User Id:

5096933

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

Personal Details
Name of Candidate:

HARSUL CHORARIA

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

SURENDRA KUMAR CHORARIA

Mother's Name:

MANJU CHORARIA

Date of Birth:

15/Jan/1993

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
5 CHARU CHANDRA AVENUE
Address :

TOLLYGUNGE

State/Union Territory:

WEST BENGAL

Other State/Union Territory:

Country:

India

Other Country:

City:

Kolkata

Pin Code:

Other Town/City :
Mobile Number:

700033

Other City With Other Country:

8939164265

Mobile Number (Alternate) :

9830658841

Email Address:

harsul93@gmail.com

Email Address (Alternate) :

harsul93@yahoo.com

Exam Centre City Preferences

Preferred City 1:

Faridabad

Preferred City 2:

New Delhi

Preferred City 3:

Gurgaon

Preferred City 4

Greater Noida

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

84.85

Month/Year of Completion:

March

Total Marks Obtained :

594

Maximum Marks :

700

SSC/10th Std/Equivalent Board

Name

Council for Indian School Certificate Examination

2009

Other Board Name:

HSC/12th/Equivalent/Diploma Course Details

Course Type:

HSC

Aggregate Marks:

81.00

Total Marks Obtained:

567

Maximum Marks:

700

12th/Equivalent Board Name:

Council for Indian School Certificate Examination

Other Board Name:

Duration of Diploma Course:
University/Board/Other Authority
Name:
Discipline:

Mathematics and Science

Month/Year of Course
Commencement:

Other Discipline Name:

Month/Year of Completion: March

2011

Bachelor Degree Details

Are you in the final year of Bachelor Degree?

No

Have you completed Bachelor

Degree?

Total Duration of Degree:

4 Year

Aggregate Marks:

93.38

Yes

Current Semester:

Other Type of University/

Institution:

Type of University/Institution:

Deemed University

State/Union Territory Where

University is Situated:

Tamil Nadu

University Name:

S.R.M. Institute of Science & Technology

Other State/Union
Territory Where University
is Situated:

Other University Name:

Name Of College:

SRM UNIVERSITY

Degree Name:

B.Tech

Other Degree Name:

Discipline:

Engineering/Technology

Other Discipline Name:

Month/Year of Course
Commencement:

July

2011

Month/Year of Completion: May

2015

Other Professional Degree Details

Have you completed any professional degree such as CA/CS/ICWA
without completing Bachelor's Degree:

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)

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)

Kolkata

IIM Ahmedabad PGP-FABM

Delhi

IIM Ahmedabad FPM

Ahmedabad

IIM Amritsar PGP

Delhi

IIM Bangalore PGP

Delhi

IIM Bangalore PGP EM

Bangalore

IIM Bangalore PGP PM

Delhi

IIM Bangalore FPM

Bangalore

IIM Bodh Gaya PGP

Delhi

IIM Calcutta PGP PGDM

Delhi

IIM Calcutta FPM

Kolkata

IIM Indore PGP

Delhi

Programme IIM Indore PGP

Mumbai

Delhi

IIM Indore EPGP

Delhi

IIM Indore FPM

Indore

IIM Kashipur PGP

Delhi

IIM Kashipur EPGPM

Kashipur

IIM Kashipur EFPM

Kashipur

IIM Kashipur FPM

Kashipur

IIM Kozhikode PGP

Delhi

IIM Kozhikode FPM

Kozhikode

IIM Lucknow PGP

Delhi - NCR

IIM Lucknow PGP ABM

Delhi - NCR

IIM Lucknow PGPSM

Delhi - NCR

IIM Lucknow FPM

Lucknow

IIM Raipur PGP

Delhi

IIM Nagpur PGP

IIM Raipur PGPWE

Raipur

IIM Raipur EFPM

Raipur

IIM Raipur FPM

Raipur

IIM Ranchi PGDM

Delhi

IIM Ranchi PGDHRM

Delhi

IIM Ranchi FPM

Ranchi

IIM Rohtak PGP

Delhi

IIM Rohtak EPGP

Delhi

IIM Rohtak FPM

Rohtak

IIM Sambalpur PGP

Delhi

RGIIM Shillong PGP

Delhi

RGIIM Shillong PGPEX

Shillong

RGIIM Shillong FPM

Shillong

IIM Sirmaur PGP

Delhi

IIM Tiruchirappalli PGP

Delhi

IIM Tiruchirappalli PGPBM

Chennai

IIM Tiruchirappalli PGPHRM

Chennai

IIM Tiruchirappalli FPM

Trichy

IIM Udaipur PGP

Delhi

IIM Udaipur FPM

Udaipur

IIM Visakhapatnam PGP

Delhi

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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