Application Form
User Id: 6003069
CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.
Personal Details
Name of Candidate: AKSHAY KHATRI
Father's/Husband's/Guardian's
JITENDRA KHATRI
Name :
Mother's Name: SHASHI KHATRI
Date of Birth: 15/Oct/1993 Candidate Gender: Male
State/Union Territory of
Category: General
Caste/Tribe:
Serial Number of caste/Tribe: Caste/Tribe Name:
Nationality: Indian Aadhar Card Number :
Person with Disability (PWD): No PWD Category:
Disability Percentage: Do you require wheelchair
support at the test centre?:
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
OPPOSITE NEHRU MAIDAN
Address:
BEHIND PETROL PUMP
Country: India
State/Union Territory: ASSAM Other State/Union Territory:
District: Sonitpur Other District:
Town/City: TEZPUR Pin Code: 784001
Mobile Number: 8753813961 Email Address: akshay.khatri1@gmail.com
Mobile Number (Alternate) : 9957513199 Email Address (Alternate) : jitendrakumarkhatri@gmail.com
Exam Centre City Preferences
Preferred City 1: Dibrugarh
Preferred City 2: Guwahati
Preferred City 3: Shillong
Preferred City 4 Silchar
Academics Details
SSC/10th Std/Equivalent Details
Aggregate marks: 81.5 Month/Year of Completion: May 2010
Total Marks Obtained : 489 Maximum Marks : 600
SSC/10th Std/Equivalent Board Assam Board of Secondary Education
Name
HSC/12th/Equivalent/Diploma Course Details
Course Type: HSC Aggregate Marks: 71
Total Marks Obtained: 355 Maximum Marks: 500
12th/Equivalent Board Name: Assam Higher Secondary Education Council
Duration of Diploma Course:
University/Board/Other Authority
Name:
Discipline: Science
Month/Year of Course
Month/Year of Completion: June 2012
Commencement:
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
Total Duration of Degree: 4 Year
Degree?
Current Semester: Semester-7 Aggregate Marks: 60.25
Type of University/Institution:
State University
State/Union Territory Where Assam
University is Situated:
First Bachelor Degree Details
University Name: Dibrugarh
Name Of College: JORHAT ENGINEERING COLLEGE
Degree Name: BE
Discipline: Engineering/Technology
Month/Year of Course Probable Month/Year OR
August 2013 July 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 months 0
as on 31st July 2016)
Programme Details
Programme Names Interview City Selected / Not
IIM Ahmedabad PGP Kolkata Selected
(Interview City 1)
IIM Ahmedabad PGP
Delhi Selected
(Interview City 2)
IIM Ahmedabad PGP-FABM Kolkata Selected
IIM Ahmedabad FPM Ahmedabad Selected
IIM Amritsar PGP Kolkata Selected
IIM Bangalore PGP Kolkata Selected
IIM Bangalore PGP EM Bangalore Selected
IIM Bangalore PGP PM Delhi Selected
IIM Bangalore FPM Bangalore Selected
IIM Bodh Gaya PGP Kolkata Selected
IIM Calcutta PGP PGDM Kolkata Selected
IIM Calcutta FPM Kolkata Selected
IIM Indore PGP Guwahati Selected
IIM Indore PGP Mumbai Guwahati Selected
IIM Indore EPGP Kolkata Selected
IIM Indore FPM Indore Selected
IIM Jammu PGP Kolkata Selected
IIM Kashipur PGP Kolkata Selected
IIM Kashipur EPGPM Kashipur Selected
IIM Kashipur EFPM Kashipur Selected
IIM Kashipur FPM Kashipur Selected
IIM Kozhikode PGP Kolkata Selected
IIM Kozhikode FPM Kozhikode Selected
IIM Lucknow PGP Kolkata Selected
IIM Lucknow PGP ABM Kolkata Selected
IIM Lucknow PGPSM Kolkata Selected
IIM Lucknow FPM Lucknow Selected
IIM Nagpur PGP No Interviews for this programme Selected
IIM Raipur PGP Kolkata Selected
IIM Raipur PGPWE Raipur Selected
IIM Raipur EFPM Raipur Selected
IIM Raipur FPM Raipur Selected
IIM Ranchi PGDM Kolkata Selected
Kolkata Selected
IIM Ranchi PGDHRM
IIM Ranchi FPM Ranchi Selected
IIM Rohtak PGP Kolkata Selected
IIM Rohtak EPGP Guwahati Selected
IIM Rohtak FPM Rohtak Selected
IIM Sambalpur PGP Kolkata Selected
RGIIM Shillong PGP Kolkata Selected
RGIIM Shillong PGPEX To be decided Later Selected
RGIIM Shillong FPM Shillong Selected
IIM Sirmaur PGP Kolkata Selected
IIM Tiruchirappalli PGP Kolkata Selected
IIM Tiruchirappalli PGPBM Chennai Selected
IIM Tiruchirappalli FPM Trichy Selected
IIM Udaipur PGP Kolkata Selected
IIM Udaipur FPM Udaipur Selected
IIM Visakhapatnam PGP Kolkata Selected
Payment Details
Payment Mode Amount Payment Status Payment Transaction Number Order ID
online 1700 S GSM34757999243 600306920160916204124640
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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