Application Form

User Id: 6102677

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

Personal Details
Name of Candidate:

ISHITA SURI

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

Sandeep Suri

Mother's Name:

Mayuri Suri

Date of Birth:

25/Dec/1995

Candidate Gender:

Category:

General

State/Union Territory of
Caste/Tribe:

Serial Number of caste/Tribe:

Female

Caste/Tribe Name:

Nationality:

Indian

Aadhar Card Number :

Person with Disability (PWD):

No

PWD Category:

445721539942

Do you require wheelchair

support at the test centre?:

Disability Percentage:
Would you be using a scribe for
the Test?:

Would you be requiring the

Zoom Feature for the Test?:

Specific query on PWD Support:

Communication Address
196
Address:

Sector 29-A

Country:

India

State/Union Territory:

CHANDIGARH

Other State/Union Territory:

District:

Chandigarh

Other District:

Town/City:

Chandigarh

Pin Code:

160030

Mobile Number:

9779973902

Email Address:

suritrue@gmail.com

Email Address (Alternate) :

mayurisuri@gmail.com

Mobile Number (Alternate) :

9463837479

Exam Centre City Preferences

Preferred City 1:

Chandigarh

Preferred City 2:

New Delhi

Preferred City 3:

Noida

Preferred City 4

Greater Noida

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

95.00

Month/Year of Completion:

May

Total Marks Obtained :

475

Maximum Marks :

500

SSC/10th Std/Equivalent Board

Name

Central Board of Secondary Education

2011

HSC/12th/Equivalent/Diploma Course Details

Course Type:

HSC

Aggregate Marks:

96.40

Total Marks Obtained:

482

Maximum Marks:

500

12th/Equivalent Board Name:

Central Board of Secondary Education

Duration of Diploma Course:

University/Board/Other Authority
Name:
Discipline:

Science

Month/Year of Course
Commencement:

Month/Year of Completion: May

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-7

Type of University/Institution:

Deemed University

State/Union Territory Where

University is Situated:

Chandigarh

Total Duration of Degree:

4 Year

Aggregate Marks:

87.66

2013

First Bachelor Degree Details

University Name:

PEC University of Technology

Name Of College:

PEC University of Technology

Degree Name:

BE

Discipline:

Engineering/Technology

Month/Year of Course
Commencement:

August

2013

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:

Month/Year of
Completion:

May

2017

Other Professional Degree Details

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

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)

Chandigarh

Selected

IIM Ahmedabad PGP

(Interview City 2)

Delhi

Selected

IIM Ahmedabad PGP-FABM

Not Selected

IIM Ahmedabad FPM

Not Selected

IIM Amritsar PGP

Not Selected

IIM Bangalore PGP

Delhi

Selected

IIM Bangalore PGP EM

Not Selected

IIM Bangalore PGP PM

Not Selected

IIM Bangalore FPM

Not Selected

IIM Bodh Gaya PGP

Not Selected

IIM Calcutta PGP PGDM

Delhi

Not Selected

IIM Calcutta FPM

IIM Indore PGP

Selected

Delhi

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

Delhi

Not Selected

IIM Kozhikode FPM

IIM Lucknow PGP

IIM Lucknow PGP ABM

Selected

Delhi - NCR

Selected
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

GCIT4744697778

610267720160911135440277

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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