     32. Bilaspur          58. Indore       84. Kurnool         110. Patiala             136. Srinagar
                                          7. Aligarh       33. Chandigarh        59. Jabalpur     85. Latur           111. Pimpri-Chinchwad    137. Surat
                                          8. Allahabad     34. Chennai           60. Jaipur       86. Lucknow         112. Pondicherry         138. Surendranagar
                                          9. Alwar         35. Chittorgarh       61. Jalandhar    87. Ludhiana        113. Pune                139. Thane
                                          10. Ambala       36. Coimbatore        62. Jalgaon      88. Madurai         114. Raipur              140. Thiruvananthapuram
                                          11. Amravati     37. Cuttack           63. Jammu        89. Mangalore       115. Rajamahendravaram   141. Thrissur
                                          12. Amritsar                                            90. Mapusa (Goa)    116. Rajkot              142. Tinsukia
                                                           38. Dehradun          64. Jamnagar



                                                                                                                                               143. Tiruchirapalli
                                          13. Anand        39. Delhi/New Delhi   65. Jamshedpur   91. Margao (Goa)    117. Ranchi              144. Tirupati
                                          14. Asansol      40. Dhanbad           66. Jhansi       92. Mathura         118. Ratlam              145. Tirupur
                                          15. Aurangabad   41. Durg              67. Jind         93. Meerut          119. Rewari              146. Tuticorin
                                          16. Bangalore    42. Durgapur          68. Jodhpur      94. Moradabad       120. Rohtak              147. Udaipur
                                          17. Bareilly     43. Ernakulam         69. Jhunjhunu    95. Mumbai          121. Rourkela            148. Udupi
                                          18. Bathinda     44. Erode             70.. Kaithal     96. Muzaffarnagar   122. Saharanpur          149. Ujjain
                                          19. Beawar       45. Faridabad         71. Kakinada     97. Mysore          123. Salem               150. Vadodara
                                          20. Belgaum      46. Fatehabad         72. Kannur       98. Nagpur          124. Sambalpur           151. Vapi
                                          21. Bellary      47. Gandhidham        73. Kanpur       99. Nanded          125. Sangli              152. Varanasi
                                          22. Berhampore   48. Gandhinagar       74. Karnal       100. Nashik         126. Sangrur             153. Vellore
                                          23. Bharuch      49. Ghaziabad         75. Karimnagar   101. Navsari        127. Satara              154. Vijayawada
                                          24 Bharatpur     50. Gorakhpur         76. Kishangarh   102. Nellore        128. Shimla              155. Visakhapatnam
                                          25. Bhavnagar    51. Guntur            77. Kolhapur     103. Neemuch        129. Sikar               156. Warangal
                                          26. Bhilwara     52. Gurgaon           78. Kolkata      104. Noida          130. Siliguri            157. Yamuna Nagar

(9)    How the application form           The application form together with Demand Draft for `1000/- or `1500/-, as the case may be, of
       should reach the Institute?        any Scheduled Bank be sent by Speed Post / Registered Post Only in the special envelope
                                          attached to this Form to the Additional Secretary (Exams.), The Institute of Chartered
                                          Accountants of India, ICAI Bhawan, Indraprastha Marg, New Delhi-110 002.

                                             Candidates are advised not to send the application through courier.

                                             Institute.
(10)                                         A list of candidates eligible to appear for IRM Course Technical Examination June, 2014
                                             will be hosted by the Committee on Banking, Insurance and Pension on the Website of the
                                             Institute www.icai.org


                                             Institute of Chartered Accountants of India, Indraprastha Marg, New Delhi - 110 002 so as to

                                             Candidates may submit the Examination Application Form, pending receipt of Eligibility

Special Note: There will no change in the examination schedule even if any examination day is declared as a Public Holiday
              by Central Government or any State Government.
(11) Admission to the IRM                           No. candidate shall be admitted to the IRM Technical Examination unless
     Technical Examination
                                                    Insurance and Pension of the Institute.

