Annexure-3

Indian Institute of Management Raipur

Atal Nagar, P.O. Kurru-Abhanpur Raipur -493661, Chhattisgarh

Post Graduate Programme in Management 2020-22

STUDENT INFORMATION FORM

1. NAME IN ENGLISH (Capital Letters)

(Name as given in 10 th Standard /School Leaving Certificate and as required to be printed in the Diploma).
HIMANSHU SHARMA

2. Name in Hindi

हहहहहहह हहहहह

3. Father’s Name Dhananjay Sharma

4. Mother’s Name Veena Sharma

5. Gender (Put  ) Male  Female Transgender

6. Marital Status (Put  ) Single Married 

7. Category General NC- SC ST  DAP General -

(Put ) OBC EWS

7 (A) If DAP, type of Disability (Put  )

Locomotor Cerebral Visual Hearing Other

Disability Palsy Impairment Impairment (Pls. Specify)

8. Whether belong to Minority Community?

Yes No 

If yes, Category (Buddhist/Christian/Jain/Muslim/Parsi/Sikh/Etc.)

9. Religion Hindu 9 (A) Nationality Indian

10. Date of Birth (DD/MM/YYYY) 1 1 0 8 1 9 9 9

11. Place of Birth Jamshedpur

12. Blood Group O+

13. Permanent Email ID Himanshu1181999@gmail.com

14. Address
14A. Permanent Address 14B. Contact person in case of emergency
C-3/35, Aya Nagar Extension, Phase – IV Name Dhananjay Sharma

Relation Father
Address C-3/35, Aya Nagar Extension
City New Delhi Phase – IV, New Delhi
Rural/Urban Urban
Tel. Phone
State Delhi (with STD NA
Code)

PIN 1 1 0 0 4 7 Mobile
9350871197
Tel Phone NA Email ID sharma.dhananjay67@gmail.com
(with STD Code)

15. Annual Income for family from all sources i.e. Salary, Rent, ₹ 9,58,433
Business etc.

16. Educational Qualification

16 A. Pre-Degree
Total Total
Standard Board/University Year of Class/ % of Marks
Max Marks
Completion Division obtained
Marks Obtained
th CBSE 2015 10 CGPA 7.6 CGPA Ist 72%
10
CBSE 2017 500 423 Ist 84.6%
12th

16 B. Graduation/Post-Graduation
Degree Specialization/
(BE/BA/B Discipline Name of Year of Max Marks
Name of the % of Marks CGPA/
Com/B (Mechanical, University/ Completi Marks/ Obtaine
Sc/B.
College Obtained CPI
Comp. Sci., Institution on GPA d/ GPA
Tech. etc.) Literature, etc.)

Shri Ram
B.com Delhi
- Hons
Commerce College of 2020 10 - - -
University
Commerce

16 C. Professional Qualification, If any (CA/CS/ICWA/ Foreign Language etc.)

 Name of The Board/University/ Year of Total Total Marks Class/
Qualification Institute/ Organization Completion Max Marks Obtained Division/Grade

17. Work Experience

17A. Full Time
(Do not include training or project or any work done as a part of curriculum requirements)
Gross
Reason for
S/N Organization Designation Job Profile Emolument Duration
Leaving
(in per Month)

Total full time Work Experience as on 31st July, 2019 (in months)

17B. Part Time, Training, Project Work etc.

(Other than the work done as part of curriculum requirement full time or full-time job)
S/N Organization Duration Nature of Work Remarks
Strategic and
1. Rhyno(Trevally Tech Mobility) 2 Months -
Operations Intern

2. Kaarmic Education Services 1 Month Camp Facilitator -

18. National Academic Depository (NAD) ID:

19. Aadhar Number: 5755 5995 1855

DECLARATION
1. The information furnished by me above is best of my knowledge and belief. I understand that in case any of the information
given by me is found incorrect, my registration is liable to be cancelled.
2. I hereby agree to abide by the rules and regulations pertaining to academic evaluation, general code of conduct, and all
other rules and regulations as stated in the PGP manual
3. I further agree to abide by any other rules and regulations that may come in force during the period of my study at the
Indian Institute of Management Raipur.
Date: 17-07-2020 Signature: ______________________

Place: New Delhi Name: Himanshu Sharma