Application Form

User Id: 6219507

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

Personal Details
Name of Candidate:

SUMIT KUMAR

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

PREM SINGH

Mother's Name:

SABNAM DEVI

Date of Birth:

07/Mar/1989

Candidate Gender:

Male

Category:

NC-OBC

State/Union Territory of
Caste/Tribe:

Jharkhand

Serial Number of caste/Tribe:

63

Caste/Tribe Name:

KURMI

Country:

Indian

Person with Disability (PWD):

No

PWD Category:
Do you require wheelchair
support at the test centre?:

Disability Percentage:

Would you be using a scribe

for the Test?

Aadhar Card Number

Communication Address
NEW NAGAR BNDHGARI

Address:

DIPATOLI

Country:

India

State/Union Territory:

JHARKHAND

Other State/Union Territory:

District:

Ranchi

Other District:

Town/City:

RANCHI

Pin Code:

834009

Mobile Number:

7870857256

Email Address:

sumitcdsir@gmail.com

Mobile Number (Alternate) :

9431358166

Email Address (Alternate) :

Exam Centre City Preferences

Preferred City 1:

New Delhi

Preferred City 2:

Ghaziabad

Preferred City 3:

Noida

Preferred City 4

Meerut

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

78.8

Month/Year of Completion:

May

Total Marks Obtained :

394

Maximum Marks :

500

SSC/10th Std/Equivalent Board

Name

Central Board of Secondary Education

2005

HSC/12th/Equivalent/Diploma Course Details

Course Type:

HSC

Aggregate Marks:

88.6

Total Marks Obtained:

443

Maximum Marks:

500

12th/Equivalent Board Name:

Central Board of Secondary Education

Duration of Diploma Course:

University/Board/Other Authority
Name:
Discipline:

Science

Month/Year of Course
Commencement:

Month/Year of Completion: May

First Bachelor Degree Details

Are you in the final year of Bachelor Degree?

No

I have more than one Bachelor's Degree?

Have you completed Bachelor
Degree?

Yes

Current Semester:

Total Duration of Degree:

4 Year

Aggregate Marks:

70.04

Type of University/Institution:

State University

State/Union Territory Where

University is Situated:

Uttar Pradesh

University Name:

Other

Name Of College:

AJAY KUMAR GARG ENGINEERING COLLEGE

Degree Name:

BTECH

2007

First Bachelor Degree Details

Discipline:

Others

Month/Year of Course
Commencement:

July

2009

July
Probable Month/Year OR
Month/Year of Completion:

Second Bachelor Degree Details

Are you in the final year of Bachelor Degree?
Have you completed Bachelor
Degree?

Total Duration of Degree:

Current Semester:

Aggregate Marks:

Type of University/Institution:

State/Union Territory Where

University is Situated:
University Name:
Name Of College:
Degree Name:
Discipline:
Probable Month/Year OR
Month/Year of Completion:

Month/Year of Course
Commencement:

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:

State/Union Territory of
University:

University Name:
Name of College/Institution:
Degree Name:
Discipline:
Month/Year of Course
Commencement:

Probable Month/Year OR
Month/Year of Completion:

2013

Other Professional Degree Details

Have you completed any professional degree such as CA/CS/ICWA? :

Professional Inter Marks:

No

Professional Final Marks:

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
Others

Telecommunications
Total Work Experience (In months
as on 31st July 2016)

10

Programme Details
Programme Names

Interview City

Selected / Not

IIM Ahmedabad PGP

(Interview City 1)

Delhi

Selected

IIM Ahmedabad PGP

(Interview City 2)

Kolkata

Selected

IIM Ahmedabad PGP-FABM

Delhi

Selected

IIM Ahmedabad FPM

Ahmedabad

Selected

IIM Amritsar PGP

Delhi

Selected

IIM Bangalore PGP

Delhi

Selected

10

IIM Bangalore PGPEM

Bangalore

Selected

IIM Bangalore PGPPM

Delhi

Selected

IIM Bangalore FPM

Bangalore

Selected

IIM Bodh Gaya PGP

Delhi

Selected

IIM Calcutta PGP PGDM

Delhi

Selected

IIM Calcutta FPM

Kolkata

Selected

IIM Indore PGP

Delhi

Selected

IIM Indore PGP Mumbai

Delhi

Selected

IIM Indore EPGP

Delhi(NCR)

Selected

IIM Indore FPM

Indore

Selected

IIM Jammu PGP

Delhi NCR

Selected

IIM Kashipur PGP

Delhi

Selected

IIM Kashipur EPGPM

Dehradun

Selected

IIM Kashipur EFPM

Kashipur

Selected

IIM Kashipur FPM

Kashipur

Selected

IIM Kozhikode PGP

Delhi

Selected

IIM Kozhikode FPM

Kozhikode

Selected

IIM Lucknow PGP

Delhi - NCR

Selected

IIM Lucknow PGP ABM

Delhi - NCR

Selected

IIM Lucknow PGPSM

Delhi - NCR

Selected

IIM Lucknow FPM

Lucknow

Selected

Not Selected

IIM Nagpur PGP

IIM Raipur PGP

Delhi

Selected

IIM Raipur PGPWE

Raipur

Selected

IIM Raipur EFPM

Raipur

Selected

IIM Raipur FPM

Raipur

Selected

IIM Ranchi PGDM

Delhi

Selected

IIM Ranchi PGDHRM

Delhi

Selected

IIM Ranchi FPM

Ranchi

Selected

IIM Rohtak PGP

Delhi

Selected

IIM Rohtak EPGP

Delhi

Selected

IIM Rohtak FPM

Rohtak

Selected

IIM Sambalpur PGP

Delhi

Selected

RGIIM Shillong PGP

Delhi

Selected

RGIIM Shillong PGPEX

To be decided Later

Selected

RGIIM Shillong FPM

Shillong

Selected

IIM Sirmaur PGP

Delhi(NCR)

Selected

IIM Tiruchirappalli PGP

Delhi

Selected

IIM Tiruchirappalli PGPBM

Chennai

Selected

IIM Tiruchirappalli FPM

Trichy

Selected

IIM Udaipur PGP

Delhi

Selected

IIM Udaipur FPM

Udaipur

Selected

IIM Visakhapatnam PGP

Delhi

Selected

Payment Details
Payment Mode

Amount

Payment Status

Payment Transaction Number

Order ID

online

1700

GCTR4768724510

621950720160921111029941

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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