Application Form

User Id: 6112135

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

Personal Details
Name of Candidate:

KHUNTI VANRAJ RAJUBHAI

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

RAJUBHAI

Mother's Name:

LILUBEN

Date of Birth:

23/Sep/1994

Candidate Gender:

Male

Category:

NC-OBC

State/Union Territory of
Caste/Tribe:

Gujarat

Serial Number of caste/Tribe:

48

Caste/Tribe Name:

Mer

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
boricha village

Address:

adityana road

Country:

India

State/Union Territory:

GUJARAT

Other State/Union Territory:

District:

Porbandar

Other District:

Town/City:

PORBANDAR

Pin Code:

360575

Mobile Number:

9687165515

Email Address:

tejasdevariya@gmail.com

Email Address (Alternate) :

khuntivanraj6869@gmail.com

Mobile Number (Alternate) :

9925476045

Exam Centre City Preferences

Preferred City 1:

Rajkot

Preferred City 2:

Ahmedabad

Preferred City 3:

Vadodara

Preferred City 4

Anand

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

67.8

Month/Year of Completion:

March

Total Marks Obtained :

339

Maximum Marks :

500

SSC/10th Std/Equivalent Board

Name

Gujarat Secondary & Higher Education Board

2012

HSC/12th/Equivalent/Diploma Course Details

Course Type:

HSC

Aggregate Marks:

72.86

Total Marks Obtained:

510

Maximum Marks:

750

12th/Equivalent Board Name:

Gujarat Secondary & Higher Education Board

Duration of Diploma Course:

University/Board/Other Authority
Name:
Discipline:

Commerce

Month/Year of Course
Commencement:

Month/Year of Completion: March

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
Degree?
Current Semester:

Semester-5

Type of University/Institution:

Others

State/Union Territory Where

University is Situated:

Gujarat

University Name:

Saurashtra

Name Of College:

SHRI V.J.MODHA COLLEGE

Degree Name:

BBA

Total Duration of Degree:

2 Year

Aggregate Marks:

80

2014

First Bachelor Degree Details

Discipline:

Management (Business Administration/Business Management/Business Studies/Management Studies)

Month/Year of Course
Commencement:

June

2014

June
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:

2017

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)

Programme Details
Programme Names

Interview City

Selected / Not

IIM Ahmedabad PGP

(Interview City 1)

Ahmedabad

Selected

IIM Ahmedabad PGP

(Interview City 2)

Bangalore

Selected

IIM Ahmedabad PGP-FABM

Ahmedabad

Selected

IIM Ahmedabad FPM

Ahmedabad

Selected

IIM Amritsar PGP

Not Selected

IIM Bangalore PGP

Not Selected

IIM Bangalore PGPEM

Not Selected

IIM Bangalore PGPPM

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

Not 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

Not 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

IIM Ranchi PGDHRM

Not Selected

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

Not 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

GSM34723762093

611213520160902170402003

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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