FORM NO.

ST-3

APPLICATION FOR REGISTRATION DE NOVO (See Regulation 22)

The application form should be filled in by the candidate in block Letters. Where blocks are provided, each block should contain one character only. A character denotes an alphabet, comma or any other sign. To indicate gap, a block may be left as blank. Please use codes, where required , as given in the code-sheet.

Passport size Photograph To be affixed here

The Secretary & CEO The Institute of Company Secretaries of India C 37, Sector 62, Noida 201309 Ph : 4522072 4522073 E-mail : archana.goel@icsi.edu Sir, I request that I may be registered as a student de novo in accordance with Regulation 22 of the Company Secretaries Regulations, 1982. The required particulars are furnished below:Previous Regn. No. ii) F Surname First & Middle Name

1.

ii) a)

Sex (M/F)

b) b)

Marital Stautus (M/S) Domicile

iii)

a)Nationality
(I-Indian,F-Foreign

Country

d) Religion

(Refer Code list I for Domicile, II for Country and III for Religion) iv) Date of Birth
v) Category Code (Refer code list IV)

vl) a) Complete Postal Address to which communication to be sent:

City State Pin

(Refer code list I for State) Email-ID _____________________ vii) Fee Mode (Refer code list I for State ) Date Amount Mobile No __________________

DD NO./Ack. No./CB/SBS NO.

Bank Code: (Refer Code list XI for Bank Codes) Bank Name

Branch City

i) Regn. Fee ii) Foundation Programme exemption fee iii) Inter/executive Programme exemption fee iv) Paperwise exemption fee v) Difference of P.T. fee vi) Cost of study material vii) viii) Educational Qualification Degree onwards & recognised Professional Qualification Exam Passed Medium of Exam Code Medium

Year

Marks in Aggregate

Maximum Marks

%age Marks

Code

Qualification

'

(Refer code list VI for Medium Code, VII for Qualification Code) ix) Other Professional course/examination which the candidate is pursuing simultaneously

(Refer Code list VIII) (Refer Code list VIII)

x)

Region

Chapter Code

Chapter Name xi) Previous Regn.

No.
(E-Employed,S-Self Employed, N-Not Employed) (Refer Code List IX)

XII) Occupational Status (E/S/N) Occupation code Designation Occupational Address of Candidate

Telephone No. (Off.) Telephone No. (Res.) Telegraphic Address Telex No. Fax No. Annual income xiii) Father/Husband's

Name

Occupation code Designation Office address of Father/Husband :

(Refer code list IX)

Off. Telephone Fax No. Family Income xiv) Particulars of Paperwise exemptions secured under previous registration

Examination Subject Code

Papers ers Subject

Basis asis Code

Syllabus Quali

(Refer Code List X for Subject Code, VII for Qualification Code) xv) Particulars of coaching completion certificate

Examination

Group / Module

CCNo.

Date

xvi) Particulars of Passing groups of Inter/Executive Prgramme/Final/Professional Programme examination under previous registration Examination Group/Module Session Year Roll No.

2. a)

I request that I may be exempted from the following papers of the Intermediate/Executive Programme/Final/Professional Programme on the basis of exemption from individual subjects previously secured by me under my former registration, pursuant to Regulation 42(4)/45(2):

Examination per Subject Code

Paper Subject

Corresponding Paper under Prev. regt.

Basis asis Code Qual.

(Refer code list X for Subject code, VII for Qualification Code) b) I request that I may be exempted from the following papers of the Intermediate/Executive Programme/Final/Professional Programme examination under Regulation 42 (3)/45(1):

Examination apers Code Subject

Papers Subject . Passed Quali. Code

Exam Passed Qualification

Refer Code list X Subject code, VII for Qualification code) 3. I request that I may be supplied with study material for the following subjects of the Intermediate/Executive Programme/Final/Professional Programme examination:

Subject Code

Subject

Issued date (for office use)

Series (for office)

Remarks

(Refer Code list X Subject code.)

4.

I hereby undertake that I shall, as a registered student of the Institute, conduct myself in a manner befitting the ideals and standards of the profession of Company Secretaries generally and as specified by the Council from time to time and shall abide by such regulations, byelaws, rules, standing orders, directions, conditions or guidelines as may be laid down by the Council and made applicable to me from time to time.

