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INDIAN INSTITUTE OF TECHNOLOGY ROORKEE ROORKEE - 247 667 (Uttarakhand) India

APPLICATION NO

122183

APPLICATION FORM FOR ADMISSION TO MBA PROGRAMME-2012 DEPARTMENT OF MANAGEMENT STUDIES

Affix your recent passport size photograph here

CAT REGISTRATION NO

CAT SCORE

CAT PERCENTILE

SR7645920
CATEGORY

246 GEN
N

95.71

PHYSICALLY DISABLED
NAME OF THE CANDIDATE D.O.B. NATIONALITY GENDER FATHER'S NAME MOTHER'S NAME ADDRESS

ALLAN IGNATIUS DSOUZA 04-Oct-1989 INDIAN M IGNATIUS DSOUZA LEENA DSOUZA Near Fatima mata church,chulna village, Vasai (W) ,Dist.Thane pc-401202 8087385659

PHONE FAX EMAIL DETAILS OF FEE PAID CHALLAN NO. BANK NAME

allan_dso@yahoo.com

M67165

DATE

24-Jan-2012

AMOUNT

2000

Punjab National Bank Vasai(E)

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EDUCATIONAL DETAILS
EXAMS PASSED SUBJECTS DISCIPLINE BOARD/ UNIVERSITY SCHOOL/COLLEGE YEAR CGPA/PERCENTAGE

10th

12th

B.E.

English,Marathi ,Hindi,Maths,Sc ience,Social Science English,Maths, Physics,Chemis try, Computer Science Distributed Computing,Mult imedia Systems Design,Softwar e Architecture,Hu man Computing Interaction

SSC

Maharashtra State Board

St.Xaviers High School

2005

84.80

Science

Maharashtra State Board

Vertak college

2007

82.66

Computer Engg.

Mumbai University

St.Francis I.T.

2011

62.00

WORK EXPERIENCE IF ANY


POST NAME OF ORGANISATION FROM TO DURATION NATURE OF DUTIES

ANY OTHER INFORMATION IF ANY

LIST OF DOCUMENT WHICH SHOULD BE ATTACHED WITH THE APPLICATION FORM


(I) PHOTOCOPY OF RELEVENT EDUCATIONAL CERTIFICATES/MARKSHEETS (II) PHOTOCOPY OF CAT SCORE CARD

DECLARATION

I ALLAN IGNATIUS DSOUZA hereby solemnly affirm that, I have carefully read the Information Brochure and agree by the terms and conditions for admission to the MBA program as laid down therein. I understand that my application will stand rejected, if it is found to be incomplete or reaches late. I certify that the particulars given by me in this application form are true to the best of my knowledge and belief .I certify that, in the past I have not taken the admission in the IIT Roorkee for the same course. I am eligible for interview/counseling for admission to the MBA program. It is my responsibility to prove my eligibility as required by the Institute at the time of group discussion/interview. I shall produce degree/mark sheet in original, special category certificate for verification at the time of group discussion/interview/counseling as may be required by the Institute. CAT Registration No.
SR7645920

Name of the candidate ALLAN IGNATIUS DSOUZA

Place : ........................................ Date : ..........................................


(Signature of the Candidate)

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APPLICATION NO

SUMMARY OF INFORMATION 122183


CAT REGISTRATION NO. CAT SCORE CAT PERCENTILE

SR7645920
CATEGORY NAME OF THE CANDIDATE

246 GEN ALLAN IGNATIUS DSOUZA

95.71 Affix your recent passport size photograph here

Academic Qualifications
EXAMS PASSED SUBJECTS DISCIPLINE BOARD/ UNIVERSITY SCHOOL/COLLEGE YEAR CGPA/PERCENTAGE

10th

12th

B.E.

English,Marathi ,Hindi,Maths,Sc ience,Social Science English,Maths, Physics,Chemis try, Computer Science Distributed Computing,Mult imedia Systems Design,Softwar e Architecture,Hu man Computing Interaction

SSC

Maharashtra State Board

St.Xaviers High School

2005

84.80

Science

Maharashtra State Board

Vertak college

2007

82.66

Computer Engg.

Mumbai University

St.Francis I.T.

2011

62.00

Work Experience
POST NAME OF ORGANISATION FROM TO DURATION NATURE OF DUTIES

Any other Information

Place : ........................................ Date : ..........................................


(Signature of the Candidate)

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