Application Form
User Id: 6202686
CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.
Personal Details
Name of Candidate: PRASHANT KUMAR NAGAR
Father's/Husband's/Guardian's
KANTI LAL NAGAR
Name :
Mother's Name: BHANU DEVI
Date of Birth: 29/Jan/1997 Candidate Gender: Male
State/Union Territory of
Category: General
Caste/Tribe:
Serial Number of caste/Tribe: Caste/Tribe Name:
Nationality: Indian Aadhar Card Number : 329291742669
Person with Disability (PWD): No PWD Category:
Disability Percentage: Do you require wheelchair
support at the test centre?:
Would you be using a scribe for
the Test?: Would you be requiring the
Zoom Feature for the Test?:
Specific query on PWD Support:
Communication Address
BANDHARO KA VAS
Address:
KHIMEL
Country: India
State/Union Territory: RAJASTHAN Other State/Union Territory:
District: Pali Other District:
Town/City: KHIMEL Pin Code: 306115
Mobile Number: 7046255184 Email Address: [email protected]
Mobile Number (Alternate) : 8128689784 Email Address (Alternate) :
Exam Centre City Preferences
Preferred City 1: Ahmedabad
Preferred City 2: Vadodara
Preferred City 3: Gandhinagar
Preferred City 4 Udaipur
Academics Details
SSC/10th Std/Equivalent Details
Aggregate marks: 84.83 Month/Year of Completion: June 2011
Total Marks Obtained : 509 Maximum Marks : 600
SSC/10th Std/Equivalent Board Rajasthan Board of Secondary Education
Name
HSC/12th/Equivalent/Diploma Course Details
Course Type: HSC Aggregate Marks: 81.40
Total Marks Obtained: 407 Maximum Marks: 500
12th/Equivalent Board Name: Rajasthan Board of Secondary Education
Duration of Diploma Course:
University/Board/Other Authority
Name:
Discipline: Science
Month/Year of Course
Month/Year of Completion: May 2013
Commencement:
First Bachelor Degree Details
Are you in the final year of Bachelor Degree? Yes
I have more than one Bachelor's Degree?
Have you completed Bachelor
Total Duration of Degree: 3 Year
Degree?
Current Semester: Semester-5 Aggregate Marks: 64.20
Type of University/Institution:
State University
State/Union Territory Where Gujarat
University is Situated:
First Bachelor Degree Details
University Name: MS University of Baroda
Name Of College: FACULTY OF SCIENCE
Degree Name: BS/BSC
Discipline: Physics
Month/Year of Course Probable Month/Year OR
August 2014 May 2017
Commencement: Month/Year of Completion:
Second Bachelor Degree Details
Are you in the final year of Bachelor Degree?
Have you completed Bachelor Total Duration of Degree:
Degree?
Current Semester: Aggregate Marks:
Type of University/Institution:
State/Union Territory Where
University is Situated:
University Name:
Name Of College:
Degree Name:
Discipline:
Month/Year of Course Probable Month/Year OR
Commencement: Month/Year of Completion:
Master Degree Details
Do you want to enter Master No
Degree Details?
Master Degree Completion Status: Duration:
Current Semester: Aggregate Marks:
State/Union Territory of
Type of University/Institution:
University:
University Name:
Name of College/Institution:
Degree Name:
Discipline:
Month/Year of Course
Month/Year of
Commencement:
Completion:
Other Professional Degree Details
Have you completed any professional degree such as CA/CS/ICWA
No
without completing Bachelor's Degree:
Professional Inter Marks: Professional Final Marks:
Month/Year of Course
Month/Year of
Commencement:
Completion:
Work Experience Details
Automobiles/Auto-ancillaries Banking/Financial Services
Durables Engineering/Industrial
Fast Moving Consumer Goods
Information Technology
(FMCG)
Pharmaceuticals/Healthcare Retail
Others
Telecommunications
Total Work Experience (In months 0
as on 31st July 2016)
Programme Details
Programme Names Interview City Selected / Not
IIM Ahmedabad PGP Ahmedabad Selected
(Interview City 1)
IIM Ahmedabad PGP
Delhi Selected
(Interview City 2)
IIM Ahmedabad PGP-FABM Not Selected
IIM Ahmedabad FPM Not Selected
IIM Amritsar PGP Not Selected
IIM Bangalore PGP Delhi Selected
IIM Bangalore PGP EM Not Selected
IIM Bangalore PGP PM Not Selected
IIM Bangalore FPM Not Selected
IIM Bodh Gaya PGP Not Selected
IIM Calcutta PGP PGDM Not Selected
IIM Calcutta FPM Not Selected
IIM Indore PGP Delhi Selected
IIM Indore PGP Mumbai Not Selected
IIM Indore EPGP Not Selected
IIM Indore FPM Not Selected
IIM Jammu PGP Not Selected
IIM Kashipur PGP Not Selected
IIM Kashipur EPGPM Not Selected
IIM Kashipur EFPM Not Selected
IIM Kashipur FPM Not Selected
IIM Kozhikode PGP Not Selected
IIM Kozhikode FPM Not Selected
IIM Lucknow PGP Not Selected
IIM Lucknow PGP ABM Not Selected
IIM Lucknow PGPSM Not Selected
IIM Lucknow FPM Not Selected
IIM Nagpur PGP No Interviews for this programme Selected
IIM Raipur PGP Not Selected
IIM Raipur PGPWE Not Selected
IIM Raipur EFPM Not Selected
IIM Raipur FPM Not Selected
IIM Ranchi PGDM Not Selected
Not Selected
IIM Ranchi PGDHRM
IIM Ranchi FPM Not Selected
IIM Rohtak PGP Not Selected
IIM Rohtak EPGP Not Selected
IIM Rohtak FPM Not Selected
IIM Sambalpur PGP Not Selected
RGIIM Shillong PGP Not Selected
RGIIM Shillong PGPEX Not Selected
RGIIM Shillong FPM Not Selected
IIM Sirmaur PGP Not Selected
IIM Tiruchirappalli PGP Not Selected
IIM Tiruchirappalli PGPBM Not Selected
IIM Tiruchirappalli FPM Not Selected
IIM Udaipur PGP Delhi Selected
IIM Udaipur FPM Not Selected
IIM Visakhapatnam PGP Not Selected
Payment Details
Payment Mode Amount Payment Status Payment Transaction Number Order ID
online 1700 S GSM34762515408 620268620160918183200568
DECLARATION
I have previewed the Application Form by clicking on the Preview Application Button and confirm that all the data reflecting in the Preview are
correct. I hereby certify that the information given by me in this Application Form is true to the best my knowledge. I certify that I fulfill the
CAT 2016 eligibility criteria and undertake to produce original documents whenever necessary and I will not demand any reschedule of exam. I
agree to abide by the declaration of the authorities regarding the eligibility of my application and understand that any misrepresentation or
omission of facts in my application may justify cancellation of my CAT 2016 application & scores. I understand that all disputes will be subject
to the territorial jurisdiction of city of Bangalore only.
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