Application Form

1. Name and Address
Name of the auditor/ audit firm
Contact person
Address
Phone number
Fax number
E-mail
Website
2. Registration
Date and place of registration
License (type and no.
3. Partners
Names of partners/shareholders
Number of partners with national audit license
4. Employees
Number of employees with audit license
Number of employees with MBA
Number of employees with BA
Other employees
Total number of employees
5. Services
Which kind of services do you provide?
To which type of clients do you mainly provide your services?
Big companies?	Sector?
Small and medium-sized enterprises?	Sector?
Individuals?	Sector?
Non-profit organisations?	Sector?
Government agencies?	Sector?
What do your clients appreciate most in your services?
6. Quality Policy
Do you have regular peer audits?	SelectYesNo
Is there a requirement for continuous professional education?	SelectYesNo
How do you internally ensure the quality of your audits?
7. Membership
Are you a member of a national professional body?	SelectYesNo	Which one?
Are you a member of an international network? Which one?	SelectYesNo	Which one?
8. International Experience
Which languages are spoken by your partners/ employees?
Have you already had assignments in other countries?	SelectYesNo	Which countries?
9. EMPACTA
How did you learn about EMPACTA?
Which benefit do you expect from your membership in EMPACTA?
Please provide the following annexes, if available:
copy of registration
copy of license
last peer audit report
copy of membership document (in professional body or network)
Yes I declare that I have read and that I acknowledge the mission statement of EMPACTA.
Place, date
Electronic Signature (enter your full name)