CISA Certification Application

Applicants who Passed CISA Exam June 2019 and Later

Please use Adobe Reader when filling out this application electronically.

APPLICANT INFORMATION

FULL NAME: Ahamed Ali Gadi ISACA ID: 1509813

EMAIL: [email protected] PHONE NUMBER: +965-97273724

STEP 1. PASS EXAM

CISA applicants are required to have passed the CISA exam in the last five years. If you have not yet passed the CISA exam,
you can register online at: https://www.isaca.org/credentialing/cisa#register.
EXAM PASS YEAR: 2023

STEP 2. SUBMIT CISA WORK EXPERIENCE

To qualify for CISA, you must have five years of information systems auditing, control, assurance or security work experience
within the past ten years of the application submission date. This experience must be in at least one CISA Job Practice
Domain Area, available to view on page V-2. If you do not meet the five-year experience requirements within Section 2A, you
may also opt to submit waivers for experience in section 2B and/or 2C (up to a maximum of three years).

SECTION A: RISK AND INFORMATION SYSTEMS CONTROL EXPERIENCE (required)

Please list related work experience you are claiming below, beginning with your current or most recent position. Do not leave
dates blank. If you are currently employed, please write today’s date for the End Date.

Dates of Employment Duration of Experience CISA Domains

(MM/YY) performing CISA tasks (check all that apply)
3. Information 4. Information
1. Information
2. Governance Systems Systems 5. Protection
Systems
Company Name Start Date End Date Years Months & Management Acquisition, Operations of Information
Auditing
of IT Development & & Business Assets
Process
Implementation Resilience
1 NBK,Kuwait 10/19 09/23 3 11
2 KBM,Kuwait 06/13 10/19 6 4
3

(minimum 2 years required) SECTION A EXPERIENCE IN YEARS: 10

SECTION B: GENERAL WORK EXPERIENCE WAIVER (optional)

To apply for a waiver in general information systems or general audit work, please fill out the details below. Must be minimum one
year to qualify. This experience can not have been earned during dates of employment already claimed in Section A.

Type of Experience Waiver (Select one if applicable) General Audit General Information Systems

COMPANY: START DATE: END DATE:

(maximum 1 year) SECTION B EXPERIENCE IN YEARS:

PAGE A-1
Version V5-0723
 CISA Certification Application
Applicants who Passed CISA Exam June 2019 and Later
Please use Adobe Reader when filling out this application electronically.

SECTION C: EDUCATION EXPERIENCE WAIVER (optional)

To apply for an education experience waiver, check the appropriate box below and enter the school information, if applicable.
*Attach a copy of your degree, transcript or letter from your college or university with the application.
**Attach a copy of your CIMA or ACCA certificate with the application.
1-year waiver for an associate degree
2-year waiver for a bachelor’s, master’s or doctorate degree in any field of study
3-year waiver for a master’s degree in Information Systems or a related field*
2-year waiver for CIMA – Chartered Institute of Management Accountants, full certification**
2-year waiver for ACCA member status from the Association of Chartered Certified Accountants**

SCHOOL NAME: FIELD OF STUDY:

(maximum 3 years) SECTION C EXPERIENCE IN YEARS:

SECTION D: EXPERIENCE TOTAL

Total experience from Sections A, B & C must be five years or more to apply for CISA certification

(Section A + Section B + Section C) TOTAL EXPERIENCE IN YEARS: 10

STEP 3: VERIFY CISA WORK EXPERIENCE

Using the Experience Verification Form on pages V-1 and V-2 of this application, please ask an employer to verify all
experience in Step 2. If more than one verifier is needed, you may fill out an additional application form (only pages V-1 and
V-2 are needed from the additional form).

STEP 4: SUBMIT APPLICATION PAYMENT

All applicants must pay a US $50.00 Application Processing Fee before the application can be fully processed. Submit your
payment at: www.isaca.org/credentialing/cisa/verify-application-fee

PAGE A-2
Version V5-0723
 CISA Certification Application
Applicants who Passed CISA Exam June 2019 and Later
Please use Adobe Reader when filling out this application electronically.