(12) Issue of Admit Card                      (a)     A list of Candidates to whom the Admit Cards have been issued
                                                      for the IRM Course Technical Examination will be hosted on the
                                                       Institute's website www.icai.org. from 5th May, 2014.
                                                      All correspondences in the above matter should be addressed to the
                                                      Additional Secretary (Exams.) of the Institute at New Delhi quoting
                                                      the following for prompt action.
                                                      IRM Regn. No.
                                                      Examination Application Form No.
                                                      Receipt No. Issued (if any)
                                                      Name of the Centre Opted
                                                      Telephone No.
                                                      Fax No.
                                                      E-mail
                                              (b)
                                                      C-1, Sector-1, Noida should be contacted on Fax No. 0120-3054841 and
                                                      3054843.or on E-mail. : irm_examhelpline@icai.in
                                                      Helpline Desk telephone Nos. 0120-3054851, 3054852, 3054853, 3054854
                                                      3054836 and 3054842

(13) Record of answer book tendered                 The Superintendents of Examination Centres are being advised to issue
     at the Examination Centre.                     receipt for the answer books handed over through the Invigilator in the
                                                    Admit Card.

                                                    Candidates are, therefore, advised to secure the signature of the Invigilator
                                                    concerned while submitting their answer books and retain the Admit Card
                                                    with themselves as record of receipt, at least till the declaration of result.

(14) Requirement for passing the IRM                A candidate for the Insurance and Risk Management Technical Examination
     Technical Examination                          shall be declared ordinarily to have passed the examination if he / she secures
                                                    at one sitting a minimum of 40% marks in each of the papers and 50% marks
                                                    in the aggregate of all the papers.

(15) Issue of Statement of Marks                Statement of Marks will be issued to all the candidates who appeared in IRM
                                                Technical Examination normally in two weeks' time from the date of declaration
                                                of result.

(16) Check-list to ensure correctness of
     enclosures to the Application                  giving all the required details and the following enclosures are annexed
                                                    securely.
                                                        Demand Draft for ........................................
                                                        Application Form
                                                        Admit Card with self attested photo
                                                        Self-addressed Envelope for sending
                                                        Admit Card.
                                                        Self addressed envelope for sending
                                                        statement of marks.
                                                        Address Slip

                                                    Before sending the application, candidates are requested to arrange serially
                                                    the pages of application keeping the demand draft, admit card and envelopes
                                                    on the Top of the Bunch.
(17)                                            After declaration of result, a candidate may, if he/she so desires, apply for
                                                verification of his/her answer book(s), necessarily in his/her own handwriting
                                                within one month from the date of declaration of result. The verification fee is
                                                ` 500/-payable by way of a demand draft drawn in favour of Secrectary, The
                                                Institute of Chartered Accountants of India, payable at New Delhi. There is no
                                                standard application form for verification. Typewritten request will not be
                                                entertained.
(18) Refund of fee                              The fee once paid by a candidate shall not be refunded / adjusted under any
                                                circumstances except where a candidate applies to the Additional Secretary
                                                (Exams) for the transfer of fee to the next Examination only, on the ground that
                                                he/she was prevented from attending the Examination on account of
                                                circumstances beyond his/her control and provided that application to this effect
                                                is not received after fifteen days of the date of the Examination.

PLEASE NOTE:
a) Application should be complete in all respects, otherwise it is liable to be rejected.
b) In the event of furnishing any incorrect information / misrepresentation, the admission shall become invalid.
c) No correspondence in this regard shall be entertained.
                     INSURANCE AND RISK MANAGEMENT
                                                                                                                                  Self Attested
                                                                                                                                  Passport Size
Control No.                                                                  Roll No.                                             LATEST
                                                                                                                                  PHOTOGRAPH
                                                                                                                                  to be pasted here.
                                 POST QUALIFICATION COURSE IN                                                                     (Please do not staple)
                 Insurance and Risk Management Technical Examination, June, 2014
                      The Institute of Chartered Accountants of India

I.     DEMAND DRAFT DETAILS
                                          D D MM             YEAR
      1) DATE                                                                                              (Specimen Signature of the Candidate)
      2) AMOUNT (Rupees)                                               Downloaded Form               Without Late Fee                  With Late Fee
      3) DRAWEE BANK
      4) DEMAND DRAFT NO.
      5) PAYABLE AT                       N EW          D E L H I

