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Application Form for Empanelment as a
Technical Reviewer with the Quality Review Board


1. Applicant's Name:
Title
 First
 Middle
 Last
2. Gender:     
3. Father's/Husband's Name:
4. Date of Birth:     
5. Mailing Address:

City:
State:
Pincode:
6. E-mail Address:
Website:
7. Telephone Number (With STD Code): -
Mobile Number:
8. Fax Number (With STD Code): -
9. Membership Number of ICAI:
(Please enclose self attested photocopy of membership certificate)		 Upload Document :
10. Associate Member Since:
(Please enclose self attested photocopy of necessary certificate issued by the ICAI)		      Upload Document :
11. Fellow Member Since:
(Please enclose self attested photocopy of necessary certificate issued by the ICAI)		      Upload Document :
12. Details of other educational & professional qualifications, if any:
13. Other major achievements, if any (maximum 500 character):
14.
a. Do you possess minimum ten years of post qualification experience as a chartered accountant in the practice of accounting and auditing and be currently active in practice:
b. Have you done course in Ind AS/IFRS or Do you have experience in Ind AS/IFRS:
15. Audit working experience (during last ten financial years):
a. Particulars of the organization working in (starting from last to first):
Firm Details  (Click on the button to add more firms detail)
S.No. FRN No. Firm Name Address Capacity of Working Working Since Firm Constitution Date Number of Partners Number of Paid Chartered Accountants Action (By clicking on Delete button the corresponding firm detail has been deleted)
b. Have you handled as a signing partner/proprietor at least three statutory audit assignments as a Central Statutory Auditor of Banks/Public Limited Companies/Government Companies/Private Limited Companies having annual turnover of rupees fifty crores and above during the last ten financial years; Provided that out of the aforesaid three statutory audit assignments, at least one must be in respect of entities other than Private Limited Companies:
c. If yes, please provide complete year-wise details thereof and attach necessary documentary evidences in support thereof such as self attested photocopies of relevant pages of signed Audit report and Profit & Loss A/c / Income & Expenditure A/c providing turnover details (Kindly give complete details specifying clearly the names of clients, year/s of audit, level of responsibility, turnover, type of audits etc.):
Name of Client Year of Audit Assignment Level of Responsibility Turnover
(in Rs. crores)		 Type of Audits
(Tick appropriate Box)		 Upload Document
(self attested photocopies of relevant pages of signed Audit report and Profit & Loss A/c / Income & Expenditure A/c providing turnover details.)
Statutory Tax Internal/Other
Central Statutory Audit of Banks(In the case of turnover of Central statutory Audit of Banks, the amount of advances of the Bank may be indicated.)
Central Statutory Audit of Companies:
   Public Limited Companies
   Government Companies
   Private Limited Companies
16. Other professional achievements, if any. May also like to give details of position held by you as a Director/Chairman, Audit Committee in a Bank/financial institution/PSU/Company etc. (maximum 500 character):
17. Are you currently a Member of the QRB or ICAI's Central Council/Regional Council/Branch level Management Committee:
If yes, please give details thereof (specifying the exact position and the year for which it is being held):
18. Are you a relative or partner of a current Member of the QRB or ICAI's Central Council/Regional Council/Branch level Management Committee
(The term 'relative' shall have the same meaning as defined u/s 2 (77) of the Companies Act, 2013):
If yes, please give details thereof:
19. Whether any disciplinary proceeding under the Chartered Accountants Act, 1949 pending against you or any disciplinary action under the Chartered Accountants Act, 1949 / penal action under any other law taken/pending against you during last three financial years and/or thereafter?
If yes, please give details thereof:
20. Upload Photograph: (only .jpg,.png)
21. Enter Image Text:
I hereby declare that the information given above is true and correct to the best of my knowledge and belief and that nothing has been concealed therefrom and I am enclosing herewith a declaration of eligibility to act as a Technical Reviewer with the Quality Review Board.


After submission of online application form, you are required to take a printout of the duly filled-up form as submitted and send the same, in hard copy by post/courier/by hand, alongwith all the necessary enclosures and a photograph to:
The Secretary,
Quality Review Board,
Gr. Floor, Admin. Block,
ICAI Bhawan, A-29, Sector 62,
NOIDA-201309 (U.P.).
For any further clarification/ information, you may contact us at reviews@qrbca.in or call us at 0120-3045983 or visit us at http://www.qrbca.in.