STEP 5. REVIEW AND SIGN TERMS & CONDITIONS AGREEMENT

Continuing Professional Education (CPE) Policy 3rd Party Information Sharing

I hereby apply to ISACA for the Certified in the Governance I acknowledge that if I am granted the Certification, my
of Enterprise IT (CISA) certification in accordance with and certification status will become public, and may be disclosed
subject to the procedures and policies of ISACA. I have read by ISACA to third parties who inquire. If my application is not
and agree to the conditions set forth in the Application for approved, I understand that I am able to appeal the decision
Certification and the Continuing Professional Education (CPE) by contacting ISACA. Appeals undertaken by a Certification
Policy in effect at the time of my application, covering the exam taker, Certification applicant or by a certified individual
Certification process and CPE policy. are undertaken at the discretion and cost of the examinee or
applicant. By signing below, I authorize ISACA to disclose my
Code of Ethics Certification status. This contact information will be used to
I agree: to provide proof of meeting the eligibility requirements; fulfill my Certification inquiries and requests.
to permit ISACA to ask for clarification or further verification
of all information submitted pursuant to the Application, Contact Policy
including but not limited to directly contacting any verifying By signing below, I authorize ISACA to contact me at the
professional to confirm the information submitted; to comply address and numbers provided and that the information I
with the requirements to attain and maintain the certification, provided is my own and is accurate. I authorize ISACA to
including eligibility requirements carrying out the tasks of a release confidential Certification application and certification
CISA, compliance with ISACA’s Code of Ethics, standards, information if required by law or as described in ISACA’s
and policies and the fulfillment of renewal requirements; to Privacy Policy. To learn more about how we use the information
notify the ISACA certification department promptly if I am you have provided on this form, please read our Privacy Notice,
unable to comply with the certification requirements; to carry available at https://www.isaca.org/privacy-notice.
out the tasks of a CISA; to make claims regarding certification
only with respect to the scope for which certification has been Usage Agreement
granted; and not use the CISA certificate or logos or marks in a I hereby agree to hold ISACA, its officers, directors, examiners,
misleading manner or contrary to ISACA guidelines. employees, agents and those of its supporting organizations
harmless from any complaint, claim, or damage arising out of
Truth in Information any action or omission by any of them in connection with this
I understand and agree that my Certification application will application; the application process; the failure to issue me any
be denied and any credential granted me by ISACA will be certificate; or any demand for forfeiture or re-delivery of such
revoked and forfeited in the event that any of the statements or certificate. Notwithstanding the above, I understand and agree
answers provided by me in this application are false or in the that any action arising out of, or pertaining to this application
event that I violate any of the examination rules or certification must be brought in the Circuit Court of Cook County, Illinois,
requirements. I understand that all certificates are owned USA, and shall be governed by the laws of the State of Illinois,
by ISACA and if my certificate is granted and then revoked, USA.
I will destroy the certificate, discontinue its use and retract
all claims of my entitlement to the Certification. I authorize
ISACA to make any and all inquiries and investigations it
deems necessary to verify my credentials and my professional
standing.

I understand that the decision as to whether I qualify for certification rests solely and exclusively with ISACA and that
the decision of ISACA is final. I have read and understand these statements and I intend to be legally bound by them.

APPLICANT SIGNATURE: DATE: 20 Sept 2023

A handwritten signature or verifiable digital signature is required.

STEP 6. SUBMIT APPLICATION

Please submit your application and verification form(s) online at: https://isaca.force.com/support/s/application-submission.
Submitted applications take approximately two-to-three weeks to process. Upon approval, you will be notified via email. A
certification packet, including a letter of approval, a CISA Certificate, and a metal CISA pin, will be sent to you via postal mail to
the primary address in your MyISACA Profile at: www.isaca.org/myisaca. Please allow four-to-eight weeks for delivery.

PAGE A-3
Version V5-0723
 CISA Experience Verification Form
Applicants who Passed CISA Exam June 2019 and Later
Please use Adobe Reader when filling out this application electronically.

APPLICANT DETAILS

FULL NAME: Ahamed Ali Gadi ISACA ID: 1509813

FORM INSTRUCTIONS FOR VERIFIER

The applicant (named above) is applying for CISA certification through ISACA. ISACA requires the applicant’s work experience
to be independently verified by a supervisor, manager, colleague or client with whom they have worked. Verifiers cannot be
immediate or extended family, nor can they work in the Human Resources department.
You must attest to the applicant’s work experience as noted on their attached application form (page A-1) and as described by
the CISA Domains and task statements (page V-2).
Please return the form to the applicant for their submission. For any questions, please contact ISACA at
https://support.isaca.org.

