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 | ||