User Id: 4121979

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

Personal Details
Name of Candidate:

BHARATH INTI

Father's/Husband's/Gaurdian's
Name :

I S NAGESWARA RAO

Mother's Name:

I NAGALAKSHMI

Date of Birth:

04/Jan/1992

Gender:

Male

General

State/Union Territory of
Caste/Tribe:

Category:
Serial Number of caste/Tribe:

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 3rd Main Papareddypalya 2nd stage Nagarbhavi
Address :

State/Union Territory:

Karnataka

Other State/Union Territory:

Country:

India

Other Country:

City:

Bangalore

Pin Code:

560072

Mobile Number:

8892119775

Email Address:

ibharath03@gmail.com

Mobile Number (Alternate) :

9441420691

Email Address (Alternate) :

Exam Centre City Preferences

Preferred City 1:

Bangalore

Preferred City 2:

Hyderabad

Preferred City 3:

Thirupathi

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

90.08

School Name:

Sri Siddaganga High School

Month/Year of Completion:

SSC/10th Std/Equivalent Board

Name

Other Boards

Other Board Name:

Karnataka Secondary Education Examination Board

March

2007

12th/Equivalent/Diploma Details
Course Type:

HSC

Aggregate Marks:

12th/Equivalent Board Name:

Andhra Pradesh Board of Intermediate Education

90.90

Other Board Name:

University/Board/Other Authority
Name:
College/Institute Name:

Narayana Junior College

Discipline:

Mathematics

Other Discipline Name:

Month/Year of Course
Commencement:

Month/Year of Completion:

March

2009

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:

77.35

Yes

Current Semester:
Type of University/Institution:

State University

Other Type of University/

Institution:

State/Union Territory Where

University is Situated:

Andhra Pradesh

Other State/Union
Territory Where University
is Situated:

University Name:

Jawaharlal Nehru Technological University

Name of College/Institution:

RRS College of Engineering and Technology

Degree Name:

B.Tech

Discipline:

Engineering/Technology

Other Degree Name:

Other Discipline Name:

Month/Year of Course
Commencement:

September

2009

Month/Year of Completion:

Other Professional Degree Details

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

No

Select the Degree:

Specify Other Professional

Degree:

Professional Inter Marks:

Professional Final Marks:

Month/Year of Course
Commencement:

Month/Year of Completion:

May

2013

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:
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
Others2
Others3

Programme Details
IIM Ahmedabad PGP

Bangalore

IIM Ahmedabad PGP-ABM

IIM Ahmedabad FPM

IIM Bangalore PGP

IIM Bangalore PGP EM

IIM Bangalore PGP PM

IIM Bangalore FPM

IIM Calcutta PGP-PGDM

Bangalore

IIM Calcutta FPM

IIM Indore PGP

Bangalore

IIM Indore PGM Mumbai

IIM Indore PGP UAE

IIM Indore EPGP

IIM Indore FPM

IIM Kashipur PGP

Bangalore

Bangalore

IIM Kashipur EPGP

IIM Kashipur EFPM

IIM Kozhikode PGP

Bangalore

IIM Kozhikode FPM

IIM Lucknow PGP

Bangalore

IIM Lucknow PGP-ABM

IIM Lucknow PGPSM

IIM Lucknow FPM

IIM Raipur PGP

IIM Raipur FPM

Bangalore

IIM Raipur PGPWE

IIM Raipur EFPM

IIM Ranchi PGDM

IIM Ranchi FPM

IIM Ranchi PGDHRM

IIM Rohtak PGP

IIM Rohtak FPM

RGIIM Shillong PGP

Bangalore

RGIIM Shillong FPM

RGIIM Shillong PGP-EX

IIM Tiruchirappalli PGP

IIM Tiruchirappalli PGPHRM

IIM Tiruchirappalli PGPBM

IIM Tiruchirappalli FPM

IIM Udaipur PGP

IIM Udaipur FPM

Applying for the Proposed New IIMs

IIM in Andhra Pradesh PGP
IIM in Bihar PGP
IIM in Himachal Pradesh PGP
IIM in Maharashtra PGP
IIM in Odisha PGP
IIM in Punjab PGP

Bangalore

Yes

Bangalore

Bangalore

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 2014 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 Indore only.

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