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CMA BHAWAN, 12 SUDDER STREET, KOLKATA-700016


FORM OF APPLICATION FOR REVALIDATION

To
The Secretary to the Council of
THE INSTITUTE OF COST ACCOUNTANTS OF INDIA
CMA Bhawan, 12, Sudder Street, Kolkata - 700 016

APPLICATION NO. RV0000280


REGISTRATION NO. 11021001606
Sir/Madam,
I beg to apply for Revalidation as a student of the Institute of Cost Accountants of India, The required particulars are furnished below:

Name in Full :

THORAT PRAVIN LAXMAN

Address :

A-1,SHIVRATNA IMAGE DHYARI NARHG ROAD NEAR IARI CO OPP FOHIGH BILLSS

State : MAHARASHTRA
Date of Birth :

City : PUNE

Pin Code : 411041

25/06/1979

Email : tnarat82@gmail.com

Mobile : 8983248638

Group : Group-IV

Institute Name : WESTERN INDIA REGIONAL COUNCIL

Payment Details
Payment Mode

Transaction/Instrument No

Transaction/Instrument Date

Drawn on/Bank

Debit/Credit

94254107

05/08/2015

HDFC

Deposited Branch

Amount
1011

I hereby declare that particulars furnished above are correct and complete to the best of my knowledge.

Place : PUNE

Signature:

Date : 02/05/2014

https://cmaicmai.in/studentfacility/WebPages/Master/Revalidation/RevalidationApplPrint.as... 8/5/2015

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