Application Form

User Id: 7165709

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

Personal Details

Name of Candidate: AMANDEEP SINGH KHOSA

Father's/Husband's/Guardian's
kaur singh khosa
Name :

Mother's Name: lakhveer kaur

Date of Birth: 24/Feb/1996 Candidate Gender: Male

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

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

Nationality: Indian Aadhar Card Number : 475258362142

Do you belong to Persons with
Disability(PwD) category as per No PwD Category:
RPwD Act 2016
Would you be requiring the Do you require wheelchair
Zoom Feature for the Test?: support at the test centre?:
Would you be using a scribe for
the Test?:

Specific query on PwD Support:

Communication Address
Mind Merchants, Ground Floor, Gopal Towers,

Address:
Lane no-1, Plot no-32,

Behind ARG building, NearAjmer Puliya

Country: India

State/Union Territory: RAJASTHAN Other State/Union Territory:

District: Jaipur Other District:

Town/City: jaipur Pin Code: 302001

Mobile Number: 9782512050 Email Address: amandeepkhosa24@gmail.com

Mobile Number (Alternate) : 9950078500 Email Address (Alternate) :

Exam Centre City Preferences
Preferred City 1: Jaipur

Preferred City 2: Ludhiana

Preferred City 3: Bhatinda

Preferred City 4 Chandigarh

Academics Details

SSC/10th Std/Equivalent Details

Aggregate marks: 57 Month/Year of Completion: May 2012

Total Marks Obtained : 285 Maximum Marks : 500

SSC/10th Std/Equivalent Board Central Board of Secondary Education

Name

HSC/12th/Equivalent/Diploma Course Details

Course Type: HSC Aggregate Marks: 52.6
Total Marks Obtained: 263 Maximum Marks: 500

12th/Equivalent Board Name: Central Board of Secondary Education

Duration of Diploma Course:

University/Board/Other Authority
Name:

Discipline: Commerce

Month/Year of Course
Month/Year of Completion: May 2014
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: 59.6

Type of University/Institution:
Private University

State/Union Territory Where Rajasthan

University is Situated:
First Bachelor Degree Details

University Name: Manipal Academy of Higher Education

Name Of College: Manipal University Jaipur

Degree Name: BBA

Discipline: Management (Business Administration/Business Management/Business Studies/Management Studies)

Month/Year of Course Probable Month/Year OR

August 2014 August 2017
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
Month/Year of
Commencement:
Completion:
Other Professional Degree Details
Have you completed any professional degree such as CA/CS/ICWA
No
without completing Bachelor's Degree:

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 0

months as on 31st July 2017)

Programme Details

Programme Names Interview City Selected / Not

IIM Ahmedabad PGP

(Interview City 1) Delhi Selected

IIM Ahmedabad PGP

Mumbai Selected
(Interview City 2)

IIM Ahmedabad EPGP

(Interview City 1
Ahmedabad Selected
IIM Ahmedabad EPGP
(Interview City 2 Delhi Selected

IIM Ahmedabad PGP-FABM Ahmedabad Selected

IIM Ahmedabad FPM Ahmedabad Selected

IIM Amritsar PGP Selected

Amritsar
IIM Bangalore PGP Delhi Selected

IIM Bangalore PGP EM Bangalore Selected

IIM Bangalore PGP PM Delhi Selected

IIM Bangalore FPM Bangalore Selected

IIM Bodh Gaya PGP Delhi Selected

IIM Calcutta PGP PGDM Delhi Selected

IIM Calcutta FPM Kolkata Selected

IIM Indore PGP Bangalore Selected

IIM Indore PGP HRM Bangalore Selected

IIM Indore EPGP Ahmedabad Selected

IIM Indore FPM Indore Selected

IIM Jammu PGP Delhi NCR Selected

IIM Kashipur PGP Selected

IIM Kashipur EPGP Not Selected

IIM Kashipur EFPM Not Selected

IIM Kashipur FPM Not Selected

IIM Kozhikode PGP Bangalore Selected

IIM Kozhikode FPM Kozhikode Selected

IIM Lucknow PGP Delhi - NCR Selected

IIM Lucknow PGP ABM Delhi - NCR Selected

IIM Lucknow PGPSM Hyderabad Selected

IIM Lucknow FPM Lucknow Selected

IIM Nagpur PGP Delhi 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

Not Selected
IIM Ranchi PGDHRM

IIM Ranchi FPM Not Selected

IIM Rohtak PGP Not Selected

IIM Rohtak EPGP Not Selected

IIM Rohtak EPGPX Not Selected

IIM Rohtak FPM Not Selected

IIM Sambalpur PGP Bangalore Selected

RGIIM Shillong PGP Delhi Selected

RGIIM Shillong PGPEX To be decided Later Selected

RGIIM Shillong FPM Shillong Selected

IIM Sirmaur PGP Bangalore Selected

IIM Tiruchirappalli PGP Not Selected

IIM Tiruchirappalli PGPBM Not Selected

IIM Tiruchirappalli FPM Not Selected

IIM Udaipur PGP Delhi Selected

IIM Udaipur FPM Udaipur Selected

IIM Visakhapatnam PGP Delhi Selected

Payment Details

Payment Mode Amount Payment Status Payment Transaction Number Order ID

online 1800.00 S JUR25661192701 716570920170915120441623

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 2017 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 2017 application & scores. I understand that all disputes will be subject
to the territorial jurisdiction of city of Lucknow only.
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