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: VESTINEO@GMAIL.COM

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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