5054192.pdf
TRANSCRIPT
User Id:
CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.
Personal Details
Name of Candidate:
Father's/Husband's/Guardian'sName :
Mother's Name:
Date of Birth: Candidate Gender:
Category: State/Union Territory of
Caste/Tribe:
Serial Number of caste/Tribe:
Caste/Tribe Name:
Nationality:
Other Nationality:
Person with Disability/DifferentlyAbled (PWD/DA):
PWD/DA Category:
Disability Percentage: Do you require wheelchair
support at the test centre?:
Communication Address
Address :
State/Union Territory: Other State/Union Territory:
Country: Other Country:
City:
Pin Code:
Other Town/City :
Other City With Other Country:
Mobile Number:
Email Address:
Mobile Number (Alternate) :
Email Address (Alternate) :
Exam Centre City Preferences
Preferred City 1:
Preferred City 2:
Preferred City 3:
Preferred City 4
110031
Indian
India
9911908669
Faridabad
Greater Noida
New Delhi
Ghaziabad
No
RAJINDER VERMA
13/Jun/1995
MEENA VERMA
5054192
Male
9999691203
East Delhi
General
DELHI
MUKUL VERMA
48-B STREET NO-10
SHASTRI NAGAR
SAROJINI PARK
Academics Details
SSC/10th Std/Equivalent Details
Aggregate marks:
Month/Year of Completion:
Total Marks Obtained :
Maximum Marks :
SSC/10th Std/Equivalent Board Name
Other Board Name:
HSC/12th/Equivalent/Diploma Course Details
Course Type: Aggregate Marks:
Total Marks Obtained: Maximum Marks:
12th/Equivalent Board Name:
Other Board Name:
Duration of Diploma Course:
University/Board/Other AuthorityName:
Discipline:
Other Discipline Name:
Month/Year of CourseCommencement:
Month/Year of Completion:
Bachelor Degree Details
Are you in the final year of Bachelor Degree?
Have you completed BachelorDegree?
Total Duration of Degree:
Current Semester: Aggregate Marks:
Type of University/Institution:
Other Type of University/ Institution:
State/Union Territory WhereUniversity is Situated:
Other State/UnionTerritory Where University is Situated:
University Name:
Other University Name:
Name Of College:
Degree Name:
Other Degree Name:
Discipline:
Other Discipline Name:
Month/Year of CourseCommencement:
Month/Year of Completion:
Semester-5
Management (Business Administration/Business Management/Business Studies/Management Studies)
600
MAHARAJA AGRASEN INSTITUTE OF MANAGEMENT STUDIES
May
HSC
500
Commerce
Guru Govind Singh Indraprastha
June 2016
3 Year
State University
Others
323
Central Board of Secondary Education
201164.06
Delhi
2013
BBA
65.10
2013
Central Board of Secondary Education
June
May
Yes
405
67.05
Other Professional Degree Details
Are you pursuing or have completed any professional degree, such as, CA/CS/ICWA?
Specify Other ProfessionalDegree:
Professional Inter Marks: Professional Final Marks:
Month/Year of CourseCommencement:
Month/Year of Completion:
Master Degree Details
Do you want to enter MasterDegree Details?
Master Degree Completion Status: Duration:
Current Semester: Aggregate Marks:
Type of University/Institution:Other Type ofUniversity/Institution:
State/Union Territory ofUniversity:
Other State/UnionTerritory of University:
University Name:
Other University Name:
Name of College/Institution:
Degree Name: Other Degree Name:
Discipline:
Other Discipline Name:
Month/Year of CourseCommencement:
Month/Year of Completion:
Work Experience Details
Automobiles/Auto-ancillaries Banking/Financial Services
Durables Engineering/Industrial
Fast Moving Consumer Goods(FMCG)
Information Technology
Pharmaceuticals/Healthcare Retail
Telecommunications
Others1 (Work Area) Others1 (Exp In Month)
Others2 (Work Area) Others2 (Exp In Month)
Others3 (Work Area) Others3 (Exp In Month)
Total Work Experience (In Months)
Recruitment
2
2
No
No
Programme Details
IIM Ahmedabad PGP (Interview City 1)
IIM Ahmedabad PGP (Interview City 2)
IIM Ahmedabad PGP-FABM
IIM Ahmedabad FPM
IIM Amritsar PGP
IIM Bangalore PGP
IIM Bangalore PGP EM
IIM Bangalore PGP PM
IIM Bangalore FPM
IIM Bodh Gaya PGP
IIM Calcutta PGP PGDM
IIM Calcutta FPM
IIM Indore PGP Programme IIM Indore PGP
Mumbai
IIM Indore EPGP
IIM Indore FPM
IIM Kashipur PGP
IIM Kashipur EPGPM
IIM Kashipur EFPM
IIM Kashipur FPM
IIM Kozhikode PGP
IIM Kozhikode FPM
IIM Lucknow PGP
IIM Lucknow PGP ABM
IIM Lucknow PGPSM
IIM Lucknow FPM
IIM Nagpur PGP
IIM Raipur PGP
IIM Raipur PGPWE
IIM Raipur EFPM
IIM Raipur FPM
IIM Ranchi PGDM
IIM Ranchi PGDHRM
IIM Ranchi FPM
IIM Rohtak PGP
IIM Rohtak EPGP
IIM Rohtak FPM
IIM Sambalpur PGP
RGIIM Shillong PGP
RGIIM Shillong PGPEX
RGIIM Shillong FPM
IIM Sirmaur PGP
IIM Tiruchirappalli PGP
IIM Tiruchirappalli PGPBM
IIM Tiruchirappalli PGPHRM
IIM Tiruchirappalli FPM
IIM Udaipur PGP
IIM Udaipur FPM
IIM Visakhapatnam PGP
Delhi
Delhi
Delhi
Delhi
Delhi
Delhi
Delhi
Delhi
Delhi
Delhi
Delhi
Delhi
Rohtak
Delhi
Delhi
Delhi - NCR
ChandigarhDelhi
Delhi
KashipurKashipur
Delhi
Delhi - NCRDelhi - NCR
Delhi
Delhi
Delhi
Delhi
Ahmedabad
Delhi
Udaipur
Delhi
DECLARATION
I hereby certify that the particulars given by me in this Application Form are true to my knowledge and belief. I certify that I fulfill the CAT 2015 eligibility criteria and undertake to produce original documents whenever necessary and I will not demand any reschedule of exam. I understand all disputes will be subject to territorial jurisdiction of city of Ahmedabad only.
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