Personal Details:

User ID 21189129
Candidate's Name PUSHPENDRA VERMA

Candidate's Surname or PUSHPENDRA

First Name
Date of Birth 16/Jan/1999

Country India

Email ID pushpendra.verma.3538@gmail.com

Mobile No 7905166035

Other Personal Details:

Father's/Guardian's Name SHIV KUMAR VERMA

Mother's/Guardian's Name GEETA DEVI VERMA

Spouse's Name

Candidate Gender Male Category NC-OBC

Nationality Do you require

Indian wheelchair support
at the test centre?
State/Union Territory of Uttar Pradesh Serial/Entry/Certifi
Category cate Number of 243173000986
Category
Caste/Tribe Name KURMI

PwD Category Would you be

using a scribe for
the Test?

Do you belong to Persons with Disabilities (PwD) category as per RPwD Act 2016? No
Communication Address :
Address Line1 VILLAGE ALHANA POST GUREPARA

Address Line2 TEHSIL LAHARPUR DIST. SITAPUR

Address Line3
Country India Pincode 261135

State/Union Uttar Pradesh

State
Territory
Town/City LAHARPUR District

Alternate Email pushpendravermapv04@gmail.com District Sitapur

Address
Emergency Contact Details :
Relationship MOTHER Emergency Mobile 8576041044
with Candidate Number
SSC/10th/Equivalent Details :
SSC/10th/Equivalent Board Name Central Board of Secondary Education

Month/Year of Completion May / 2014

Maximum Marks 500

Total Marks Obtained 399 Aggregate 79.8

Percentage :
HSC/12th/Equivalent/Diploma Course Details:
Course Type HSC

University/Board/Other Authority
Name
12th/Equivalent Board Name Central Board of Secondary Education

Duration of Diploma Course

12th/Equivalent Discipline Science

Month/Year of Course / Month/Year of May / 2016

Commencement Completion
Maximum Marks 500 Total Marks 397

Aggregate Percentage 79.40

First Bachelor's Degree Details:

Are you in the final year of Bachelor's Degree? No

Have you completed Bachelor's Degree? Yes

Total Duration of Degree 4 Year Current Semester

Aggregate Marks 79.5 Discipline Engineering/Technology

Type of NITs Degree Name BTECH

University/Institution
State/Union Territory of Uttar Pradesh University/Institute Sardar Vallabhbhai National Institute of
University Name Technology, Surat

Month/Year of Course (Month/Year of

Commencement July
/
2017
Course Completion) /
May
/ 2021
(Probable Month/Year
of Course Completion)
Do you have or are you undergoing dual or 5 year integrated course? No
Aggregate Marks or Promotion/Pass without Marks?
Name of College/Institution :- SARDAR VALLABHBHAI NATIONAL INSTITUTE OF
TECHNOLOGY SURAT

I have more than one Bachelor's Degree

Second Bachelor's Degree Details:

Are you in the final year of Bachelor's Degree?
Have you completed Current Semester
Bachelor's Degree?
Total Duration of Degree Type of
University/Institution
Aggregate Marks (%) State/Union Territory of
University
Aggregate Marks or Promotion/Pass without Marks?
Degree Name University/Institute
Name

Discipline Name of
College/Institution

Month/Year of Course (Month/Year of Course

/
Commencement Completion) /(Probable
/ Month/Year of Course
Completion)
Master's Degree Details:
Do you want to enter No Master's Degree
Master's Degree details? Completion Status

Total Duration of Current Semester

Degree

Aggregate Marks (%) Type of

University/Institution

Degree Name State/Union Territory

of University

Discipline University/Institute
Name

Name of Month/Year of Course /

College/Institution Commencement

(Month/Year of Course Completion) /(Probable Month/Year of Course Completion) /

Aggregate Marks or Promotion/Pass without Marks?
Other Professional Degree Details:
Are you a Fellow of the Institute of Actuaries of India (FIAI) ? No

FIAI Final Aggregate Marks (%)

Month/Year of Course Commencement / Month/Year of Completion /
Have you completed any professional degree such as No
CA/CS/ICWA?
CA Degree Completion Status :
ICWA Degree Completion Status :
CS Degree Completion Status :
Name of professional Professional Inter Marks
degree
Professional Final Marks (%)
Professional Final Month/Year of Course /
Aggregate Marks Commencement
Month/Year of / Probable Month/Year of /
Completion Completion
Work Experience (If any) :
Industry Type Break in Work Experience (In
Start Date End Date days as on July 31, 2021)
Experience
Automobiles/
Auto-ancillaries
Banking/
Financial Servics
Durables
Engineering/ 15/07/2021 31/07/2021 0 17
Industrial
Fast Moving
Consumer Goods
(FMCG)
Information
Technology
Pharmaceuticals/
Healthcare
Retail
Telecommunications

Others

Total Work Experience(In days as on July 31, 2021) 17

Programmes:
Programme Name Selected/Not Interview City
Ahmedabad
IIM Ahmedabad PGP Selected
Mumbai

