User Id: 4148323

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

Personal Details

Name of Candidate: PRASHANT GOYAL

Father's/Husband's/Guardian's
MANOJ K GOYAL Mother's Name: ANURADHA GOYAL
Name :

Date of Birth: 17/Apr/1989 Candidate Gender: Male

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

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

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

FLAT NO. 4B 23
Address : KALPTARU RIVERSIDE SOCIETY PANVEL
NEAR PANCH MUKHI HANUMAN MANDIR
State/Union Territory: Maharashtra Other State/Union Territory:

Country: India Other Country:

City: PANVEL Pin Code: 410206

Mobile Number: 9969228718 Email Address: prashant.bits2007@gmail.com

Mobile Number (Alternate) : 7503666000 Email Address (Alternate) : manojgoel9000@gmail.com

Exam Centre City Preferences

Preferred City 1: Navi Mumbai

Preferred City 2: Mumbai

Preferred City 3: Pune

Academics Details
SSC/10th Std/Equivalent Details

Aggregate marks: 86.80 Month/Year of Completion: May 2005

School Name: SILVEL LINE GHAZIABAD

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: 92.00

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

Other Board Name:

University/Board/Other Authority
Name:

College/Institute Name: SILVER LINE GHAZIABAD

Discipline: Mathematics and Science Other Discipline Name:

Month/Year of Course
Month/Year of Completion: May 2007
Commencement:

Bachelor Degree Details

Are you in the final year of Bachelor Degree? No

Have you completed Bachelor
Yes Total Duration of Degree: 4 Year
Degree?

Current Semester: Aggregate Marks: 96.80

Deemed University Other Type of University/

Type of University/Institution:
Institution:

State/Union Territory Where Other State/Union

Rajasthan Territory Where University
University is Situated:
is Situated:

University Name: BITS PILANI

Name of College/Institution: BITS PILANI GOA CAMPUS

Degree Name: B.E

Other Degree Name:

Discipline: Engineering/Technology

Other Discipline Name:

Month/Year of Course
August 2007 Month/Year of Completion: August 2011
Commencement:

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 No
Degree Details?

Master Degree Completion Status: Duration:

Current Semester: Aggregate Marks:

Other Type of
Type of University/Institution:
University/Institution:
State/Union Territory of Other State/Union
University: 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 8 Banking/Financial Services

Durables Engineering/Industrial 26

Fast Moving Consumer Goods

Information Technology
(FMCG)

Pharmaceuticals/Healthcare Retail

Telecommunications

Others1

Others2

Others3
Programme Details
IIM Ahmedabad PGP Mumbai IIM Ahmedabad PGP-ABM Ahmedabad
IIM Ahmedabad FPM Ahmedabad IIM Bangalore PGP Mumbai
IIM Bangalore PGP EM Bangalore IIM Bangalore PGP PM Bangalore
IIM Bangalore FPM Bangalore IIM Calcutta PGP-PGDM Mumbai
IIM Calcutta FPM Kolkata IIM Indore PGP Mumbai
IIM Indore PGM Mumbai Mumbai IIM Indore PGP UAE Mumbai
IIM Indore EPGP Mumbai IIM Indore FPM Indore
IIM Kashipur PGP Mumbai IIM Kashipur EPGP Kashipur
IIM Kashipur EFPM IIM Kozhikode PGP Mumbai
IIM Kozhikode FPM Kozhikode IIM Lucknow PGP Mumbai
IIM Lucknow PGP-ABM IIM Lucknow PGPSM Mumbai
IIM Lucknow FPM Lucknow IIM Raipur PGP Mumbai
IIM Raipur FPM Raipur IIM Raipur PGPWE Raipur
IIM Raipur EFPM Raipur IIM Ranchi PGDM Mumbai
IIM Ranchi FPM Ranchi IIM Ranchi PGDHRM Mumbai
IIM Rohtak PGP Mumbai IIM Rohtak FPM Rohtak
RGIIM Shillong PGP Mumbai RGIIM Shillong FPM Shillong
RGIIM Shillong PGP-EX Guwahati IIM Tiruchirappalli PGP Mumbai
IIM Tiruchirappalli PGPHRM Chennai IIM Tiruchirappalli PGPBM Chennai
IIM Tiruchirappalli FPM Tiruchirappalli IIM Udaipur PGP Mumbai
IIM Udaipur FPM Udaipur
Applying for the Proposed New IIMs
IIM in Andhra Pradesh PGP
Yes
IIM in Bihar PGP
Yes
IIM in Himachal Pradesh PGP
Yes
IIM in Maharashtra PGP
Yes
IIM in Odisha PGP
Yes
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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