J. B. NAGAR CPE STUDY CIRCLE OF WIRC
(OF THE INSTITUTE OF CHARTERED ACCOUNTANTS OF INDIA)
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609 Sunshine, Above Union Bank of India, Shastri Nagar,
Andheri (West), Mumbai - 400 053 Tel No. 98202 40246
Website: www.jbnagarca.org Email: jbnagarcpe@gmail.com
APPLICATION FORM FOR MEMBERSHIP
(F.Y. 2016 - 2017) New / Renewal
Name : Mr./Ms. ____________________________________________
ICAI M. No. : _________________
Name of the Firm / Company: ______________________________________________________________________
Occupation
: Practice  Service 

Designation: ______________________________________
Address for Correspondence _______________________________________________________________________
_______________________________________________________________________
______________________________________________________________________
Tel.:1)________________ 2)_____________________ Fax: _____________ Mobile: ______________________
E-mail: _____________________________________ Website:________________________________________
Date of Birth: _______/_____/________
Blood Group: __________ Spouse Name: _______________________
Are You Member of C.A. Benevolent Fund : Yes  No  If Yes give your details:_________________________
STUDY CIRCLE MEMBERSHIP FEES
PARTICULARS
FEES UPTO
31/05/2016
FEES AFTER
31/05/2016
MEMBERSHIP FEES
STUDY GROUP 1) Direct Taxes / Allied Laws &
2) Indirect Taxes
ENTRANCE FEES (FOR NEW MEMBERS
ONLY)
CA BENEVOLENT FUND (OPTIONAL)
TOTAL
2,100
1,000
2,200
1,000
0
300
100
3,200
100
3,600
AMOUNT PAID
Would you like to contribute to the following activities of study circle?
 Being a faculty / speaker at study circle Meeting/Conferences/Seminar/Work shop etc.
If Yes: Topic ________________________________________________________________________________
 Being part of the core group, which runs the functioning of Study Circle:
If Yes: How _________________________________________________________________________________
 I agree to received SMS From J. B. Nagar CPE Study Circle.
I agree to be a member of the Study Circle and enclosing herewith cash/cheque no. _________dated______________
drawn on _______________________ in favour of “J. B. NAGAR CPE STUDY CIRCLE OF WIRC” for Rs. ______
Date : ____________
_______________________
Signature of Applicant