Application Form

User Id: 7279119

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

Personal Details

Name of Candidate: PRADIKSHA N

Father's/Husband's/Guardian's
Natarajan T.
Name :

Mother's Name: Jayamala N.

Date of Birth: 01/Jul/1996 Candidate Gender: Female

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

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

Nationality: Indian Aadhar Card Number : 414552146144

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
1, 2nd cross shanthi nagar,

Address:
near balaji theatre

pondicherry

Country: India

State/Union Territory: PUDUCHERRY Other State/Union Territory:

District: Pondicherry Other District:

Town/City: pondicherry Pin Code: 605011

Mobile Number: 8012466699 Email Address: pradhi1796@gmail.com

Mobile Number (Alternate) : 8012166699 Email Address (Alternate) : pradhi1796@yahoo.com

Exam Centre City Preferences
Preferred City 1: Puducherry

Preferred City 2: Chennai

Preferred City 3: Coimbatore

Preferred City 4 Madurai

Academics Details

SSC/10th Std/Equivalent Details

Aggregate marks: 85.4 Month/Year of Completion: March 2011

Total Marks Obtained : 427 Maximum Marks : 500

SSC/10th Std/Equivalent Board Tamil Nadu Board of Secondary Education (Matriculation)

Name

HSC/12th/Equivalent/Diploma Course Details

Course Type: HSC Aggregate Marks: 69.33
Total Marks Obtained: 832 Maximum Marks: 1200

12th/Equivalent Board Name: Tamil Nadu Board of Higher Secondary Education

Duration of Diploma Course:

University/Board/Other Authority
Name:

Discipline: Science

Month/Year of Course
Month/Year of Completion: March 2013
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: 4 Year
Degree?
Current Semester: Aggregate Marks: 66.3

Type of University/Institution:
Deemed University

State/Union Territory Where Tamil Nadu

University is Situated:
First Bachelor Degree Details

University Name: S.R.M. Institute of Science & Technology

Name Of College: S.R.M. UNIVERSITY

Degree Name: BTECH

Discipline: Biotechnology

Month/Year of Course Probable Month/Year OR

July 2013 May 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 2

Others
Telecommunications

Total Work Experience (In 2

months as on 31st July 2017)

Programme Details

Programme Names Interview City Selected / Not

IIM Ahmedabad PGP

(Interview City 1) Ahmedabad Selected

IIM Ahmedabad PGP

Mumbai Selected
(Interview City 2)

IIM Ahmedabad EPGP

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

IIM Ahmedabad PGP-FABM Ahmedabad Selected

IIM Ahmedabad FPM Ahmedabad Selected

IIM Amritsar PGP Selected

Chennai
IIM Bangalore PGP Bangalore Selected

IIM Bangalore PGP EM Bangalore Selected

IIM Bangalore PGP PM Bangalore Selected

IIM Bangalore FPM Bangalore Selected

IIM Bodh Gaya PGP Mumbai Selected

IIM Calcutta PGP PGDM Bangalore Selected

IIM Calcutta FPM Kolkata Selected

IIM Indore PGP Chennai Selected

IIM Indore PGP HRM Mumbai Selected

IIM Indore EPGP Chennai Selected

IIM Indore FPM Indore Selected

IIM Jammu PGP Mumbai Selected

IIM Kashipur PGP Mumbai Selected

IIM Kashipur EPGP Dehradun Selected

IIM Kashipur EFPM Kashipur Selected

IIM Kashipur FPM Kashipur Selected

IIM Kozhikode PGP Mumbai Selected

IIM Kozhikode FPM Kozhikode Selected

IIM Lucknow PGP Mumbai Selected

IIM Lucknow PGP ABM Not Selected

IIM Lucknow PGPSM Not Selected

IIM Lucknow FPM Lucknow Selected

IIM Nagpur PGP Mumbai Selected

IIM Raipur PGP Mumbai Selected

IIM Raipur PGPWE Raipur Selected

IIM Raipur EFPM Not Selected

IIM Raipur FPM Not Selected

IIM Ranchi PGDM Mumbai Selected

Not Selected
IIM Ranchi PGDHRM

IIM Ranchi FPM Not Selected

IIM Rohtak PGP Mumbai Selected

IIM Rohtak EPGP Not Selected

IIM Rohtak EPGPX Not Selected

IIM Rohtak FPM Not Selected

IIM Sambalpur PGP Not Selected

RGIIM Shillong PGP Mumbai Selected

RGIIM Shillong PGPEX Not Selected

RGIIM Shillong FPM Not Selected

IIM Sirmaur PGP Not Selected

IIM Tiruchirappalli PGP Mumbai Selected

IIM Tiruchirappalli PGPBM Not Selected

IIM Tiruchirappalli FPM Not Selected

IIM Udaipur PGP Mumbai Selected

IIM Udaipur FPM Not Selected

IIM Visakhapatnam PGP Mumbai Selected

Payment Details

Payment Mode Amount Payment Status Payment Transaction Number Order ID

online 1800.00 S JAXG5686807433 727911920170925164931972

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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