From
______,
Chartered Accountants,
______,
______.
To
The General Manager,
Tamilnad Mercantile Bank Ltd,
Inspection Department,
D.No.196 / A & B, Ettayapuram Road,
Thoothukudi – 628 002.
Dear sir,
Sub: Application for empanelment for concurrent Audit ---2016-17
We are submitting the application for empanelment of our firm for Concurrent Audit in your Bank for following Centers (Please mention the name of state in bracket).
1)
2)
3)
We enclose herewith our firm's profile for your perusal.
Thanking you,
Yours faithfully,
For Chartered Accountants
Proprietor / Partner
Encl: as above
Profile of the Firm for Empanelment for Concurrent Audit
Si.No / Particulars / Details1 / Name of the CA Firm:
2 / Constitution:
3 / Address of Head Office:
4 / Address Of Branch Offices:
5 / Contact Phone Nos.:
(Land Line nos. / Fax no.)
6 / E-Mail Address:
7 / Date Of Establishment:
8 / Centres applied:
Distance of the centre (KM.) from the HO/Branch of the firm to be mentioned in bracket if it is outside the city / local place.
9 / Registration No. of Firm with ICAI:
10 / Unique code No. for Bank Audit:
11 / Details of training attended by the partners / staff in connection with Concurrent audit during:
12 / Whether any disciplinary action by ICAI instituted / pending against any member of the firm (if ‘yes’ give details):
13 / Whether any assignment given by Tamilnad Mercantile Bank Ltd., in past was refused / discontinued / terminated:
14 / Manpower (Nos) / A) Qualified Professionals:
(i) Partner ______
(ii) Others ______
B) Articles: ______
C) Details of other Audit Staff
( including of Ex Bank Officer / Executives) ______
15 / Out of above staff, manpower available for Concurrent Audit
16 / No. of Audit staff having CISA / DISA qualification with names.(including proprietor / partner)
17. Particulars of Individual / Partners / Proprietor:
Si.No / Name / Qualification / ICAI Member-ship No. / Date of Certificate of practice / Whether DISA / CISA / Mobile No. / E -mail
18. Details of Associate Firms, if any, of the Applicant Firm:
Name of Associate Firm / Name of partners / Address / ICAI Member-ship No. / Whether DISA / CISA / Mobile No. / E-mailEXPERIENCE:
19. Experience of Concurrent Audit of Banks including Tamilnad Mercantile Bank Ltd., (In applicant firm’s name):
Name Of the Bank / Name of the Branch / Period20. Details of Current Assignment of Concurrent Audits of Banks on hand (including Tamilnad Mercantile Bank Ltd):
Name Of the Bank / Name of the Branch / Period21. Details of Current Assignment of Concurrent Audits of Banks on hand in the name of associate concerns(including Tamilnad Mercantile Bank Ltd):
Name Of the Bank / Name of the Branch / Period22. Experience of Statutory Audit of Banks (In applicant firm's name):
Name Of the Bank / Name of the Branch / PeriodADDITIONAL INFORMATION
23. If Firm or partners are having any Credit Facilities / stood as a guarantor with Tamilnad Mercantile Bank Ltd., please furnish necessary details indicating nature of the dealings and the name of the Bank’s branch where the account/s is/are maintained:
Name of the partner / Name of Bank’s Branch / Nature of credit Facilities / guarantee / Account No.24. Whether the Firm or any partner has ever been debarred by ICAI / RBI, if yes, details:
Si.No / Name of the partner / Brief reasons for debarment25. Whether any partner is relative of existing staff member of Tamilnad Mercantile Bank Ltd.:
Name of Staff and Designation / Name of the Branch / Relation26. Whether any employee of firm is retired Bank Employee of our Bank / Public Sector Bank:
Name of Employee / Name of Bank / Last Designation / No. of Years of Service / Date of VRS / Superannuation / Branches served during last five years** The employee cannot be deputed for Concurrent Audit of Bank Branches where he has served.
27. Whether any partner is retired officer of Our Bank / Public Sector Bank:
Name of partner / Name of Bank / Departments worked / No. of Years of Service / Date of VRS / Superannuation / Branches served during last -05- years28. If any of the clients is having credit facilities with our Bank, please furnish name of the branches (with details of credit etc.,):
29. Please furnish the name of borrowers of our Branches, where your firm is a statutory Auditor/Internal Auditor:
30. Certificate/s
a) I / We hereby confirm that the Firm / any partner is neither Statutory Auditor nor associate concern (as defined by RBI) of Statutory Auditors of Branches of Tamilnad Mercantile Bank Ltd. and we are not disqualified under any of grounds given in Sec. 226 of the Companies Act, 1956.
b) I / we hereby declare that neither I nor any of our partners/members of my/their families (family will include besides spouse, only children, parents, brothers, sisters or any of them who are wholly or mainly dependent on the Chartered Accountants) or the firm/Company in which I am/they are partners/directors have been declared as willful defaulter by any bank / financial institution.
c) I / We hereby confirm that I / We am / are not disqualified / ineligible for appointment at Concurrent Auditor of any Branch / Office of Bank under Sections 139 to 146 of the Companies Act 2013.
d) I / We confirm that the information furnished here are true to the best of my knowledge.
Place :Date : / Signature