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
Branches)
5. Polling Booth Number allotted as
per List of Voters - 2015
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6. Grounds on which permission to
vote by post is being sought; i.e.
suffering from any permanent
infirmity;
or
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
Hospital.
(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.
Or
(i) Reason(s) for permanent change
in the address, e.g. routine
transfer, transfer on promotion,
retirement, joining new
organization and the like.
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(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).
OR
· Proof of permanent change in address duly signed by authorized personnel of the
organization in which I am employed.
Place:
Date: Signature of the Member
VERIFICATION
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.
Place:
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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