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Form of Application for permission to vote by post
September, 10th 2015
             Last Date for Receipt of Application complete in all respect: 1st October, 2015

     The Institute of Chartered Accountants of India
                                   Form of
                  Application for permission to vote by post
                    [See sub-rule (2) of Rule 28 of the Chartered Accountants
                              (Election to the Council) Rules, 2006 ]

The Returning Officer,
The Institute of Chartered Accountants of India,
ICAI Bhawan,
Indraprastha Marg,
NEW DELHI ­ 110 002:

                                        Sub: Elections 2015
Dear Sir,

       I hereby apply for permission to vote by post under sub-rule (2) of rule 28 of the
Chartered Accountants (Election to the Council) Rules, 2006. I give below the following
information/particulars for your perusal:-

1.          Full Name
            [As published in the List of Voters]

2.          Membership Number

3.          Serial Number in the List of Voters
            (If known)

4.          Address (As published in the List
            of Voters ­ 2015 ­ Copy available
            in the Headquarters of the
            Institute, its Regional Councils and

5.          Polling Booth Number allotted as
            per List of Voters - 2015

6.          Grounds on which permission to
            vote by post is being sought; i.e.

            suffering from    any   permanent
            there has been a        permanent
            change in address;

            if so, whether you are in Service.

            ("Member in Service" under the said
            Rules means, a member of the
            Institute who is employed in an
            organization not being a firm.)

7.   (i)    Name and address of medical
            practitioner holding a position not
            below the rank of a Surgeon in
            Government Hospital together
            with full address of Government

 (ii) (a)   Name, designation and contact
            telephone/mobile number of the
            personnel authorized by the
            Organisation to issue proof of
            permanent change in address.

     (b)    Full address of the organization

8.   (i)    Nature of permanent infirmity:

     (ii)   Date from which suffering from
            permanent infirmity.


      (i)   Reason(s) for permanent change
            in the address, e.g. routine
            transfer, transfer on promotion,
            retirement,      joining   new
            organization and the like.

       (ii)   Date on which permanent change
              in address took place (The date of
              permanent change should be a
              date after 1st April 2015)

    (iii)     Details of change i.e. new address

          In support of my application, I enclose herewith ­

   ·      Medical certificate confirming the above permanent infirmity issued by medical
          practitioner, namely, Dr._________________________________________________
          _________________________________________________(who is not below the
          rank of a Surgeon in a Government Hospital).


   ·      Proof of permanent change in address duly signed by authorized personnel of the
          organization in which I am employed.


Date:                                                                            Signature of the Member


         I declare that the particulars given above are correct to the best of my knowledge
and belief. I am aware that under sub-rule (4) of rule 28 of the said Rules, any misuse of
the above concession or any mis-statement or false verification in this behalf shall attract
disciplinary action against me under the Chartered Accountants Act, 1949 and the rules
framed thereunder.


Date:                                                                            Signature of the Member


   For example in the case of resigning from one organization and joining the other organization,
proofs of date of leaving the old organization and joining the new organization including copy of
appointment letter are required to be submitted.
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