QPRT Application Form 0311
2
ApplicAtion to register As A QuAlified 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 uK t +44 (0)1908 248 038 e [email protected] 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 YYY Y 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 the Rehabilitation o Oenders Act 1974 do not apply in the case o persons seeking to become chartered accountants. QPRTs are required to declare any act or deault likely to bring discredit on themselves, ICAEW, their respective institute or the proession o accountancy, however long ago the oence or circumstances occurred. Oences or circumstances occurring ollowing initial registration should be declared to ICAEW 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 disqualifcation undertaking, 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 inormati on or administr ation, communicat ion and research . To do this we will share your inor mation with ou r student an d district societies a nd with organisations 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 ensure that your privacy rights are still protected. For more inormation about our data protection policy please go to icaew.com/dataprotection © ICAEW LPDDIG9769 03/1 1
Transcript of QPRT Application Form 0311
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 [email protected]
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
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
© ICAEW LPDDIG9769 03/11
