Form 1 As Per ICAI PRB
Form 1 As Per ICAI PRB
APPLICATION
Dear Sir,
(ii) Voluntarily:
3. I/We hereby declare that my/our firm has signed reports pertaining to
the following assurance services during the period under review:
4 Tax Audit
5 Concurrent Audit
6 Certification work
Signature
Name of Proprietor/Partner/
individual Practicing in own name:
Date:
Annexure
QUESTIONNAIRE
(PART A - PROFILE OF PRACTICE UNIT (PU)
from: d d m m y y y y To: d d m m y y y y
10. Contact person of PU for Peer Review (along with Mobile No. and
Email id) _________________________________________________
________________________________________________________
________________________________________________________
11. Particulars about the constitution of the PU during the period under
review (as per Form 18 filled with the ICAI). Is there assurance service
like Statutory audit, tax audit, Taxation etc. headed by different
partners, if yes details to be provided in the below table:
Name of Membership Association Any Post Professional Predominant Details of
sole- no. of sole- with Practice Qualification experience in function (e.g. Changes
practitioner/ practitioner/ unit or practice audit, tax,
Joined Left
sole- sole- (in years) Certificate consulting)
(Year) (Year)
proprietor/ proprietor/ course
partner partner pursued
within or
outside ICAI.
15. How is the control procedure followed by the Branch/es. And whether
any periodic sample testing of clients handled by branch/es is done by
HO?
________________________________________________________
________________________________________________________
16. Gross receipts of the Practice Unit [both H.O. and branch(es)] as per
books of accounts from assurance functions for the period under
review. In case of centralized billing the branch turnover may be added
with HO otherwise separate figures (Rs. in Lakhs) to be given:
Financial Year Head Office Branch -- Branch -- Branch --
OR
Total Gross receipts of the Practice Unit [both H.O. and branch(es)] as
per books of accounts for the period under review. In case of
centralized billing the branch turnover may be added with HO
otherwise separate figures (Rs. in Lakhs) to be given:
Financial Year Head Office Branch -- Branch -- Branch --
17. Concentration: Furnish details where professional fees from any client
exceed 15% of the PU’s total gross receipts:
Name or code Type of Service % of PU’s total Financial Year
number of the (Assurance / Non gross receipts
Client Assurance)
20. Whether any Partner/Employee of Practice Unit has been found guilty
by the Disciplinary Committee in the past 3 years in any capacity.
Name of Membership No. Case No. Whether found
Partner/Employee guilty YES/NO
Entities having Net Worth of more than Rs.100 Crores rupees or having turnover of
J
Rs.250 crore or above during the period under review.
J1
J2
J3
K Any other
K1
K2
K3
Name of Proprietor/Partner/ :
individual Practicing in own name:
Stamp of Firm :
Date :