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)