User Id: 4364339

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

Personal Details
Name of Candidate:

MANJU SAGAR

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

Manik Chandra Sagar

Mother's Name:

Pushpa Sagar

Date of Birth:

31/Mar/1986

Candidate Gender:

Female

Category:

SC

State/Union Territory of
Caste/Tribe:

Uttar Pradesh

Serial Number of caste/Tribe:

24

Caste/Tribe Name:

Jatav

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
Address :

A-23
Rajiv Park
Krishnanagar

State/Union Territory:

Gujarat

Other State/Union Territory:

Country:

India

Other Country:

City:

Ahmedabad

Pin Code:

382346

Mobile Number:

9033716758

Email Address:

manju.dohre31@gmail.com

Email Address (Alternate) :

dohre.deepakkumar@gmail.co
m

Mobile Number (Alternate) :

Exam Centre City Preferences

Preferred City 1:

Ahmedabad

Preferred City 2:

GandhiNagar

Preferred City 3:

Vadodara

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

71.00

School Name:

Kendriya Vidhyala Chandkheda

SSC/10th Std/Equivalent Board

Name
Other Board Name:

Central Board of Secondary Education

Month/Year of Completion:

May

2002

HSC/12th/Equivalent/Diploma Course Details

Course Type:

HSC

Aggregate Marks:

12th/Equivalent Board Name:

Central Board of Secondary Education

55.00

Other Board Name:

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

Kendriya Vidhyala Chandkheda

Discipline:

Mathematics and Science

Month/Year of Course
Commencement:

Other Discipline Name:

Month/Year of Completion:

May

2004

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:

70.03

Yes

Current Semester:
Type of University/Institution:

NIT's

Other Type of University/

Institution:

State/Union Territory Where

University is Situated:

West Bengal

Other State/Union
Territory Where University
is Situated:

University Name:

NIT Durgapur

Name of College/Institution:

NIT Durgapur

Degree Name:

B.Tech

Other Degree Name:

Discipline:

Engineering/Technology

Other Discipline Name:

Month/Year of Course
Commencement:

June

2004

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

2008

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

State Government as Project Manager in

GUDM

10

Others2

Specify Work Area

Exp(In
months)

Others3

Specify Work Area

Exp(In
months)

58

Programme Details
IIM Ahmedabad PGP

Ahmedabad

IIM Ahmedabad PGP-ABM

Ahmedabad

IIM Ahmedabad FPM

Ahmedabad

IIM Bangalore PGP

Mumbai

IIM Bangalore PGP EM

Bangalore

IIM Bangalore PGP PM

Bangalore

IIM Bangalore FPM

Bangalore

IIM Calcutta PGP-PGDM

Mumbai

IIM Calcutta FPM

Kolkata

IIM Indore PGP

Mumbai

IIM Indore PGM Mumbai

Mumbai

IIM Indore PGP UAE

Mumbai

IIM Indore EPGP

Mumbai

IIM Indore FPM

IIM Kashipur PGP

Mumbai

IIM Kashipur EPGP

Kashipur

IIM Kashipur EFPM

Kashipur

IIM Kozhikode PGP

Mumbai

IIM Lucknow PGP

Mumbai

IIM Kozhikode FPM

IIM Lucknow PGP-ABM

Mumbai

IIM Lucknow PGPSM

Mumbai

IIM Lucknow FPM

Lucknow

IIM Raipur PGP

Mumbai

IIM Raipur FPM

Raipur

IIM Raipur PGPWE

Raipur

IIM Raipur EFPM

IIM Ranchi PGDM

IIM Ranchi FPM

IIM Ranchi PGDHRM

IIM Rohtak PGP

IIM Rohtak FPM

RGIIM Shillong PGP

RGIIM Shillong FPM

RGIIM Shillong PGP-EX

IIM Tiruchirappalli PGP

Mumbai

IIM Tiruchirappalli PGPHRM

IIM Tiruchirappalli PGPBM

Chennai

IIM Tiruchirappalli FPM

IIM Udaipur PGP

Mumbai

IIM Udaipur FPM

Udaipur

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

Yes
Yes
Yes
Yes
Yes
Yes

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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