II.    APPLICANT DETAILS (IN BLOCK LETTERS)
      1) NAME (MR/MS.) :
         (as appearing on

      2) FATHER'S NAME (Shri)

         of Membership) Attach a

      3) CITY OF YOUR PROFESSIONAL ADDRESS

      4) MEMBERSHIP NO.                                                          5) GENDER                     MALE                        FEMALE
      6) IRM REGISTRATION NO.                 D     I   R M        /         /
      7) CENTRE OPTED
                                                                                                                             D D MM                YEAR
      8) ELIGIBILITY CERT. NO.                                                               & DATE OF ISSUE

      9) ADDRESS FOR
         COMMUNICATION
         (IN BLOCK LETTERS)



                       CITY                                                                                    PIN
                                                  STATE
                         TEL. : STD CODE                                         NUMBER
                                                                             MOBILE NO. 0

      10) E-MAIL ADDRESS

         I request for permission to present myself for the Insurance and Risk Management Course Technical Examination to be held in June, 2014
conducted by the Institute of Chartered Accountants of India. I solemnly affirm that the above facts and information are complete and correct to the best of
my knowledge and belief. I also undertake to abide by the Chartered Accountants Regulations, 1988 framed by the Council for the guidance of candidates
appearing for the Insurance and Risk Management Technical Examination.

Encls.: 1. Demand Draft. Yes No
        2. Copy of evidence of membership. Yes                No
        3. Admit Card Proforma. Yes No
        4. Envelope for Admit Card. Yes No                                                                       (Full Signature of Candidate)
        5. Envelope for Statement of Marks. Yes              No
        6. Address slip. Yes No                                                                       Date..........................................   P.T.O.
                              HOW TO FILL-IN FORM

I.    1.   Kindly write the date of issue of demand draft.
      2.   Write amount of fee paid. Please also ( ) the relevant box. (Fee is `1000/- without
           late fee and `1500/- with late fee. Please add `100/- if the form is downloaded
           from the Institute's website).
      3.   Write name of the Bank.
      4.   Write number of the Demand Draft.
      5.   Demand Draft should be drawn in favour of "The Secretary, The Institute of Chartered
           Accountants of India" and payable at New Delhi only.
II.   1.   Kindly write your name exactly as recorded in the Register of Members i.e.
           Membership Certificate..
      2.   Write the name of your father exactly as appearing in the Membership Certificate.
           Married female members are to write Father's Name only.
      3.   Write the name of the place you belong to. The same will appear on the pass
           certificate issued to all the pass candidates.
      4.   Write your membership number. Kindly take special care to write your correct
           membership number.
      5.   Tick the appropriate box.
      6.   Supposing your registration number is DIRM/S/00718, Fill in like :
            D I R M / S / 0 0 7 1 8
      7.   Write the name of a city from amongst the list of centres as given in Col.8 of "Notes
           for Information and Guidance of Applicants: from where you wish to write the IRM
           Technical Examination.
      8.   Write the No. and Date of Eligibility Certificate, as recorded on the Eligibility
           Certificate issued to you by the Committee on Banking, Insurance and Pension.
      9.   Write your complete postal address, very clearly in Capital Letters for mailing Admit
           Card, Pass Certificate, Correspondence, if any.
      10. Write your E-mail address for our records / use.
      11. Write your Phone No. also under your address in column No.9

Enclosures :    Please attach (i) demand draft (ii) copy of evidence of being a member of ICAI
                (iii) Admit card proforma (iv) Envelope for Admit Card (v) Envelope for Statement
                of Marks and (vi) Address Slips.
                Please tick in relevant boxes.
     Address Slip                      Address Slip
(Please fill in Name & Address)   (Please fill in Name & Address)
                 THE INSTITUTE OF CHARTERED ACCOUNTANTS OF INDIA
                                                                (Examination Department)
                                       ICAI Bhawan, Indraprastha Marg, New Delhi - 110 002
                                                                                                                                                      IRM
             LATEST                         ADMIT CARD (DUPLICATE)                                                          Roll No.
             PHOTO                          IRM TECHNICAL EXAMINATION-JUNE, 2014
              ONLY




                                            Name of the Candidate .........................................................................................
 self attested photograph
 which should be pasted in                  Membership No. ...................................................................................................

 this space and not merely                  I.R.M. Regn. No. ..................................................................................................
 stapled.                                   Centre : City : .......................................................................................................
                                            Specimen Signature of the Candidate ..................................................................

