Personal Details:

User ID 20251773
Candidate's Name KHAZI MOHAMMED OWAIS

Date of Birth 20/Jul/1996

Country India

Email ID khazifaizowais@gmail.com

Mobile No 8867835072

Other Personal Details:

Father's/Guardian's Name KHAZI ZAFRUL ISLAM

Mother's/Guardian's Name UMERA TABASSUM

Spouse's Name

Candidate Gender Male Category General

Nationality Do you require

Indian wheelchair support
at the test centre?
State/Union Territory of Serial/Entry/Certifi
Category cate Number of
Category
Caste/Tribe Name Aadhaar Card
Number
PwD Category Would you be
using a scribe for
the Test?

Do you belong to Persons with Disabilities (PwD) category as per RPwD Act 2016? No
Communication Address :
Address Line1 688, 6th Cross

Address Line2 K.R.Puram

Address Line3 Hassan - 573201

Country India Pincode 573201

State/Union Karnataka
State
Territory
Town/City Hassan District

Alternate Email District Hassan

Address
Emergency Contact Details :
Relationship Emergency Mobile 9880119418
with Candidate Number
SSC/10th/Equivalent Details :
SSC/10th/Equivalent Board Name Central Board of Secondary Education

Month/Year of Completion May / 2013

Maximum Marks 500

Total Marks Obtained 389.5 Aggregate 77.90

Percentage :
HSC/12th/Equivalent/Diploma Course Details:
Course Type HSC

University/Board/Other Authority
Name
12th/Equivalent Board Name Central Board of Secondary Education

Duration of Diploma Course

12th/Equivalent Discipline Science

Month/Year of Course / Month/Year of May / 2015

Commencement Completion
Maximum Marks 500 Total Marks 413

Aggregate Percentage 82.60

First Bachelor's Degree Details:

Are you in the final year of Bachelor's Degree? No

Have you completed Bachelor's Degree? Yes

Total Duration of Degree 4 Year Current Semester

Aggregate Marks 71.40 Discipline Engineering/Technology

Type of State University Degree Name BE

University/Institution
State/Union Territory of Karnataka University/Institute Visveswaraiah Technological University

University Name

Month/Year of Course (Month/Year of / 2019

Commencement
August / 2015 Course Completion) /
July

(Probable Month/Year
of Course Completion)
Name of College/Institution :- M.S. Ramaiah Institute of Technology

I have more than one Bachelor's Degree

Second Bachelor's Degree Details:

Are you in the final year of Bachelor's Degree?
Have you completed Current Semester
Bachelor's Degree?
Total Duration of Degree Type of
University/Institution
Aggregate Marks (%) State/Union Territory of
University
Degree Name University/Institute
Name

Discipline Name of
College/Institution

Month/Year of Course (Month/Year of Course

/
Commencement Completion) /(Probable
/ Month/Year of Course
Completion)
Master's Degree Details:
Do you want to enter No Master's Degree
Master's Degree details? Completion Status

Total Duration of Current Semester

Degree

Aggregate Marks (%) Type of

University/Institution

Degree Name State/Union Territory

of University

Discipline University/Institute
Name

Name of Month/Year of Course /

College/Institution Commencement
(Month/Year of Course Completion) /(Probable
Month/Year of Course Completion) /

Other Professional Degree Details:

Have you completed any professional degree such as

No
CA/CS/ICWA?
CA Degree Completion Status :
ICWA Degree Completion Status :
CS Degree Completion Status :
Name of professional Professional Inter Marks
degree
Professional Final Month/Year of Course /
Aggregate Marks Commencement
Month/Year of / Probable Month/Year of /
Completion Completion
Work Experience (If any) :
Industry Type Break in Experience (In
Start Date End Date
Experience days)
Automobiles/
Auto-ancillaries
Banking/
Financial Servics
Durables
Engineering/
Industrial
Fast Moving
Consumer Goods
(FMCG)
Information
Technology
Pharmaceuticals/
Healthcare
Retail
Telecommunications

Others

Total Work Experience(In days as on July 31, 2020)

Programmes:

Programme Name Selected/Not Interview City

Bengaluru
IIM Ahmedabad PGP Selected
Hyderabad

IIM Ahmedabad PGP- Bengaluru

FABM Selected
Hyderabad

Bengaluru
IIM Ahmedabad ePGP
Selected Hyderabad

IIM Ahmedabad PhD Selected Ahmedabad

Bengaluru
IIM Amritsar MBA Selected
Delhi

Bengaluru
IIM Amritsar PhD Selected
Delhi

IIM Amritsar EMBA Bengaluru

Selected
Delhi

Bengaluru
IIM Amritsar MBA-
Selected
Business Analytics Delhi

Bengaluru
IIM Amritsar MBA-HRM Selected
Delhi

Bengaluru
IIM Bangalore PGP Selected
Hyderabad

IIM Bangalore PGPEM Selected Bengaluru

IIM Bangalore PhD Selected Bengaluru

Bengaluru
IIM Bangalore PGPBA Selected
Hyderabad

Bengaluru
IIM Bodh Gaya PGP Selected
Delhi

IIM Bodh Gaya PhD (FPM) Selected Bodh Gaya

Bengaluru
IIM Calcutta MBA Selected
Hyderabad

IIM Calcutta PhD Selected Kolkata

Bengaluru
IIM Indore PGP Selected
Hyderabad
 Bengaluru
IIM Indore PGP-HRM Selected
Hyderabad

