Self-Declaration Form to avail CPE Hours Credit for Unstructured Learning Activities
For the Calendar Year 2014



Membership No.:




Contact No.                           


E-mail id:                              


Details of Unstructured Learning Activities Undergone
Type of ULAs Particulars


Topic Date Requested CPE hours


Web-based Learning modules


Self-learning Modules and Courses

(1)    Audio-tapes/video-tapes.

(2)    Correspondence courses.

(3)    Computer based learning programmes

Home study

Reading and Individual Home Study

Discussion on Technical Issues

Group or Bilateral Discussion on Technical Issues

Acting as Faculty

Acting as visiting faculty or guest faculty at various Universities / Management Institutions / Institutions of National Importance

Teleconferencing Programmes

Participation in CPE Teleconferencing Programmes without supervision of the POU


Providing solutions to questionnaires / puzzles available on Web / Professional Journals

Internal Training Programmes

Internal Training Programmes being organised by firms of Chartered Accountants with seven or more partners
Total CPE Hours requested



I, (              ), hereby declare that I have undergone the unstructured learning activities as indicated by me in this form above.

I also confirm that the information given by me for claiming CPE credit hours for each unstructured activity is correct.

Place:               Kanpur

Signature of the Member


Note:               Members may annex a separate sheet if the given format is not sufficient for filling in complete details.

Annexure –A

Home Study- Reading and Individual Home Study

Topic Date Requested CPE hours


DOWNLOAD unstuctured cpe hour

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