Yours faithfully,

Place: Date : Signature

CODE LIST I DOMICILE CODES/STATE CODES MN Manipur MG Meghalaya MZ NG OR PC PB RJ SK TN TR UC UP WB UT Mizoram Nagaland Orissa Pondicherry Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttranchal Uttar Pradesh West Bengal Union Territories

AN AP AS BI CH DE GO GJ HR HP JK JH KR KE MP MH

Arunachal Pradesh Andhra Pradesh Assam Bihar Chattisgarh Delhi Goa Gujrat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra

001 002 003 004 005 006 007 008 010 011 012 013 014 015 016 017 018 019 020

Australia Bahamas Bahrain Bangladesh Bhutan Canada Doha Qatar East Africa India Jamaica Indonesia Japan Kenya Kuwait Malasia Nepal Netherland Nigeria North Ireland

CODE LIST II COUNTRY CODES 021 Pakistan 022 Portugal 023 024 025 026 027 028 029 030 031 032 033 034 035 036 037 099 Saudi Arabia Singapore South Africa Sultanate of Oman Tanzania Thailand U.A.E Uganda United Kingdom (U.K.) United States of America West Africa West Indies Yamen Arab Republic Zambia Zimbabwe Others

01 02 03 04

Hindu Muslim Sikh Christian

CODE LIST - III RELIGION CODES 05 Buddhist 06 Parsi 07 10 Jain Others

01 02 03 04 05

General SC/ST OBC Physically Handicapped Ex-Serviceman

CODE LIST - IV CATEGORY CODES 06 Staff Member 07 Ward of Staff 08 09 10 CODE LIST V FEE MODE CODES Ward of Council Member of ICSI Ward of Member of ICSI Spouse, Blood, First Relation

DD BC BS CA

Demand Draft CashThrough Pay-in-slip of Canara Bank Cash-Through Pay-in-slip of State bank of Saurastra Cash (Through Reception Receipt)

CODE LIST VI

01 02 03 04 05 06 07 08 09 10

English Assamee Bengali Gujrati Hindi Kannada Kashmiri Konkani Malyalam Manipuri

MEDIUM OF EXAM 11 12 13 14 15 16 17 18 19 20

Marathi Nepali Oriya Punjabi Sanskriti Sindhi Tamil Telugu Urdu Others

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38

A.M.I.E B.Com. B.Ed. B.A. (Other than Fine Arts) B.A. (Corporate Secretaryship) B.A. (Hon) B.A. (Vocational) B.A.L. B.B.A. B.B.M. B.B.S. B.C.L. B.Com. (Hon) B.G.L. B.L. B.P.Ed. B.Pharma. B.S.L. B.Sc. B.Sc. (Applied Commerce) B.Sc. (Dairy Tech.) B.Sc. (Eng.) B.Sc. (Hon) B.Tech.

CODE LIST - VII QUALIFICATION CODES (INTER) 39 Diploma in Commerce 40 Diploma in Company Law (Banking Law Practice) 41 Diploma in Law 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 70 90 91 92 99 Diploma in Management Final Pass of ICSA, London Final Pass of ICWAI Final Pass of ICAI I.E.T.E. LL.B. LL.M. M.Ed. M.A. (Corporate Secretaryship) M.A. (Public Administration) M.A. (Other than Fine Arts) M.B.A. M.B.B.S. M.C.S. M.Com. M.D. M.Phil. M.F.A. M.M.S. M.S. M.Sc. M.Tech. Master of Computer Sc. & Application Master of Finance and Control Master of Library Science MBM MSW PGD in Business Admin. PGD in Finance Management PGD in PMIR Others Bachelor of Fine Arts Master of Fine Arts Foundation Passed

Bachelor of Banking & Commerce Bachelor of Computer Sc. & Application Bachelor of Engineering Bachelor of Library Science BAMS Bus. Admin. of IIM,Abad,Blore, Calcutta,Lucknow Business Admin. of Allahabad University Business Management of IMT, Ghaziabad Business Management of XLRI, Jamshedpur Business Management of XISS, Ranchi BV & AH C.F.A CAIIB D.Phil

