QAM Form Re-categorization

FORM F002 ANNUAL FIRM LICENCE RENEWAL FORM (2022)

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Dear Practitioner,

Kindly read the following carefully before completing the 2022 Firm re-profiling and re-categorisation form

1. Completion of this form is mandatory for all firms.

2. After completing and submitting the form you will receive an email (in the email address you indicated on the form)

3. The email will indicate your Firm's category and the applicable fee and serves as the invoice to be used to pay your 2022 Firm licence renewal fees.

4. Please note that the deadline for submission of the completed form is 31st December 2021.

5. Firms that fail to meet the 31st December deadline will be sanctioned per ICA Act 2020, Act 1058.

RENEWAL OF FIRM LICENCE

Does the firm intend to renew its licence for the year 2022?*

Yes

Name of Firm*

Firm's Licensed Number*

Firm's Tax Payer Identification Number (TIN)*

Name of Managing Partner/Practitioner*

Email Address of Managing Partner/Practitioner*

Telephone number of Managing Partner/Practitioner*

Name of other Partners (Where Applicable)

Email Addresses & Telephone numbers of other Partners

State the Reason/s for non-renewal*

How will the existing clients be catted for?*

Please note that you cannot sign any financial statements for the period of non-renewal of your firm's licence. The firm will be sanctioned per ICA Act 2020, (Act 1058) if it is found out that it has signed financial statements or conducted any business in the name of the firm. In any year that the firm wishes to renew its licence, the Institute should be formally notified in December, prior to the year of renewal.

Declartion*

I declare that the information provided above is true and complete to the best of my knowledge

Signed (Intitials):*

Designation: (Managing Partner/Practitioner)*

Name:*

Date:*

Please Provide Your Practice Firm Details

Name of Firm*

Firm's Licensed Number*

Firm's Tax Payer Identification Number (TIN)*

Attach a scanned copy of the Firm's Tax Clearance Certificate (30th September)

Upload

Attach Firms Current Professional Indemnity Issurance

Upload

Firm's Physical Locational Address*

Firm's Digital/GPS Address*

Firm's Email Address (Primary for receipt of invoice)*

Firm's Email Address (Secondary)

Firm's Active Telephone numbers: mobile*

Firm's Active telephone numbers: landline (where applicable)

Does the Firm have a Branch?*

Yes

If yes, please provide branch's postal, physical and digital/GPS address*

Does the Firm has international affiliation/collaboration?*

Yes

If yes, please provide name of affiliate, country of residence, key contact*

DETAILS OF MANAGING PRACTITIONER / PARTNERS

Name of Managing Practitioner / Managing Partner*

Email of Managing Practitioner / Managing Partner*

Telephone Number of Managing Practitioner / Managing Partner*

Number of Partners

Name of Partner 1

Email Address Partner 1

Phone Number Partner 1

Name of Partner 2

Email Address Partner 2

Phone Number Partner 2

Name of Partner 3

Email Address Partner 3

Phone Number Partner 3

Name of Partner 4

Email Address Partner 4

Phone Number Partner 4

Name of Partner 5

Email Address Partner 5

Phone Number Partner 5

Please attach details of other partners if there are more

Upload

STAFFING

Total Number of Staff*

Number of Qualified Staff*

Number of Non-Qualified Staff*

Number of Permanent Staff*

Number of Non-Permanent Staff*

EARNINGS PROFILE

Total Number of Clients*

Number of Audit Client*

Number of Non-Audit Clients*

Number of Public Interest (PIE) Clients*

Total Actual Firm Income/Revenue for 2020*

Audit Income GHS*

Non-Audit Income GHS*

Total Firm Income/Revenue for 2021 (estimated as the year has not ended)*

Annual Turnover*

Category*

Fee*

Audit Income GHS*

Non-Audit Income GHS*

Any Revelant Significant Change in the Practice (change in location, partnership structure, inactive/resigned/joined partners etc.)

Declaration*

I declare that the information provided above is true and complete to the best of my knowledge

Consent of Disclosure of Firm Information

To ensure the Institute achieves its objective of ensuring high standards are maintained within the accountancy profession and to gain public and investors' confidence in the services rendered by practitioners and practicing firms, we shall make limited information about your firm and its partners to the public and other public institutions for that purpose.

In compliance with International Federation of Accountants (IFAC) Statement of Members Obligation (SMO) 1, I will avail my firm at all times for ICAG Quality Assurance Inspection.

Signed (Initials):*

Designation: (Managing Partner/Managing Practitioner)*

Name:*

Date:*

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FORM F002 ANNUAL FIRM LICENCE RENEWAL FORM (2022)

RENEWAL OF FIRM LICENCE

Please Provide Your Practice Firm Details

DETAILS OF MANAGING PRACTITIONER / PARTNERS

STAFFING

EARNINGS PROFILE

Consent of Disclosure of Firm Information

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