User Id: 4121979
CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.
Personal Details
Name of Candidate:
BHARATH INTI
Father's/Husband's/Gaurdian's
Name :
I S NAGESWARA RAO
Mother's Name:
I NAGALAKSHMI
Date of Birth:
04/Jan/1992
Gender:
Male
General
State/Union Territory of
Caste/Tribe:
Category:
Serial Number of caste/Tribe:
Caste/Tribe Name:
Nationality:
Indian
Other Nationality:
Person with Disability/Differently
Abled (PWD/DA):
No
PWD/DA Category:
Do you require wheelchair
support at the test centre?:
Disability Percentage:
Communication Address
#5 3rd Main Papareddypalya 2nd stage Nagarbhavi
Address :
State/Union Territory:
Karnataka
Other State/Union Territory:
Country:
India
Other Country:
City:
Bangalore
Pin Code:
560072
Mobile Number:
8892119775
Email Address:
ibharath03@[Link]
Mobile Number (Alternate) :
9441420691
Email Address (Alternate) :
Exam Centre City Preferences
Preferred City 1:
Bangalore
Preferred City 2:
Hyderabad
Preferred City 3:
Thirupathi
Academics Details
SSC/10th Std/Equivalent Details
Aggregate marks:
90.08
School Name:
Sri Siddaganga High School
Month/Year of Completion:
SSC/10th Std/Equivalent Board
Name
Other Boards
Other Board Name:
Karnataka Secondary Education Examination Board
March
2007
12th/Equivalent/Diploma Details
Course Type:
HSC
Aggregate Marks:
12th/Equivalent Board Name:
Andhra Pradesh Board of Intermediate Education
90.90
Other Board Name:
University/Board/Other Authority
Name:
College/Institute Name:
Narayana Junior College
Discipline:
Mathematics
Other Discipline Name:
Month/Year of Course
Commencement:
Month/Year of Completion:
March
2009
Bachelor Degree Details
Are you in the final year of Bachelor Degree?
No
Have you completed Bachelor
Degree?
Total Duration of Degree:
4 Year
Aggregate Marks:
77.35
Yes
Current Semester:
Type of University/Institution:
State University
Other Type of University/
Institution:
State/Union Territory Where
University is Situated:
Andhra Pradesh
Other State/Union
Territory Where University
is Situated:
University Name:
Jawaharlal Nehru Technological University
Name of College/Institution:
RRS College of Engineering and Technology
Degree Name:
[Link]
Discipline:
Engineering/Technology
Other Degree Name:
Other Discipline Name:
Month/Year of Course
Commencement:
September
2009
Month/Year of Completion:
Other Professional Degree Details
Have you completed any professional degree such as CA/CS/ICWA
without completing Bachelor's Degree:
No
Select the Degree:
Specify Other Professional
Degree:
Professional Inter Marks:
Professional Final Marks:
Month/Year of Course
Commencement:
Month/Year of Completion:
May
2013
Master Degree Details
Do you want to enter Master
Degree Details?
No
Master Degree Completion Status:
Duration:
Current Semester:
Aggregate Marks:
Type of University/Institution:
Other Type of
University/Institution:
State/Union Territory of
University:
Other State/Union
Territory of University:
University Name:
Name of College/Institution:
Degree Name:
Other Degree Name:
Discipline:
Other Discipline Name:
Month/Year of Course
Commencement:
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
Others2
Others3
Programme Details
IIM Ahmedabad PGP
Bangalore
IIM Ahmedabad PGP-ABM
IIM Ahmedabad FPM
IIM Bangalore PGP
IIM Bangalore PGP EM
IIM Bangalore PGP PM
IIM Bangalore FPM
IIM Calcutta PGP-PGDM
Bangalore
IIM Calcutta FPM
IIM Indore PGP
Bangalore
IIM Indore PGM Mumbai
IIM Indore PGP UAE
IIM Indore EPGP
IIM Indore FPM
IIM Kashipur PGP
Bangalore
Bangalore
IIM Kashipur EPGP
IIM Kashipur EFPM
IIM Kozhikode PGP
Bangalore
IIM Kozhikode FPM
IIM Lucknow PGP
Bangalore
IIM Lucknow PGP-ABM
IIM Lucknow PGPSM
IIM Lucknow FPM
IIM Raipur PGP
IIM Raipur FPM
Bangalore
IIM Raipur PGPWE
IIM Raipur EFPM
IIM Ranchi PGDM
IIM Ranchi FPM
IIM Ranchi PGDHRM
IIM Rohtak PGP
IIM Rohtak FPM
RGIIM Shillong PGP
Bangalore
RGIIM Shillong FPM
RGIIM Shillong PGP-EX
IIM Tiruchirappalli PGP
IIM Tiruchirappalli PGPHRM
IIM Tiruchirappalli PGPBM
IIM Tiruchirappalli FPM
IIM Udaipur PGP
IIM Udaipur FPM
Applying for the Proposed New IIMs
IIM in Andhra Pradesh PGP
IIM in Bihar PGP
IIM in Himachal Pradesh PGP
IIM in Maharashtra PGP
IIM in Odisha PGP
IIM in Punjab PGP
Bangalore
Yes
Bangalore
Bangalore
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 2014 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 Indore only.
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Photograph
Signature