CODE LIST - VIII CHAPTER CODES

UNDER EIRC
Eastern India Regional Councils (EIRC) office at Kolkata Comprising The States of Arunachal Pradesh, Assam, Bihar ,Jharkhand ,Maghalaya, Manipur,Mizoram, Nagaland, Orissa, Sikkim, Tripura and West Bengal 01 Bhubaneswar 05 Ranchi 02 Guwahati (North East) 06 Dhanbad 03 04 Jamshedpur Patna 07 19 Hooghly Kolkata RO

UNDER NIRC
Northern India Regional Councils (NIRC) office at Delhi Comprising The States of Delhi, Haryana, Himachal Pradesh, Jammu Kashmir, Punjab,Rajasthan, Uttranchal,Uttar Pradesh and the Union Territory of Chandigrah 21 Chandigrah 33 Yamuna Nagar (Satellite) 22 23 24 25 26 27 28 29 30 31 32 Faridabad Ghaziabad Jaipur Kanpur Ludhiana Lucknow Modinagar Shimla Udaipur Noida Meerut (Satellite) 34 35 36 37 38 39 81 82 83 84 85 Agra (Satellite) Allahabad (Satellite) Jodhpur (Satellite) Gurgaon Beawer (Satellite) Delhi - RO Varanasi (Satellite) Bhilwara (Satellite) Bareilly (Satellite) Dehradun (Satellite) Jammu (Satellite)

UNDER SIRC
Southern India Regional Councils (SIRC) office at Chennai Comprising The States of Andhra Pradesh, Karnatka, Kerala, Tamil Nadu, Pondicherry and the Union Territories of Andaman & Nicobar Islands and Lakshadeep 41 Bangalore 51 Mangalore 42 43 44 45 46 48 49 50 Coimbatore Kochi Hyderabad Madurai Mysore Tiruchirapalli Thiruvanathapuram Visakhapatnam 52 53 54 55 56 57 58 59 Pondicherry Kottayam (satellite) Vijayawada (satellite) Thrissur (satellite) Hubli/Dharwad (satellite) Salem (Satellite) Calicut (Satellite) Chennai RO

UNDER WIRC
Western India Regional Councils (WIRC) office at Mumbai Comprising The States of Chattisgarh, Goa, Gujarat, Madhya Pradesh, Maharastra, and the Union Territories of Dadra & Nagar Haveli, Diu & Daman. 61 Ahmedabad 68 Pune 62 63 64 65 66 67 Vadodra Bhopal Dombivli Goa Indore Nagpur 69 70 71 72 73 79 Surat Nashik (Satellite) Raipur (Satellite) Aurangabad (Satellite) Rajkot (Satellite) Mumbai (RO)

Important. If address of a candidate falls at a place where there is no chapter he may indicate code of a nearby chapter for participating in the activities meant for students:

01 02 03 04 05 06 07 21 26

Indian Administrative Services Indian Foreign Services Indian Police Services Indian Audit & Accounts Services

CODE LIST - IX OCCUPATION CODES CENTRAL GOVERNMENT 08 Indian Railway Services 09 Other Civil Services 10 11 12 13 STATE GOVERNMENT Indian Economic Services Company Law Services Indian Legal Services Others

Indian Customs and Central Excise Services Indian Income Tax Services Indian Postal Services State Civil Services Officer

22 27

Others Others

DEFENCE SERVICES
ALL INDIA FINANCIAL INSTITUTIONS/STATE FINANCIAL INSTITUTIONS/STATE INDUSTRIAL DEVELOPMENT CORPORATIONS 31 Chairman/Managing Dir./Chief Executive/ Director 33 Non Executive 32 36 38 40 41 42 46 47 50 51 55 56 60 61 64 65 68 69 72 73 76 78 79 81 82 84 85 86 87 88 89 Executive Chairman/Managing Dir / Chief Executive / Director Non Executive Mayor Commissioner Administrator Chairman/Managing Dir./Chief Executive/ Director Executive Chairman Secretary/Member Chairman/Managing Dir./Chief Executive/ President/Vice President/General Manager Executive Chairman/Managing Dir./Chief Executive/ President/Vice President/General Manager Executive Chairman/Managing Dir./Chief Executive/ President/Vice President/General Manager Executive Research Teaching Medical Para Medical Executive Chairman/Managing Dir./Chief Executive/ Director Executive Chief Executive/Director Executive Not Covered in any above Categories Company Secretary Chartered Accountant Cost & Works Accountant Advocate Management Consultant 90 91 92 93 99 Business Doctor Architect Engineer Unemployed 48 Non Executive 37 Executive

