FORMAT FOR APPOINTMENT OF AUTHORISED REPRESENTATIVES

                                    ELECTIONS - 2015

The Polling Officer,
Polling Booth No. _______
______________________

______________________

Dear Sir,

              Re:     Appointment of Authorised Representatives:

       I am a candidate for election to the Central Council/__________ India Regional
Council of the Institute of Chartered Accountants of India from ____________ India
Regional Constituency.






        In terms of the provisions of sub-rule (2) of rule 26 of the Chartered Accountants
(Election to the Council) Rules, 2006, read with sub-regulation (10) of regulation 134 of the
Chartered Accountants Regulations, 1988, I hereby appoint the following two members of
the Institute as my authorized representatives to remain present at your polling booth. It is,
however, understood that only one of them shall be entitled to be present at any given time
on my behalf.

Sl.     Full Name of the        Membership          Full Professional       Mobile    E-mail
No.        Authorized              No.                   Address            Number      Id
         Representative
1.









2.



                                                                                Yours faithfully


                                                               (Signature of the Candidate)
Place: ________________                Full Name ____________________________________
Date : ________________                              Membership No. ___________________


                  Signature(s) of the Authorised Representative(s):

                        1.___________________________________

                       2. ___________________________________


                            ---------------------------------------------
                               Signature of the Candidate: