Self Declaration Form to Avail CPE Hours Credit for Unstructured Learning Activities

Self Declaration Form to avail CPE Hours Credit for Unstructured Learning Activities

For the Calendar Year:2014

Name :

Membership No :

Address :

Contact No :
E-mail id :

Details of Unstructured Learning Activities Undergone:-

Type of
ULAs / Particulars / Details
Topic / Date / Requested CPE
Hours
Web- based / (1) Web-based Learning Modules
(2) Viewing of programmes hosted on the web channel of ICAI / Taxation- Income Tax, Vat, Service Tax, Company and other
Audit etc
Through and
Diff. online Groups, websites such as / Whole of the year / 10 Hours
Self-learning / Self-learningModules andCourses
(1)Audiotapes/videotapes.
(2) Correspondence courses.
(3) Computerbasedlearningprogrammes / Taxation- Income Tax, Vat, Service Tax and other Audit etc / Whole of the year
Home study / Reading andIndividual HomeStudy / Taxation- Income Tax, Vat, Service Tax and other Audit etc / Whole of the year
Discussion on
Technical
Issues / Group or BilateralDiscussion onTechnical Issues
Acting as Faculty / Acting as visitingfaculty or guestfaculty at variousUniversities/ManagementInstitutions /Institutions ofNational Importance
Teleconferencing
Programmes / Participant in CPETeleconferencingProgrammes withsupervision of thePOU
Questionnaires/Journals / Providing solutions toquestionnaires /puzzles available on
Web/ProfessionalJournals
Internal Training
Programmes / Internal TrainingProgrammes beingorganised by firms of
CharteredAccountancy withseven or morepartners
Total CPE Hours requested / 10 Hours

Undertaking

I, ______, (name of the Member) hereby declare that I have undergone the unstructuredlearning activities as indicated by me in this form above.

I also confirm that the information given by me for claiming CPE credit hours for eachunstructured activity is correct.

Place : MUMBAI

Date: 31/12/2014 Signature of the Member

Note : Members may annex a separate sheet if the given format is not sufficient forfilling in complete details.