AUTONOMOUS BODIES

LOCAL SELF GOVT./BODIES, MUNICIPAL CORPORATIONS/COMMITTEES

43 44 Executive Others

PUBLIC SECTOR UNDERTAKING

CANTONMENT BOARDS/HOUSING/ELECTRICITY BOARDS

52 53 57 Executive Others Non Executive

BANKING SECTOR

INSURANCE SECTOR
62 Non Executive

FINANCIAL SERVICES SECTOR

66 Non Executive

EDUCATIONAL AND RESEARCH INSTITUTES

70 71 74 75 77 80 Administration Others Administration Others Non Executive Non Executive

HOSPITAL

HOTEL & TRAVEL COOPERATIVE SECTOR

OTHER PRIVATE SECTOR COMPANIES

83 Non Executive

MISCELLANEOUS SELF EMPLOYED

CODE LIST - X SUBJECT CODES

FOUNDATION PROGRAMME
211 212 213 English & Business Communication Economics and Statistics Financial Accounting GROUP II 224 225 226 Company Law Economic and labour Laws Securities Laws & compliances 214 Elements of Business Laws & Management

EXECUTIVE PROGRAMME
MODULE I 221 222 223 General & Commercial Laws Company Accounts and Cost & Management Accounting Tax Laws

FINAL OLD SYLLABUS

GROUP I 131 132 133 137 138 139 231 232 233 234 235 236 237 238 Advanced Company Law & Practice Secretarial Practice relating to Economic Laws and Drafting & Coveyancing Secretarial and Management Audit GROUP II 134 135 136 Financial, Treasury and Forex Management Corporate Restructuring Law & Practice Banking and Insurance-Law & Practice

GROUP-III WTO-International Trade, Joint Ventures and Foreign Collaborations Direct & Indirect Taxation- Law & Practice Human Resource Management and Industrial Relations

PROFESSIONAL PROGRAMME

Module - I COMPANY SECRETARIAL PRACTICE DRAFTING, APPEARANCES AND PLEADINGS Module - II FINANCIAL, TREASURY & FOREX MANAGEMENT CORPORATE RESTRUCTURING & INSOLVENCY Module III STRATEGIC MANAGEMENT, ALLIANCES AND INTERNATIONAL TRADE ADVANCED TAX LAWS AND PRACTICE Module IV DUE DILIGENCE & CORPORATE COMPLIANCE MANAGEMENT GOVERNANCE, BUSINESS ETHICS AND SUSTAINABILITY CODE LIST XI BANK CODES Andhra Bank 25 Vijaya Bank Allahabad Bank ANZ Grindlays Bank Bank of America Bank of India Bank of Baroda Bank of Maharashtra Bank of Tokyo The Bank of Punjab Limited Canara Bank Corporation Bank Citi Bank Dena Bank Honkong & Shanghai Bank Indian Bank Indian Overseas Bank State Bank of India State Bank of Indore State Bank of Travancore State Bank of Bikaner & Jaipur State Bank of Patiala State Bank of Saurashtra Syndicate Bank Punjab National Bank 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 99 Standard Chartered Bank Union Bank of India Punjab & Sind Bank Bank of Rajasthan Vysya Bank United Bank of India United Commercial Bank ABN Amro Bank State Bank of Mysore Oriental Bank of Commerce State Bank of Hyderabad Central Bank of India Karnataka Bank HDFC Bank ICICI Bank UTI Bank Times Bank Deutsche Bank Swan Bank Delhi State Cooperative Bank Vaish Cooperative Bank Bank of Madurai Others

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24