User Id: 4223263

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

Personal Details

Name of Candidate: GAURAV KUMAR SINHA

Father's/Husband's/Guardian's
Name : ANIL KUMAR SINHA Mother's Name: POONAM SINHA

Date of Birth: 05/Mar/1991 Candidate Gender: Male

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

Serial Number of caste/Tribe: 232 Caste/Tribe Name: YADAV

Nationality: Indian Other Nationality:

Person with Disability/Differently No PWD/DA Category:

Abled (PWD/DA):
Do you require wheelchair
Disability Percentage:
support at the test centre?:

Communication Address
Address :
State/Union Territory:
S/O ANIL KUMAR SINHA NEW BYEPASS RAMKRISHNA NAGAR
SHIVA JI CHOWK WEST ROAD NO G
P.O- NEW JAGANPURA
Bihar Other State/Union Territory:

Country: India Other Country:

City: Pin Code:

PATNA 800027

Mobile Number: 9614345652 Email Address: gaurav.sinha1272030@gmail.c

om
Mobile Number (Alternate) : 9308691112 Email Address (Alternate) : gaurav296@gmail.com

Exam Centre City Preferences

Preferred City 1: Patna

Preferred City 2: Durgapur

Preferred City 3:
Ranchi
Academics Details
SSC/10th Std/Equivalent Details

Aggregate marks: 91.23 Month/Year of Completion: May 2008

School Name: PATNA CENTRAL SCHOOL

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

Other Board Name:

HSC/12th/Equivalent/Diploma Course Details
Course Type: HSC Aggregate Marks: 80.03

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

Other Board Name:

University/Board/Other Authority
Name:

College/Institute Name: DELHI PUBLIC SCHOOL

Discipline: Mathematics and Science Other Discipline Name:

Month/Year of Course
Commencement: Month/Year of Completion: May 2010
Bachelor Degree Details

Are you in the final year of Bachelor Degree? Yes

Have you completed Bachelor
Degree? Total Duration of Degree: 3 Year

Current Semester: Semester-5 Aggregate Marks: 65.50

Other Type of University/
Type of University/Institution: State University
Institution:

State/Union Territory Where Other State/Union

University is Situated: West Bengal Territory Where University
is Situated:

University Name: WEST BENGAL UNIVERSITY OF TECHNOLOGY

Name of College/Institution: NSHM KNOWLEDGE CAMPUS

Degree Name: Others Other Degree Name: B.B.A

Discipline: Management

Other Discipline Name:

Month/Year of Course
Commencement: August 2012 Month/Year of Completion: July 2015

Other Professional Degree Details

Have you completed any professional degree such as CA/CS/ICWA
without completing Bachelor's Degree: No
Specify Other Professional
Select the Degree:
Degree:

Professional Inter Marks: Professional Final Marks:

Month/Year of Course
Month/Year of Completion:
Commencement:
Master Degree Details
Do you want to enter Master
Degree Details?
No

Master Degree Completion Status: Duration:

Current Semester: Aggregate Marks:

Type of University/Institution:
State/Union Territory of
University:
Other Type of
University/Institution:
Other State/Union
Territory of University:

University Name:

Name of College/Institution:

Degree Name: Other Degree Name:

Discipline:

Other Discipline Name:

Month/Year of Course
Month/Year of Completion:
Commencement:

Work Experience Details

Automobiles/Auto-ancillaries Banking/Financial Services

Durables Engineering/Industrial

Fast Moving Consumer Goods

Information Technology
(FMCG)

Pharmaceuticals/Healthcare Retail

Telecommunications

Others1

Others2

Others3
Programme Details
IIM Ahmedabad PGP IIM Ahmedabad PGP-ABM

IIM Ahmedabad FPM IIM Bangalore PGP

IIM Bangalore PGP EM IIM Bangalore PGP PM

IIM Bangalore FPM IIM Calcutta PGP-PGDM

IIM Calcutta FPM IIM Indore PGP

IIM Indore PGM Mumbai IIM Indore PGP UAE

IIM Indore EPGP IIM Indore FPM

IIM Kashipur PGP Kolkata IIM Kashipur EPGP

IIM Kashipur EFPM IIM Kozhikode PGP

IIM Kozhikode FPM IIM Lucknow PGP

IIM Lucknow PGP-ABM IIM Lucknow PGPSM

IIM Lucknow FPM IIM Raipur PGP

IIM Raipur FPM IIM Raipur PGPWE

IIM Raipur EFPM IIM Ranchi PGDM Kolkata

IIM Ranchi FPM IIM Ranchi PGDHRM

IIM Rohtak PGP Kolkata IIM Rohtak FPM

RGIIM Shillong PGP Kolkata RGIIM Shillong FPM

RGIIM Shillong PGP-EX IIM Tiruchirappalli PGP

IIM Tiruchirappalli PGPHRM IIM Tiruchirappalli PGPBM

IIM Tiruchirappalli FPM IIM Udaipur PGP

IIM Udaipur FPM

Applying for the Proposed New IIMs

IIM in Andhra Pradesh PGP

IIM in Bihar PGP

Yes
IIM in Himachal Pradesh PGP
Yes
IIM in Maharashtra PGP

IIM in Odisha PGP

IIM in Punjab PGP

Yes
DECLARATION
I hereby certify that the particulars given by me in this Application Form are true to my knowledge and belief. I certify that I
fulfill the CAT 2014 eligibility criteria and undertake to produce original documents whenever necessary and I will not
demand any reschedule of exam. I understand all disputes will be subject to territorial jurisdiction of city of Indore only.
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