8/2/2019 QPRT Application Form 0311

http://slidepdf.com/reader/full/qprt-application-form-0311 1/1

ApplicAtion to register As AQuAlified person responsible

for trAining (Qprt)

non icAeW members.

Please complete and return this orm to

ta Aha lpd icAeW ma H 321 A ba m K mK9 2fZ uKt +44 (0)1908 248 038 e training@icaew.com

ApplicAtion detAils

mAndAtory declArAtions

Gender Male Female

Preerred title Mr Mrs Miss Dr Pro other 

Name (title/orename/surname) 

Title/position

Date o birth Nationality Designatory letters (eg, FCCA) DD MM YYYY

Proessional body Membership number 

Employer 

Employer address

Postcode/zipcode Country

Telephone

Fax

Email

detAils of nominAted Adviser ( a icAeW )

Name in ull ICAEW membership number 

Please note that the provisions o s4.2 o theRehabilitation o Oenders Act 1974 do not applyin the case o persons seeking to become chartered

accountants.

QPRTs are required to declare any act or deaultlikely to bring discredit on themselves, ICAEW, their respective institute or the proession o accountancy,however long ago the oence or circumstancesoccurred. Oences or circumstances occurring

 ollowing initial registration should be declared toICAEW as soon as is practicably possible. I you are

 ound to have ailed to disclose this inormation your registration may be revoked.

A q w ( a ):• being ound guilty o (or having pleaded guilty to) any criminal oences;

• having been charged with a criminal oence which is as yet to come to

trial;• entering into an Individual Voluntary Arrangement or similar composition

with creditors;

• ailing to satisy a judgement debt;• being the subject o an adverse fning by a proessional body or regulator;

• having had a disqualifcation order made, or having given a disqualifcationundertaking, under the Company Directors Disqualifcation Act 1986, or similar overseas legislation;

• having entered into bankruptcy or being a discharged bankrupt.

I any o the above statements apply to you, or you think that there are similar matters which you should declare, please attach details with your registration.

Do any o the above circumstances (or similar) apply to you? Yes No

 Applicant’s signature Date DD MM YY

u a a. We will treat any personal inormation collected on this orm in accordance with data protection legislation. We will use your inormation or administration, communicat ion and research. To do this we will share your inormation with our student and district societies and withorganisations that help us administer our training and exams. We may transer your inormation outside the European Economic Area (EEA) eg, to one o our ofces. These countries may not have similar data protection laws to the EEA. So, i we do transer your inormation we will take the necessary steps to ensurethat your privacy rights are still protected. For more inormation about our data protection policy please go to

h ttp ://w w w.icaew.com/dataprotection  

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