Application Form

User Id: 6212316

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

Personal Details

Name of Candidate: GUTHULA R NAGA MOHANA

Father's/Husband's/Guardian's
G. Muralidhara Rao
Name :

Mother's Name: G. Koteswari

Date of Birth: 06/Apr/1996 Candidate Gender: Female

State/Union Territory of
Category: NC-OBC Andhra Pradesh
Caste/Tribe:

Serial Number of caste/Tribe: 4 Caste/Tribe Name: Settibalija

Nationality: Indian Aadhar Card Number : 717655923000

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
B. Tech 4th year B-Block Room no.210

Address:
GVP girls hostel

Country: India

State/Union Territory: ANDHRA PRADESH Other State/Union Territory:

District: Visakhapatnam Other District:

Town/City: Visakhapatnam Pin Code: 530048

Mobile Number: 9959059480 Email Address: ramyanagamohana6@gmail.com

Mobile Number (Alternate) : 9393585826 Email Address (Alternate) : ramyanagamohana123@gmail.com

Exam Centre City Preferences
Preferred City 1: Vishakapatnam

Preferred City 2: Vijayawada

Preferred City 3: Hyderabad

Preferred City 4 Thirupathi

Academics Details

SSC/10th Std/Equivalent Details

Aggregate marks: 90.83 Month/Year of Completion: March 2011

Total Marks Obtained : 545 Maximum Marks : 600

SSC/10th Std/Equivalent Board Andhra Pradesh Board of Secondary Education

Name

HSC/12th/Equivalent/Diploma Course Details

Course Type: HSC Aggregate Marks: 96.8
Total Marks Obtained: 968 Maximum Marks: 1000

12th/Equivalent Board Name: Andhra Pradesh Board of Intermediate 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? 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: 80.94

Type of University/Institution:
State University

State/Union Territory Where Andhra Pradesh

University is Situated:
First Bachelor Degree Details

University Name: J.N.T.U.

Name Of College: Gayatri Vidya Parishad College of Engineering Autonomous

Degree Name: BTECH

Discipline: Engineering/Technology

Month/Year of Course Probable Month/Year OR

October 2013 April 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 Hyderabad Selected

(Interview City 1)

IIM Ahmedabad PGP

Bangalore Selected
(Interview City 2)

IIM Ahmedabad PGP-FABM Not Selected

IIM Ahmedabad FPM Not Selected

IIM Amritsar PGP Hyderabad Selected

IIM Bangalore PGP Hyderabad Selected

IIM Bangalore PGP EM Not Selected

IIM Bangalore PGP PM Not Selected

IIM Bangalore FPM Not Selected

IIM Bodh Gaya PGP Bangalore Selected

IIM Calcutta PGP PGDM Hyderabad Selected

IIM Calcutta FPM Not Selected

IIM Indore PGP Hyderabad Selected

IIM Indore PGP Mumbai Hyderabad Selected

IIM Indore EPGP Not Selected

IIM Indore FPM Not Selected

IIM Jammu PGP Bangalore Selected

IIM Kashipur PGP Bangalore Selected

IIM Kashipur EPGPM Selected

IIM Kashipur EFPM Not Selected

IIM Kashipur FPM Not Selected

IIM Kozhikode PGP Hyderabad Selected

IIM Kozhikode FPM Not Selected

IIM Lucknow PGP Hyderabad Selected

IIM Lucknow PGP ABM Not Selected

IIM Lucknow PGPSM Not Selected

IIM Lucknow FPM Not Selected

IIM Nagpur PGP No Interviews for this programme Selected

IIM Raipur PGP Bangalore Selected

IIM Raipur PGPWE Not Selected

IIM Raipur EFPM Not Selected

IIM Raipur FPM Not Selected

IIM Ranchi PGDM Bangalore Selected

Not Selected
IIM Ranchi PGDHRM

IIM Ranchi FPM Not Selected

IIM Rohtak PGP Bangalore Selected

IIM Rohtak EPGP Not Selected

IIM Rohtak FPM Not Selected

IIM Sambalpur PGP Hyderabad Selected

RGIIM Shillong PGP Bangalore Selected

RGIIM Shillong PGPEX Not Selected

RGIIM Shillong FPM Not Selected

IIM Sirmaur PGP Bangalore Selected

IIM Tiruchirappalli PGP Bangalore Selected

IIM Tiruchirappalli PGPBM Not Selected

IIM Tiruchirappalli FPM Not Selected

IIM Udaipur PGP Bangalore Selected

IIM Udaipur FPM Not Selected

IIM Visakhapatnam PGP Hyderabad Selected

Payment Details

Payment Mode Amount Payment Status Payment Transaction Number Order ID

online 1700 S GSM24767362826 621231620160920175616537

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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