04/01/2019 ICAI

APPLICATION FOR CHANGE OF EMAIL/MOBILE

Ref. No.: UEM0000072757 Space for official stamp

Date: 04/01/2019
Registration Number: 068906
1. Name in full AJOYDEEP DAS
2. Professional Address H NO 10 BANDHU NIWAS,
GEETA PATH,
LALGANESH,
ODALBAKRA,

City GUWAHATI, ASSAM,INDIA

Pincode 781034
3. Email address AJOYDEEP.DAS@GMAIL.COM
4. Mobile number 9864270510
DECLARATION
1. I hereby declare that all the information above is true to the best of my knowledge.

2. Since we are in the process of digitization and committed to provide paperless and seamless services,
we wish to inform you.
Your updated mobile number and email id will be used for all future correspondence and authentication
purposes as in lieu of your signature, where ever it is required to approve or authenticate any
form/transaction with ICAI.

Date: 04/01/2019
Signature of the Member
EASTERN REGIONAL OFFICE: THE INSTITUTE OF CHARTERED ACCOUNTANTS OF INDIA, ICAI BHAWAN, 7
ANANDILAL PODDAR SARANI (RUSSELL STREET),KOLKATA - 70007, TELEPHONE NOS. 91-33-30211140/41, FAX NO. : 91-
33-22292397

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