MAT September-2019 Registration Form

Registration No.

* Opted Test Mode Computer Based Test (CBT)

* Test Date 14 September 2019 (Saturday)

* Test Timing In single/different time slots at specific test venues; subject to candidates registration

Test City Choice 1. ORISSA : BHUBANESWAR

* Test Centre City for Computer Based Test (CBT)
Test City Choice 2. MAHARASHTRA : MUMBAI

Personal Particulars
* Name of the Candidate Mr. Ansuman Mishra

Pratap Chandra
* Father's Name * Mother's Name Monalisa Mishra
Mishra

* Date of Birth 10-Apr-1998 * E-mail ID ansumanmishra0880@gmail.com

* Gender Male * Category General

* Nationality Indian

* Address for Communication Nigam nagar 4th line , Ankoli

Brahmapur, Odisha, 760008

Contact Number (Telephone no.) with STD Code 9348888267 * Mobile No.+91- 9348888267

* Are you a Person with Disabilities (PWD)? NO

* Photo ID to be produced at test centre Aadhar Card * Photo-ID No. 667691060175

Qualification & Experience Details

* Qualification Name * Percentage of * Status of Qualification * Stream/Discipline
Marks

10+2 78 % Passed NA

Bcom - Appeared - Result Awaited Commerce

Experience in Months

* Have you earlier appeared in GMAT - NO CAT - NO XAT - NO

Whether your MAT score and other details to be shared with NO

B-Schools not opted by you. (There will be no additional fee
for this service)?

Payment Details
Transaction Reference No. Payment Date Receipt No/ PG Ref.No. Amount

5881187687 16/08/2019 19:20:32 QICI7878906358 1550.00

5881187687 16/08/2019 19:20:32 QICI7878906358 118.00

Declaration
I here by affirm that the particulars filled by me in this form are true and correct. I have read and understood the terms
and conditions of the test and agree to abide by those.
Registration No. 876021

Signature of Candidate

You are NOT required to send Registration Form/any documents/receipt to AIMA. Candidate can view/download the MAT
Prospectus from AIMA website. No separate Prospectus/CD will be dispatched.
 MAT September-2019 Registration Form (Part II)
Options for Management Institute Choices
Registration No. 876021

Name of Candidate Mr. Ansuman Mishra

Date of Birth 10-Apr-1998

Management Institute Choices :

* Choice 1 4911-ITM University : Raipur

* Choice 2 4134-Christ Institute of Management : Pune

* Choice 3 5639-Christ Universit : Bengaluru

* Choice 4 4154-Institute for Technology & Management : Mumbai

* Choice 5 7034-Institute of Business Management : Kolkata

* Choice 6 4122-Indus Business School : Pune

You may Change/Modify the MI Choice Options filled by you, by logging in at the website https://mat.aima.in/sep19 upto 21 September 2019.