Application Form

User Id: 7206931

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

Personal Details

Name of Candidate: ABANTY MAJUMDAR

Father's/Husband's/Guardian's
APURBA KUMAR MAJUMDAR
Name :

Mother's Name: MAITREYI MAJUMDAR

Date of Birth: 30/Aug/1994 Candidate Gender: Female

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

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

Nationality: Indian Aadhar Card Number : 518576266522

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
AZIMGANJ

Address:
SARODAPALLI

MURSHIDABAD

Country: India

State/Union Territory: WEST BENGAL Other State/Union Territory:

District: Murshidabad Other District:

Town/City: AZIMGANJ Pin Code: 742122

Mobile Number: 8373807588 Email Address: amajumdar93@gmail.com

subhradipghosh10@gmail.com
Mobile Number (Alternate) : 9434641994 Email Address (Alternate) :
Exam Centre City Preferences
Preferred City 1: Kolkata

Preferred City 2: Howrah

Preferred City 3: Kalyani

Preferred City 4 Burdwan

Academics Details

SSC/10th Std/Equivalent Details

Aggregate marks: 60 Month/Year of Completion: May 2010

Total Marks Obtained : 480 Maximum Marks : 800

SSC/10th Std/Equivalent Board West Bengal Board of Secondary Education

Name

HSC/12th/Equivalent/Diploma Course Details

Course Type: HSC Aggregate Marks: 57.2
Total Marks Obtained: 286 Maximum Marks: 500

12th/Equivalent Board Name: West Bengal Council of Higher Seconday Education

Duration of Diploma Course:

University/Board/Other Authority
Name:

Discipline: Arts

Month/Year of Course
Month/Year of Completion: June 2012
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: 74

Type of University/Institution:
State University

State/Union Territory Where West Bengal

University is Situated:
First Bachelor Degree Details

University Name: West Bengal University of Technology

Name Of College: GITARAM INSTITUTE OF MANAGEMENT

Degree Name: BCA

Discipline: Information Technology

Month/Year of Course Probable Month/Year OR

August 2014 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 0

months as on 31st July 2017)

Programme Details

Programme Names Interview City Selected / Not

IIM Ahmedabad PGP

(Interview City 1) Not Selected

IIM Ahmedabad PGP

Not Selected
(Interview City 2)

IIM Ahmedabad EPGP

(Interview City 1 Not Selected
IIM Ahmedabad EPGP
(Interview City 2 Not Selected

IIM Ahmedabad PGP-FABM Not Selected

IIM Ahmedabad FPM Not Selected

IIM Amritsar PGP Not Selected

IIM Bangalore PGP Kolkata 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 Kolkata Selected

IIM Calcutta FPM Not Selected

IIM Indore PGP Not Selected

IIM Indore PGP HRM Not Selected

IIM Indore EPGP Not Selected

IIM Indore FPM Not Selected

IIM Jammu PGP Not Selected

IIM Kashipur PGP Not Selected

IIM Kashipur EPGP Not Selected

IIM Kashipur EFPM Not Selected

IIM Kashipur FPM Not Selected

IIM Kozhikode PGP Not Selected

IIM Kozhikode FPM Not Selected

IIM Lucknow PGP Not Selected

IIM Lucknow PGP ABM Not Selected

IIM Lucknow PGPSM Not Selected

IIM Lucknow FPM Not Selected

IIM Nagpur PGP Kolkata 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 Not Selected

RGIIM Shillong PGP Kolkata 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 Kolkata Selected

Payment Details

Payment Mode Amount Payment Status Payment Transaction Number Order ID

online 1800.00 S JAXG5666828468 720693120170917215528026

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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