User Id:
5054192
CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.
Personal Details
Name of Candidate:
MUKUL VERMA
Father's/Husband's/Guardian's
Name :
RAJINDER VERMA
Mother's Name:
MEENA VERMA
Date of Birth:
13/Jun/1995
Candidate Gender:
Category:
General
State/Union Territory of
Caste/Tribe:
Serial Number of caste/Tribe:
Male
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
48-B STREET NO-10
Address :
SAROJINI PARK
SHASTRI NAGAR
State/Union Territory:
DELHI
Other State/Union Territory:
Country:
India
Other Country:
City:
East Delhi
Pin Code:
Other Town/City :
Mobile Number:
110031
Other City With Other Country:
9999691203
Mobile Number (Alternate) :
9911908669
Email Address:
[email protected]
Email Address (Alternate) :
[email protected]
Exam Centre City Preferences
Preferred City 1:
New Delhi
Preferred City 2:
Ghaziabad
Preferred City 3:
Faridabad
Preferred City 4
Greater Noida
Academics Details
SSC/10th Std/Equivalent Details
Aggregate marks:
64.06
Month/Year of Completion:
May
Total Marks Obtained :
323
Maximum Marks :
500
SSC/10th Std/Equivalent Board
Name
Central Board of Secondary Education
2011
Other Board Name:
HSC/12th/Equivalent/Diploma Course Details
Course Type:
HSC
Aggregate Marks:
67.05
Total Marks Obtained:
405
Maximum Marks:
600
12th/Equivalent Board Name:
Central Board of Secondary Education
Other Board Name:
Duration of Diploma Course:
University/Board/Other Authority
Name:
Discipline:
Commerce
Other Discipline Name:
Month/Year of Course
Commencement:
Month/Year of Completion: May
2013
Bachelor Degree Details
Are you in the final year of Bachelor Degree?
Yes
Have you completed Bachelor
Degree?
Total Duration of Degree:
3 Year
65.10
Current Semester:
Semester-5
Aggregate Marks:
Type of University/Institution:
State University
Other Type of University/
Institution:
State/Union Territory Where
University is Situated:
Delhi
University Name:
Guru Govind Singh Indraprastha
Other State/Union
Territory Where University
is Situated:
Other University Name:
Name Of College:
MAHARAJA AGRASEN INSTITUTE OF MANAGEMENT STUDIES
Degree Name:
Others
Other Degree Name:
BBA
Discipline:
Management (Business Administration/Business Management/Business Studies/Management Studies)
Other Discipline Name:
Month/Year of Course
Commencement:
June
2013
Month/Year of Completion: June
2016
Other Professional Degree Details
Are you pursuing or have completed any professional degree, such
as, CA/CS/ICWA?
No
Specify Other Professional
Degree:
Professional Inter Marks:
Professional Final Marks:
Month/Year of Course
Commencement:
Month/Year of Completion:
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:
Other 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 (Work Area)
Recruitment
Others1 (Exp In Month)
Others2 (Work Area)
Others2 (Exp In Month)
Others3 (Work Area)
Others3 (Exp In Month)
Total Work Experience (In Months)
Programme Details
IIM Ahmedabad PGP
(Interview City 1)
Delhi
IIM Ahmedabad PGP
(Interview City 2)
Chandigarh
IIM Ahmedabad PGP-FABM
Delhi
IIM Ahmedabad FPM
Ahmedabad
IIM Amritsar PGP
Delhi
IIM Bangalore PGP
Delhi
IIM Bangalore PGP EM
IIM Bangalore PGP PM
Delhi
IIM Bangalore FPM
IIM Bodh Gaya PGP
Delhi
IIM Calcutta PGP PGDM
Delhi
IIM Calcutta FPM
IIM Indore PGP
Delhi
Programme IIM Indore PGP
Mumbai
IIM Indore EPGP
Delhi
IIM Indore FPM
IIM Kashipur PGP
Delhi
IIM Kashipur EPGPM
IIM Kashipur EFPM
Kashipur
IIM Kashipur FPM
IIM Kozhikode PGP
Delhi
IIM Kozhikode FPM
IIM Lucknow PGP
Delhi - NCR
IIM Lucknow PGP ABM
IIM Lucknow PGPSM
Delhi - NCR
IIM Lucknow FPM
IIM Nagpur PGP
IIM Raipur PGP
IIM Raipur PGPWE
IIM Raipur EFPM
IIM Raipur FPM
IIM Ranchi PGDM
Delhi
Kashipur
Delhi - NCR
Delhi
Delhi
IIM Ranchi PGDHRM
Delhi
IIM Ranchi FPM
IIM Rohtak PGP
Delhi
IIM Rohtak EPGP
Delhi
IIM Rohtak FPM
Rohtak
IIM Sambalpur PGP
Delhi
RGIIM Shillong PGP
Delhi
RGIIM Shillong PGPEX
RGIIM Shillong FPM
IIM Tiruchirappalli PGP
IIM Sirmaur PGP
Delhi
IIM Tiruchirappalli PGPHRM
Delhi
IIM Tiruchirappalli PGPBM
IIM Tiruchirappalli FPM
IIM Udaipur PGP
Delhi
IIM Visakhapatnam PGP
Delhi
IIM Udaipur FPM
Udaipur
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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Candidate Photograph
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