                                            Venue of the examination :

Additional Secretary (Exams.)
The Institute of Chartered Accountants of India




                 THE INSTITUTE OF CHARTERED ACCOUNTANTS OF INDIA
                                                                (Examination Department)
                                       ICAI Bhawan, Indraprastha Marg, New Delhi - 110 002
                                                                                                                                                      IRM
             LATEST                         ADMIT CARD                                                                      Roll No.
             PHOTO                          IRM TECHNICAL EXAMINATION-JUNE, 2014
              ONLY

                                            Name of the Candidate .........................................................................................
 self attested photograph
 which should be pasted in                  Membership No. ...................................................................................................

 this space and not merely                  I.R.M. Regn. No. ..................................................................................................
 stapled.                                   Centre : City : .......................................................................................................
                                            Specimen Signature of the Candidate ..................................................................

                                            Venue of the examination :

Additional Secretary (Exams.)
The Institute of Chartered Accountants of India
        Record of Answer Books tendered at the examination centre
 Day & Date of Examination        IRM Technical               Name of the        Signature of the Invigilator in
 Afternoon Session                Examination                 Invigilator        confirmation of receipt of
 (2.00 p.m. to 5.00 p.m.) (IST)   Papers                                         answer book
 Tuesday                          Module-I
 3rd June, 2014                   Principles and Practice
                                  of Insurance
 Thursday                         Module-II
 5th June, 2014                   Technical Aspects of
                                  Insurance
 Saturday                         Module-III
 7th June, 2014                   Risk Management and
                                  Reinsurance
 Monday                           Module-IV
 9th June, 2014                   Business Strategic
                                  Planning & Information
                                  Technology
Special Note: There will be no change in the examination schedule even if any examination day is declared as a Public
              Holiday by Central Government or any State Government.




        Record of Answer Books tendered at the examination centre
 Day & Date of Examination        IRM Technical               Name of the        Signature of the Invigilator in
 Afternoon Session                Examination                 Invigilator        confirmation of receipt of
 (2.00 p.m. to 5.00 p.m.) (IST)   Papers                                         answer book
 Tuesday                          Module-I
 3rd June, 2014                   Principles and Practice
                                  of Insurance
 Thursday                         Module-II
 5th June, 2014                   Technical Aspects of
                                  Insurance
 Saturday                         Module-III
 7th June, 2014                   Risk Management and
                                  Reinsurance
 Monday                           Module-IV
 9th June, 2014                   Business Strategic
                                  Planning & Information
                                  Technology
Special Note: There will be no change in the examination schedule even if any examination day is declared as a Public
              Holiday by Central Government or any State Government.
              Statement of Marks
                                          SPEED POST
                                                           for 39/-
                                                              or
                       IRM                               as applicable
                                                        for speed post
                                                       from New Delhi
                                                         to your place



                                    To




                                              Pin




If undelivered please return to :
The Additional Secretary (Examinations)
The Institute of Chartered Accountants of India
"ICAI Bhawan", Indraprashta Marg
New Delhi - 110 002
                                    SPEED POST
                                                                        for 39/-
 Admit Card - Insurance and Risk Management Technical Examination          or
                             June, 2014                               as applicable
                                                                     for speed post
                                                                    from New Delhi
                                          To                          to your place




                                       City             Pin
                                       State


The Additional Secretary (Examinations)
The Institute of Chartered Accountants of India
"ICAI Bhawan", Indraprashta Marg, New Delhi - 110 002
         SPEED POST / REGISTERED

         To
         The Additional Secretary (Examinations)




   IRM
         The Institute of Chartered Accountants of India
         ICAI Bhawan
         Indraprastha Marg
         New Delhi - 110 002
From :

 
 
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