Peer Review

QUESTIONNAIRE

PART A - PROFILE OF PRACTICE UNIT (PU)

1. Name of practice unit

2. PU No.

3. Address

4. Status

||Partnership||Proprietorship|||Limited Liability Partnership|||Practicing in Individual Name||

5.|Date of establishment of the PU||||||||||||||||||||||||||||||||||

|||d|||d||m||m||y||y||y||y||||||||||||||

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6.|Firm registration number|||||||||||||||||||||||||||||||||||

|(Membership no., in case of an individual practising in own name)|||||||||||||||

|Period under review1||||||||||||||||||||||||||

7.||From:|d||d||m|m||y||y||y||y|To:|d|d|m|m|y|y|y|y|||

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8. Contact Person for Peer Review

9. Particulars about the constitution of the PU during the period under review (as per Form 18 filled with the ICAI):

|Name of partner|Membership|Association|Professional|Predominant|Details of Changes|

||||no. of|with PU unit|experience|function (eg audit,||||

||||partner|(in years)|in practice|tax, consulting)||Joined|Left|

||||||||||||(Year)|(Year)|

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10.|Particulars of Chartered Accountants Employed|||||||

|Name (s)|||Membership no.||Association with||Experience|

||||||||||the practice unit||(in years)|

||||||||||(in years)||||

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11.|Details of Other Employees||||||||||

|Particulars|||||||Number||||

|(a) Semi-Qualified Assistants||||||||||

|(b)|Articled Assistants|||||||||||

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|(c)|Administrative Staff|||||||||||

|(d)|Others|||||||||||

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1 Refer Para 3.3 of Statement on peer Review (Revised) issued by the Institute

12|If the PU has any branch offices, furnish the following details|||

|S. No|Member in Charge|Membership No||Address|Tick if turnover|

||||||Exceeds|

||||||Rs. 10 Lacs|

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13|Gross receipts of the...