IIM Ahmedabad PGP- Ahmedabad

FABM Selected
Mumbai

IIM Ahmedabad PhD Selected Ahmedabad

Mumbai
IIM Amritsar MBA Selected
Delhi

Mumbai
Selected
IIM Amritsar PhD
Delhi

IIM Amritsar EMBA Mumbai

Selected
Delhi

Mumbai
IIM Amritsar MBA- Selected
Business Analytics Delhi

Mumbai
IIM Amritsar MBA-HRM Selected
Amritsar

Mumbai
IIM Bangalore PGP Selected
Bengaluru

IIM Bangalore PGPEM Selected Bengaluru

IIM Bangalore PhD Selected Bengaluru

Mumbai
IIM Bangalore PGPBA Selected
Bengaluru

Mumbai
IIM Bodh Gaya PGP Selected
Delhi

IIM Bodh Gaya PhD (FPM) Selected Bodh Gaya

Mumbai
IIM Calcutta MBA Selected
Kolkata

IIM Calcutta PhD Selected Kolkata

Indore
IIM Indore PGP Selected
Mumbai
 Mumbai
IIM Indore PGP-HRM Selected
Indore

IIM Indore FPM Selected Indore

IIM Jammu MBA Not Selected

IIM Jammu PhD Not Selected

IIM Kashipur MBA Not Selected

Not Selected
IIM Kashipur EMBA

IIM Kashipur PhD Not Selected

IIM Kashipur MBA

Not Selected
(Analytics)
Mumbai
IIM Kozhikode PGP Selected
Kozhikode

Mumbai
IIM Kozhikode PGP-F Selected
Kozhikode

Mumbai
IIM Kozhikode PGP-LSM Selected
Kozhikode

Mumbai
IIM Kozhikode PGP-BL Selected
Kozhikode

IIM Kozhikode EPGP Selected

Kozhikode

Kochi Kochi

IIM Kozhikode PhD Not Selected

IIM Kozhikode PhD (PT) Not Selected

Mumbai
IIM Lucknow PGP Selected
Lucknow

Mumbai
IIM Lucknow PGP-ABM Selected
Lucknow

Mumbai
IIM Lucknow PGP-SM Selected
Lucknow

IIM Lucknow PhD Selected Lucknow

IIM Nagpur PGP

Mumbai
Selected
Nagpur
 IIM Nagpur PhD Selected Nagpur

Mumbai
IIM Raipur PGP Selected
Delhi

IIM Raipur FPM/PhD Not Selected

IIM Raipur EFPM Not Selected

Mumbai
IIM Ranchi PGP Selected
Delhi

IIM Ranchi PGP (Business Mumbai

Analytics) Selected
Delhi

Mumbai
IIM Ranchi PGP-HRM Selected
Ranchi

IIM Ranchi PhD Selected Ranchi

IIM Ranchi EPhD Selected Ranchi

Mumbai
IIM Rohtak PGP Selected
Delhi

IIM Rohtak EPGPX Not Selected

IIM Rohtak EPGDSM Not Selected

IIM Rohtak PhD Not Selected

IIM Sambalpur MBA Not Selected

IIM Sambalpur
Executive MBA Not Selected

IIM Sambalpur PhD Not Selected

IIM Sambalpur Not Selected

Executive PhD
Mumbai
IIM Shillong PGP Selected
Delhi

IIM Shillong PGPEX Not Selected

IIM Shillong PGPWE Not Selected

Not Selected
IIM Shillong PhD
 Not Selected
IIM Shillong PhDWP

IIM Sirmaur MBA Not Selected

IIM Sirmaur MBA Not Selected

(TandHM)

IIM Sirmaur PhD Not Selected

Mumbai
IIM Tiruchirappalli PGPM Selected
Delhi

IIM Tiruchirappalli PGPM- Not Selected

HR

IIM Tiruchirappalli PGPBM Not Selected

IIM Tiruchirappalli FPM Not Selected

IIM Tiruchirappalli E-FPM Not Selected

IIM Udaipur MBA Not Selected

IIM Udaipur MBA-DEM Not Selected

IIM Udaipur MBA-GSCM Not Selected

IIM Udaipur PGDBAWE Not Selected

IIM Udaipur PhD Not Selected

IIM Visakhapatnam PGP Not Selected

IIM Visakhapatnam PhD Not Selected

IIM Visakhapatnam PGPEx Not Selected

IIM Visakhapatnam Not Selected

PGPDGM
Test City Preferences:
Preferred Test City 1 Vadodara Preferred Test City 2 Surat

Preferred Test City 3 Ahmedabad Preferred Test City 4 Mumbai

Preferred Test City 5 Navi Mumbai Preferred Test City 6 Anand

Payment Details :
Amount 2200 Payment Mode online

Payment Status S Payment Transaction No. 13962566562

Declaration:
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 2021 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 2021 application & scores. I understand that all disputes will be subject to
the territorial jurisdiction of city of Ahmedabad only.