STAFF COMPLIANCE CONFIRMATION
CHECKLIST
Statement of Independence
Audit Engagement: Audit of the Financial Statements for the xxxxxxxxx
Name: xxxxxxxxx
ICAI audit regulations require the Office to obtain confirmation from all staff, sub-contractors and
consultants involved in audits that they are independent.
Please complete this form, sign it and return it to HR Team by XXXXXXX
at the latest.
Please let the Senior Manager of Audit know if you have any questions; you will be asked to renew this
statement for every audit. In the meantime, any changes must immediately be notified to the Senior
Manager of Audit.
A. Independence
In accordance with the policy of this office, all partners, professional staff and others involved in or
otherwise connected with audit work must complete and sign a statement of independence.
No. Independence Assertions to be made YES/NO
1. As an auditor of the Office of the Senior Manager of Audit ( M O J) has
there been any contravention of your independence regarding any direct
or material indirect financial interest in the XXXXXX for the period
ended March 31st 2022.
I confirm that with respect to the client audited by the (M O J) I:
Have a beneficial interest
Do not have any beneficial interest
Where the answer is ‘affirmative’, please list below the
investments held.
1-
2-
3-
1
No. Independence Assertions to be made YES/NO
2. As an auditor of the Office of the Senior Manager of Audit (M O J) has
there been any contravention of your independence regarding business
relationships for the period ended March 31, 2022.
Where the answer is ‘positive’ or if there are any exceptions, please list
below the details:
1-
2-
3-
3. As an auditor of the Office of the Senior Manager of Audit (M O J) has
there been any contravention of your independence regarding Loans for
the period ended March 31, 2022.
Where the answer is ‘positive’ or if there are any exceptions, please list
below the details:
1-
2-
3-
4. As an auditor of the Office of the Senior Manager of Audit (M O J) has
there been any contravention of your independence regarding
employment of family members and personal relationships for the period
ended March 31, 2022.
Where the answer is ‘positive’ or if there are any exceptions, please list
below the details:
1-
2-
3-
2
No. Independence Assertions to be made YES/NO
5. As an auditor of the Office of the Senior Manager of Audit (M O J) has
there been any contravention of your independence regarding
employment with audit clients in certain prohibited roles for the
period ended March 31, 2022.
Where the answer is ‘positive’ or if there are any exceptions, please
list below the details:
1-
2-
3-
6. As an auditor of the Office of the Senior Manager of Audit (M O J)has
there been any contravention of your independence regarding recent
service (during the last five years) with audit client for the period
ended March 31, 2022.
Where the answer is ‘positive’ or if there are any exceptions, please
list below the details:
1-
2-
3-
7. As an auditor of the Office of the Director of Audit (ODA) has there
been any contravention of your independence regarding purchase
of goods and services for the period ended March 31, 2022 and
you did not accept any material goods or services on favorable
terms, or received under hospitality from the audit client?
If there are any exceptions, please list below the details:
1-
2-
3-
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*Beneficial interest includes ownership of assets by yourself or a closely connected person. The
ownership may be direct or indirect, for example as a trustee of a trust that has an interest.
The following will normally be regarded as being closely connected with a person:
a) An employee or officer of the company.
b) A person who is a partner or who is in employment of an officer or employee of the company.
c) A person who or his relative or partner is having interest or holding security in a company.
However, a relative can hold security or interest in a company not exceeding the face value of Rs.
1,000 or Rs. 1,00,000 as prescribed by the rules. In case the amount of security or interest held by a
relative exceeds the threshold limits, a corrective action shall be taken by the auditor to maintain
the limits, within 60 days from the date of such acquisition or interest.
d) A person who or his relative or partner has indebted to a company or its holding or its subsidiary or
an associate company or a subsidiary of such holding company for an amount exceeding Rs.
5,00,000.
e) A person who or his relative or partner has given guarantee to the indebtedness of any third party
to the company or its holding or its subsidiary or an associate company or a subsidiary of such
holding company for an amount exceeding Rs. 1,00,000.
f) A person or a firm who, whether directly or indirectly has any business relationship with the
company or its holding or its subsidiary or an associate company or a subsidiary of such holding
company.
In all considerations of the independence of a person or firm, regard must be given to the
substances of a relationship. The above list is not, therefore, exhaustive.
B. Confirmation
I have answered the questions above truthfully and honestly, to the best of my knowledge and belief.
Should any of the circumstances above change, I shall inform the Senior Manager of Audit
immediately.
Signed ………………………………………. Date ………………………..
(employee)
4
C. Review
I have considered the answers given on the staff Independence checklist. I am satisfied that the above
person is eligible to carry out audit work for the Office.
Signed ………………………………………. Date …………………………
