User Id:

5119424

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

Personal Details
Name of Candidate:

S VENKATESAN

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

S SUNDARARAMAN

Mother's Name:

S VIJAYALAKSHMI

Date of Birth:

28/Jul/1995

Candidate Gender:

Category:

General

State/Union Territory of
Caste/Tribe:

Serial Number of caste/Tribe:

Male

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
NO.782D IX CROSS STREET
Address :

DR.RADHAKRISHNAN NAGAR
VELLORE TAMIL NADU

State/Union Territory:

TAMIL NADU

Other State/Union Territory:

Country:

India

Other Country:

City:

Vellore

Pin Code:

Other Town/City :
Mobile Number:

632006

Other City With Other Country:

8973792014

Mobile Number (Alternate) :

7845883119

Email Address:

venky500@gmail.com

Email Address (Alternate) :

venkatesan_sundar@yahoo.com

Exam Centre City Preferences

Preferred City 1:

Chennai

Preferred City 2:

Thirupathi

Preferred City 3:

Chittoor

Preferred City 4

Bangalore

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

94.00

Month/Year of Completion:

May

Total Marks Obtained :

470

Maximum Marks :

500

SSC/10th Std/Equivalent Board

Name

Central Board of Secondary Education

2010

Other Board Name:

HSC/12th/Equivalent/Diploma Course Details

Course Type:

HSC

Aggregate Marks:

91.08

Total Marks Obtained:

1093

Maximum Marks:

1200

12th/Equivalent Board Name:

Tamil Nadu Board of Higher Secondary Education

Other Board Name:

Duration of Diploma Course:
University/Board/Other Authority
Name:
Discipline:

Mathematics and Science

Month/Year of Course
Commencement:

Other Discipline Name:

Month/Year of Completion: May

2012

Bachelor Degree Details

Are you in the final year of Bachelor Degree?

Yes

Have you completed Bachelor

Degree?

Total Duration of Degree:

4 Year
83.89

Current Semester:

Semester-7

Aggregate Marks:

Type of University/Institution:

Deemed University

Other Type of University/

Institution:

State/Union Territory Where

University is Situated:

Tamil Nadu

University Name:

S.R.M. Institute of Science & Technology

Other State/Union
Territory Where University
is Situated:

Other University Name:

Name Of College:

SRM UNIVERSITY

Degree Name:

B.Tech

Other Degree Name:

Discipline:

Engineering/Technology

Other Discipline Name:

Month/Year of Course
Commencement:

August

2012

Month/Year of Completion: June

2016

Other Professional Degree Details

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

No

Specify Other Professional

Degree:
Professional Inter Marks:

Professional Final Marks:

Month/Year of Course
Commencement:

Month/Year of Completion:

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:
Other 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 (Work Area)

Others1 (Exp In Month)

Others2 (Work Area)

Others2 (Exp In Month)

Others3 (Work Area)

Others3 (Exp In Month)

Total Work Experience (In Months)

Programme Details

IIM Ahmedabad PGP

(Interview City 1)

Chennai

IIM Ahmedabad PGP

(Interview City 2)

Bangalore

IIM Ahmedabad PGP-FABM

Bangalore

IIM Ahmedabad FPM

Ahmedabad

IIM Amritsar PGP

Bangalore

IIM Bangalore PGP

Bangalore

IIM Bangalore PGP EM

Bangalore

IIM Bangalore PGP PM

Bangalore

IIM Bangalore FPM

Bangalore

IIM Bodh Gaya PGP

Delhi

IIM Calcutta PGP PGDM

Bangalore

IIM Calcutta FPM

Kolkata

IIM Indore PGP

Chennai

Programme IIM Indore PGP

Mumbai

Chennai

IIM Indore EPGP

Chennai

IIM Indore FPM

Indore

IIM Kashipur PGP

Chennai

IIM Kashipur EPGPM

Kashipur

IIM Kashipur EFPM

Kashipur

IIM Kashipur FPM

Kashipur

IIM Kozhikode PGP

Chennai

IIM Kozhikode FPM

Kozhikode

IIM Lucknow PGP

Bangalore

IIM Lucknow PGP ABM

Bangalore

IIM Lucknow PGPSM

Bangalore

IIM Lucknow FPM

Lucknow

IIM Raipur PGP

Chennai

IIM Nagpur PGP

IIM Raipur PGPWE

Raipur

IIM Raipur EFPM

Raipur

IIM Raipur FPM

Raipur

IIM Ranchi PGDM

Chennai

IIM Ranchi PGDHRM

Chennai

IIM Ranchi FPM

Ranchi

IIM Rohtak PGP

Chennai

IIM Rohtak EPGP

Chennai

IIM Rohtak FPM

Rohtak

IIM Sambalpur PGP

Chennai

RGIIM Shillong PGP

Bangalore

RGIIM Shillong PGPEX

Shillong

RGIIM Shillong FPM

Shillong

IIM Sirmaur PGP

Bangalore

IIM Tiruchirappalli PGP

Chennai

IIM Tiruchirappalli PGPBM

Chennai

IIM Tiruchirappalli PGPHRM

Chennai

IIM Tiruchirappalli FPM

Trichy

IIM Udaipur PGP

Chennai

IIM Udaipur FPM

Udaipur

IIM Visakhapatnam PGP

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
2015 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 Ahmedabad only.

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