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:

mukulverma0@yahoo.com

Email Address (Alternate) :

mukulverma648@gmail.com

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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