UNSTRUCTURED CPE HOUR IN WORD

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	Web-based Learning modules
Self-learning	Self-learning Modules and Courses (1)    Audio-tapes/video-tapes. (2)    Correspondence courses. (3)    Computer based learning programmes
Home study	Reading and Individual Home Study
Discussion on Technical Issues	Group or Bilateral Discussion on Technical Issues

Acting as Faculty	Acting as visiting faculty or guest faculty at various Universities / Management Institutions / Institutions of National Importance
Teleconferencing Programmes	Participation in CPE Teleconferencing Programmes without supervision of the POU
Questionnaires/Journals	Providing solutions to questionnaires / puzzles available on Web / Professional Journals
Internal Training Programmes	Internal Training Programmes being organised by firms of Chartered Accountants with seven or more partners
Total CPE Hours requested

 

Undertaking

I, (              ), hereby declare that I have undergone the unstructured learning activities as indicated by me in this form above.

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

Place:               Kanpur

Signature of the Member

Date:

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

Annexure –A

Home Study- Reading and Individual Home Study

Topic	Date	Requested CPE hours
TOTAL

 

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