VERIFIER INFORMATION

VERIFIER NAME: Islam Said Mohammed

COMPANY NAME: KBM,Kuwait JOB TITLE: Network Support Team Leader
EMAIL: [email protected] PHONE NUMBER: +965-50884889

VERIFIER QUESTIONS

1. I am attesting to the following work experience earned by the applicant, as indicated on page A- (check all that apply):
Section A: Company 1 Section A: Company 3
Section A: Company 2 Section A: Company 4
2. I am attesting to the following waivers as indicated on page A-1, sections B and/or C (check all that apply):
Section B: Work Experience Waiver Section C: Educational Degree
3. I have functioned in the following role(s) to the applicant:
Supervisor Manager
Colleague Client
4. I can also attest that the tasks performed by the applicant, as listed on page A-1 and V-2 of this form, are correct to the best
of my knowledge.
Yes No

VERIFIER AGREEMENT

I hereby confirm that the information on page A-1, V-1 and V-2 is correct to the best of my knowledge and there is no reason
this applicant should not be certified as an information systems auditor. I am also willing, if required, to answer questions from
ISACA about the above information.
VERIFIER SIGNATURE: DATE: 20 Sept 2023
A handwritten signature or verifiable digital signature is required.

PAGE V-1
Version V5-0723
 CISA Experience Verification Form
Applicants who Passed CISA Exam June 2019 and Later
Please use Adobe Reader when filling out this application electronically.

JOB PRACTICE DOMAIN INSTRUCTIONS

Applicant is required to check any domain in which any or all tasks have been completed.

DOMAIN 1. INFORMATION SYSTEM AUDITING PROCESS

Task Statements:
• Plan audit to determine whether information systems are • Conduct audit follow-up to evaluate whether risks have been
protected, controlled, and provide value to the organization. sufficiently addressed.
• Conduct audit in accordance with IS audit standards and a risk- • Utilize data analytics tools to streamline audit processes.
based IS audit strategy. • Provide consulting services and guidance to the organization in
• Communicate audit progress, findings, results, and order to improve the quality and control of information systems.
recommendations to stakeholders.

DOMAIN 2. GOVERNANCE AND MANAGEMENT OF IT

Task Statements:
• Ensure that processes are in place to manage the lifecycle of IT • Ensure the alignment of IT resource management processes with
resources and capabilities. the enterprise’s resources management processes.
• Incorporate sourcing strategies into the framework for the • Ensure that processes are in place for the assessment and
governance of enterprise IT to ensure optimization and control. development of personnel to align with business needs.

DOMAIN 3. INFORMATION SYSTEMS ACQUISITION, DEVELOPMENT AND IMPLEMENTATION

Task Statements:
• Evaluate whether the business case for proposed changes to • Evaluate the readiness of information systems for implementation
information systems meet business objectives. and migration into production.
• Evaluate the organization’s project management policies and • Conduct post-implementation review of systems to determine
practices. whether project deliverables, controls, and requirements are met.
• Evaluate controls at all stages of the information systems
development lifecycle.

DOMAIN 4. INFORMATION SYSTEMS OPERATIONS AND BUSINESS RESILIENCE

Task Statements:
• Evaluate IT operations to determine whether they are controlled • Evaluate change, configuration, release, and patch management
effectively and continue to support the organization’s objectives. policies and practices.
• Evaluate IT maintenance practices to determine whether they are • Evaluate end user computing to determine whether the processes
controlled effectively and continue to support the organization’s are effectively controlled.
objectives. • Evaluate the organization’s ability to continue business operations.
• Evaluate database management practices. • Evaluate policies and practices related to asset lifecycle
• Evaluate data governance policies and practices. management.
• Evaluate problem and incident management policies and
practices.

DOMAIN 5. PROTECTION OF INFORMATION ASSETS

Task Statements:
• Evaluate the organization’s information security and privacy • Evaluate data classification practices for alignment with the
policies and practices. organization’s policies and applicable external requirements.
• Evaluate physical and environmental controls to determine • Perform technical security testing to identify potential threats and
whether information assets are adequately safeguarded. vulnerabilities.
• Evaluate logical security controls to verify the • Evaluate potential opportunities and threats associated with
confidentiality,integrity, and availability of information. emerging technologies, regulations, and industry practices.

PAGE V-2
Version V5-0723