User Id: 4199215

CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.

Personal Details
Name of Candidate:

AMBER AGARWAL

Father's/Husband's/Guardian's
Name :

Surendar Kumar Agarwal

Mother's Name:

Suman Agarwal

Date of Birth:

13/Mar/1993

Candidate 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
Address :

5th main taverekere main road

flat-305 sai balaji residency
opposite top in town

State/Union Territory:

Karnataka

Other State/Union Territory:

Country:

India

Other Country:

City:

bangalore

Pin Code:

560029

Mobile Number:

9886859424

Email Address:

amberagarwal13@gmail.com

Mobile Number (Alternate) :

Email Address (Alternate) :

Exam Centre City Preferences

Preferred City 1:

Bangalore

Preferred City 2:

Mysore

Preferred City 3:

Hyderabad

Academics Details
SSC/10th Std/Equivalent Details
Aggregate marks:

91.00

School Name:

delhi publc school megacity

SSC/10th Std/Equivalent Board

Name
Other Board Name:

Month/Year of Completion:

Council for Indian School Certificate Examination

April

2010

HSC/12th/Equivalent/Diploma Course Details

Course Type:

HSC

Aggregate Marks:

12th/Equivalent Board Name:

Council for Indian School Certificate Examination

92.50

Other Board Name:

University/Board/Other Authority
Name:
College/Institute Name:

delhi public school megacity

Discipline:

Commerce

Other Discipline Name:

Month/Year of Course
Commencement:

Month/Year of Completion:

April

2012

Bachelor Degree Details

Are you in the final year of Bachelor Degree?

Yes

Have you completed Bachelor

Degree?

Total Duration of Degree:

3 Year
75.00

Current Semester:

Semester-5

Aggregate Marks:

Type of University/Institution:

Deemed University

Other Type of University/

Institution:

State/Union Territory Where

University is Situated:

Karnataka

Other State/Union
Territory Where University
is Situated:

University Name:

christ university

Name of College/Institution:

christ college

Degree Name:

Others

Other Degree Name:

BBA

Discipline:

Management

Other Discipline Name:

Month/Year of Course
Commencement:

June

2012

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:

March

2015

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

Ahmedabad

IIM Bangalore PGP

Bangalore

IIM Bangalore PGP EM

Bangalore

IIM Bangalore PGP PM

Bangalore

IIM Bangalore FPM

Bangalore

IIM Calcutta PGP-PGDM

Bangalore

IIM Calcutta FPM

Kolkata

IIM Indore PGP

Bangalore

IIM Indore PGM Mumbai

Bangalore

IIM Indore PGP UAE

Bangalore

IIM Indore EPGP

Bangalore

IIM Indore FPM

Indore

IIM Kashipur PGP

Bangalore

IIM Kashipur EPGP

Kashipur

IIM Kashipur EFPM

Kashipur

IIM Kozhikode PGP

Bangalore

IIM Kozhikode FPM

Kozhikode

IIM Lucknow PGP

Bangalore

IIM Lucknow PGP-ABM

Bangalore

IIM Lucknow PGPSM

Bangalore

IIM Lucknow FPM

Lucknow

IIM Raipur PGP

Bangalore

IIM Raipur FPM

Raipur

IIM Raipur PGPWE

Raipur

IIM Raipur EFPM

Raipur

IIM Ranchi PGDM

Bangalore

IIM Ranchi FPM

Ranchi

IIM Ranchi PGDHRM

Bangalore

IIM Rohtak PGP

Bangalore

IIM Rohtak FPM

Rohtak

RGIIM Shillong PGP

Bangalore

RGIIM Shillong FPM

Shillong

RGIIM Shillong PGP-EX

Guwahati

IIM Tiruchirappalli PGP

Bangalore

IIM Tiruchirappalli PGPHRM

Chennai

IIM Tiruchirappalli PGPBM

Chennai

IIM Tiruchirappalli FPM

Tiruchirappalli

IIM Udaipur PGP

Bangalore

IIM Udaipur FPM

Udaipur

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

Yes
Yes
Yes
Yes
Yes
Yes

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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