Form A

[See sub-rule (1) of rule 6)] Application for registration as a valuer by an individual To

The Authority [Insert address] From [Name and address] Subject: Application for registration as a valuer Sir/Madam, I, having been enrolled as a member with the (please write the name of the Registered valuers

organisation), hereby apply for registration as a valuer under section 247 of the Companies Act, 2013 read with sub-rule (1) of rule 6 of the Companies (Registered Valuers and Valuation) Rules, 2017 for the following class(es) of assets:- (a)________ (b)________

My details are as under:

A. PERSONAL DETAILS 1. Title (Mr/Mrs/Ms):

2. Name:

3. Father’s Name:

4. Mother’s Name:

5. Date of Birth:

6. PAN No.:

7. AADHAAR No.:

8. Passport No.:

9. Address for Correspondence:

10. Permanent Address:

11. E-Mail Address

12. Mobile No: B. EDUCATIONAL, PROFESSIONAL AND VALUATION EXAMINATION

QUALIFICATIONS 1. Educational Qualifications [Please provide educational qualifications from Bachelor’s degree onwards] Educational

Qualifications Year of

Passing Marks

(Per cent.) Grade/Class University/College Remarks, if any 2. Professional Qualifications [excluding valuation specific courses] Professional

Qualification [excluding valuation specific education/courses] Institute/

Professional Body Membership No.

(if applicable) Date of

enrolment Remarks, if any

3(a) Details of valuation examination passed Date of

examination Asset class, if any Marks secured Percentage 3(b) Valuation Qualifications Valuation specific

qualification/course Recognised Registered

Valuers Organisation Asset

class Membership No.

in Registered Valuers Organisation Remarks, if

any Name Recognition

No C. WORK EXPERIENCE 1. Are you presently in practice / employment? (Yes or No)

2. Number of years in practice or of work experience in the relevant profession or in valuation (in years and months): 3. If in practice, address for professional correspondence: 4. Number of years in employment (in years and months) 5. Experience Details Sl. No. From Date To Date Employment/

Practice If employed, Name of Employer and Designation If in practice, experience in the relevant profession/ valuation Area of work

D. REGISTERED VALUERS ORGANISATION 1. Please give details of the registered valuers organisation of which you are a member.

2. Please state your membership number. E. ADDITIONAL INFORMATION 1. Have you ever been convicted for an offence? Yes or No If yes, please give details.

2. Are any criminal proceedings pending against you? (Yes or No) If yes, please give details. 3. Have you ever been declared as an undischarged bankrupt, or applied to be adjudged as Bankrupt? (Yes or No) If yes, please give details. 4. Please provide any additional information that may be relevant for your application. F. ATTACHMENTS 1. Copy of proof of residence.

2. Copies of documents in support of educational qualifications, professional qualifications and Registered Valuation Examination qualifications. 3. Copies of documents demonstrating practice or work experience for the relevant period. 4. Copies of certificate of employment by the relevant employer(s), specifying the period of such employment. 5. Income Tax Returns for the last three years. 6. Copy of proof of membership with a registered valuers organisation. 7. Passport-size photo. 8. Evidence of deposit/ payment of five thousand rupees. G. AFFIRMATIONS 1. Copies of documents, as listed in section F of this application form have been attached/

uploaded. The documents attached/ uploaded are …… I undertake to furnish any additional information as and when called for.

2. I am not disqualified from being registered as a valuer under the Companies (Registered

Valuers and Valuation) Rules, 2017. 3. This application and the information furnished by me along with this application is true and complete. If found false or misleading at any stage, my registration shall be summarily cancelled. I hereby undertake to comply with the requirements of the Companies Act, 2013, the rules made thereunder, the directions given by the authority, and the bye-laws, directions and guidelines issued or the resolutions passed in accordance with the bye-laws by the registered valuers organisation with which I am enrolled. 4. The applicable fee has been paid.

Name and Signature of applicant Place: Date: VERIFICATION BY THE REGISTERED VALUERS ORGANISATION We have verified the above details submitted by … who is our member with membership no. …

and confirm these to be true and correct. We recommend registration of … as a valuer. (Name and Signature) Authorised Representative of the Registered Valuers Organisation Seal of the Registered Valuers Organisation Place: Date: