Personal Interview Form
MASTER OF BUSINESS ADMINISTRATION : ADMISSION-2017
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Application No. : 171000777 CAT Reg No 6107176
Interview Date 02/03/2017 Interview Centre 04-Kolkata
Interview Time Morning (Reporting at 9.00 AM) Tentative Panel No. Panel-6
RAKHI AGARWAL
Name (Block Letters):_____________________________________________________________________________________
(As per your last marksheet)
E-mail : agarwalrakhi23@[Link]
_____________________________________________________________________
Applicants
7980380613 Photograph
Mobile : ________________________________________
Gender : Female Date of Birth: 21-08-1994
__________________________
Subhas Agarwal
Fathers Name :_______________________________________________________________________
A. EDUCATION Note : For the purpose of calculating Total Maximum Marks, Marks Obtainedand Aggregate Percentage of
Marks, please include marks of ALL SUBJECTS i.e. compulsory as well as optional (if any) for SSC, HSC & Graduation.
Total Maximum Obtained Aggregate Year of First Attempt
Particular Board Name Marks/CGPA
Marks / CGPA Percentage of Marks Passing (Y/N)
S.S.C icse 614 700 87.7 2011 Yes
H.S.C. icse 548 600 91.33 2013 Yes
Name of the Graduation Degree bcom Mode : Full Time
Stream Commerce Specialization if any marketing
College Name JD BIRLA
University Name JADAVEPUR
Graduation Status Completed Year of Admission : 2013
Marks Obtained Total Aggregate Year of
Year Maximum
Obtained Percentage Passing
(Mention only upto pre-final 1st Sem 2nd Sem 3rd Sem Marks of Marks
Marks
years Marks only) (a) (b) (c) (a+b+c)
(a+b+c) (a+b+c)
First Year* 9.6 9.4 19 20 76.2 2014
Second Year* 9 9.4 18.4 20 70.2 2015
Third Year* 9.2 9.6 18.8 20 76.2 2016
1
MENTION GRADUATION PRE-FINAL MARKS (Calculate all subjects marks (compulsory and optional) upto prefinal year
Total Marks Obtained Maximum Aggregate
Total Marks Maximum
(consider up to pre-final exam) CGPA/CPI CGPA/CPI percentage
Obtained Total Marks (if applicable) (if applicable) of Marks
For Example BA\BCom\BSc
should mention the marks for
first year and second year only.
Similarly B.E.\[Link] should
mention the marks for first,
second and third year only Note : In case the university awards CGPA \ CPI instead of percentage of marks the
candidate is required to provide the conversion formula for converting CGPA \ CPI in to
percentage of marks and mention the computed percentage in column no. 5. Also
please attach the Grade Conversion formula
Have you passed all examinations in single attempt? Yes
B. Any other Qualifications:
Name of the Exam Passed Duration Year of Passing Name of the Aggregate Marks
University/Institute Obtained (%)
C. WORK EXPERIENCE* (Only full-time job after graduation in a professional organization) as on 31.01.2017
Sr. Period (in months)
Organisation Position P.F. No
No. From To Total Months
1.
2.
3.
Total Number of Months
* Please submit relevant documents.
a) experience certificate indicating date of joining, date of relieving, designation held, salary and [Link].
b) Salary slip indicating salary detail showing PF deduction and professional tax deduction.
c) In the absence of experience certificate, submit a copy of the offer letter along with the first salary slip and
last salary slip bearing P.F. No.
1)CREATING SHORT FILMS ,VIDEO,ADVERTISEMENT,EDITING PHOTOS
D. EXTRA-CURRICULAR ACTIVITIES (IF ANY):______________________________________________________
[Link] PAST WHICH BROUGHT DISCIPLINE IN LIFE
_______________________________________________________________________________________________
[Link] DANCING WHICH HELPED ME D EVELOP SELF CONFIDENCE.
_______________________________________________________________________________________________
[Link] SKILLS FOR BETTER COMMUNICATION AND PRESENTATION OF OF IDEAS ANDTHOUGHTS
_______________________________________________________________________________________________
2
E.
RECEIVED BEST SEMINAR AWARD BY JD BIRLA INSTITUTE
ACHIEVEMENTS (IF ANY):______________________________________________________________________
SECOND PRIZE FOR ADVERTISEMENT MAKING IN INTER COLLEGE FEST
_______________________________________________________________________________________________
INTERNSHIP OF SIX MONTHS AS BUSINESS DEVELOPMENT EXECUTIVE IN [Link] AND [Link]
_______________________________________________________________________________________________
RECEIVED FIRST AND SECOND PRICE FOR CREATIVITY IN DESIGNING BROCHURES IN INTER SCHOOL FEST .
_______________________________________________________________________________________________
Note : List of Documents (self-attested photo copies except Data Sheet) to be submitted to the interview panel in the sequence
as mentioned below
Sr No. Particular Checklist
1. Personal Interview Form
2. CAT Score cards
3. S.S.C Marksheet
4. H.S.C Marksheet
5. Graduation Marksheet
First Year Marksheet Sem-I Sem-II
Second Year Marksheet Sem-III Sem-IV
Third Year Marksheet Sem-V Sem-VI
6. Proof for Grade conversion formula in case the same is not indicated in
the Grade report (If applicable)
7. Work experience certificate
8. Salary Slip (First \ Last)
9. Copy of the ID proof (driving license\election ID \ ID card issued by the
college/organization)
Declaration:
I hereby declare that the information given by me in the form is true to the best of my knowledge and belief, and I am
aware that providing incorrect information may result in cancellation of the admission secured, any time during the
entire period of my study at the Institute of Management, Nirma University.
I Agree
kolkata
Place: ___________________
Signature of the Applicant
24-02-2017
Date : ___________________
