Application Form

User Id: 6283077

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

Personal Details

Name of Candidate: SUHAS SATISHRAO NIPANE

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

Mother's Name: PUSHPA NIPANE

Date of Birth: 09/Apr/1991 Candidate Gender: Male

State/Union Territory of
Category: General
Caste/Tribe:

Serial Number of caste/Tribe: Caste/Tribe Name:

Country: Indian

Person with Disability (PWD): No PWD Category:

Do you require wheelchair

Disability Percentage:
support at the test centre?:
Would you be using a scribe
Aadhar Card Number 348988358236 for the Test?

Communication Address
OPP. MAHARASHTRA BANK

Address:
BEHIND SUNIL RADIOS TELANGPURA

WARD NO. 23 WARDHA

Country: India

State/Union Territory: MAHARASHTRA Other State/Union Territory:

District: Wardha Other District:

Town/City: WARDHA Pin Code: 442001

Mobile Number: 9689079034 Email Address: suhasnipane@gmail.com

Mobile Number (Alternate) : 9730984088 Email Address (Alternate) : suhas.707@rediffmail.com

Exam Centre City Preferences
Preferred City 1: Mumbai(Mumbai,Navi Mumbai,Thane)

Preferred City 2: Nagpur

Preferred City 3: Nasik

Preferred City 4 Amravati

Academics Details

SSC/10th Std/Equivalent Details

Aggregate marks: 73.23 Month/Year of Completion: March 2007

Total Marks Obtained : 476 Maximum Marks : 650

SSC/10th Std/Equivalent Board Maharashtra State Board of Secondary and Higher Secondary Education
Name

HSC/12th/Equivalent/Diploma Course Details

Course Type: Diploma Aggregate Marks: 66.90

Total Marks Obtained: 1104 Maximum Marks: 1650

12th/Equivalent Board Name:

Duration of Diploma Course: 2

University/Board/Other Authority MSBTE

Name:

Discipline:

Month/Year of Course June 2009 Month/Year of Completion: July 2011

Commencement:

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 Yes Total Duration of Degree: 3 Year

Degree?
Current Semester: Aggregate Marks: 64.25

Type of University/Institution:
State University

State/Union Territory Where Maharashtra

University is Situated:

University Name: Rashtrasant Tukadoji Maharaj Nagpur

Name Of College: DMIETR

Degree Name: BE
First Bachelor Degree Details

Discipline: Engineering/Technology

Month/Year of Course 2011 2014

August Probable Month/Year OR December
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
Probable Month/Year OR
Commencement:
Month/Year of Completion:
Other Professional Degree Details
Have you completed any professional degree such as CA/CS/ICWA? :
No

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 Mumbai Selected

(Interview City 1)

IIM Ahmedabad PGP Ahmedabad Selected

(Interview City 2)

IIM Ahmedabad PGP-FABM Not Selected

IIM Ahmedabad FPM Not Selected

IIM Amritsar PGP Mumbai Selected

IIM Bangalore PGP Mumbai Selected

IIM Bangalore PGPEM Bangalore 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 Mumbai Selected

IIM Indore PGP Mumbai Mumbai Selected

IIM Indore EPGP Mumbai 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 Mumbai Selected

IIM Lucknow PGP ABM Mumbai Selected

IIM Lucknow PGPSM Not Selected

IIM Lucknow FPM Not Selected

IIM Nagpur PGP No Interviews for this programme Selected

IIM Raipur PGP Mumbai 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 Bangalore 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 S GCIT4782277043 628307720160926225814774

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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