IIM Indore FPM Selected Indore

Bengaluru
IIM Jammu PGP Selected
Delhi (NCR)

IIM Jammu PhD Selected Jammu

Bengaluru
IIM Kashipur MBA Selected
Delhi

Kashipur
IIM Kashipur MBA (WX) Selected
Dehradun

IIM Kashipur PhD Selected Kashipur

Bengaluru
IIM Kashipur MBA Selected
(Analytics) Chennai

IIM Kashipur EFPM Selected Kashipur

Bengaluru
IIM Kozhikode PGP Selected
Hyderabad

Bengaluru
IIM Kozhikode PGP-F Selected
Hyderabad

Bengaluru
IIM Kozhikode PGP-LSM Selected
Hyderabad

Bengaluru
IIM Kozhikode PGP-BL Selected
Delhi

IIM Kozhikode PhD Selected Kozhikode

IIM Kozhikode PhD (PT) Selected Kozhikode

Bengaluru
IIM Lucknow PGP Selected
Hyderabad

Bengaluru
IIM Lucknow PGP-ABM Selected
Hyderabad

Bengaluru
IIM Lucknow PGP-SM Selected
Hyderabad

IIM Lucknow FPM Selected Lucknow

IIM Nagpur PhD Selected Nagpur

 Bengaluru
IIM Nagpur PGP Selected
Delhi

Bengaluru
IIM Raipur PGP Selected
Delhi

IIM Raipur FPM/PhD Selected Raipur

IIM Raipur EFPM Selected Raipur

Bengaluru
IIM Ranchi PGP Selected
Delhi

IIM Ranchi PGP (Business Bengaluru

Analytics) Selected
Delhi

Bengaluru
IIM Ranchi PGP-HRM Selected
Delhi

IIM Ranchi PhD Selected Ranchi

IIM Ranchi EPhD Selected Ranchi

Bengaluru
IIM Rohtak PGP Selected
Hyderabad

IIM Rohtak EPGPX Selected Rohtak

IIM Rohtak EPGDSM Selected Rohtak

IIM Rohtak PhD Selected Rohtak

IIM Rohtak Part-time FPM Selected Rohtak

Bengaluru
IIM Sambalpur MBA Selected
Hyderabad

IIM Sambalpur PhD Selected

Bengaluru

Hyderabad

IIM Sambalpur E PhD Selected Sambalpur

Bengaluru
IIM Shillong PGP Selected
Delhi

IIM Shillong PGPEX Selected

Bengaluru

Delhi

Shillong
IIM Shillong PGPWE Selected
Guwahati

IIM Shillong PhD Bengaluru

Selected
Delhi
 Shillong
Selected
IIM Shillong PhDWP Guwahati

Bengaluru
IIM Sirmaur MBA Selected
Delhi (NCR)

IIM Sirmaur MBA Selected

Bengaluru

(TandHM) Delhi

Delhi
IIM Sirmaur PhD Selected
Sirmaur

Bengaluru
IIM Tiruchirappalli PGPM Selected
Delhi

IIM Tiruchirappalli PGPM- Selected

Bengaluru

HR Delhi

IIM Tiruchirappalli PGPBM Selected Chennai

IIM Tiruchirappalli FPM Selected Trichy

IIM Tiruchirappalli E-FPM Selected Trichy

Bengaluru
IIM Udaipur MBA Selected
Chennai

IIM Udaipur PhD Selected Udaipur

Bengaluru
IIM Visakhapatnam PGP Selected
Hyderabad

IIM Visakhapatnam PhD Selected Visakhapatnam

IIM Visakhapatnam PGPEx Selected Visakhapatnam

IIM Visakhapatnam Selected

Visakhapatnam
PGPDGM

Test City Preferences:

Preferred Test City 1 Bengaluru Preferred Test City 2 Mysuru (Mysore)

Preferred Test City 3 Hubballi (Hubli) Preferred Test City 4 Belagavi (Belgaum)

Preferred Test City 5 Coimbatore Preferred Test City 6 Hyderabad

Payment Details :
Amount 2000 Payment Mode online

Payment Status S Payment Transaction No. 11170527405

Declaration:
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 2020 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 2020 application & scores. I understand that all disputes will be subject to the territorial
jurisdiction of city of Indore only.