Application Form

Application No: JSB/PGDM/2024-26/0648

Applicant and Program Details

Basic Details
Course PGDM Specialization BUSINESS ANALYTICS
Personal Details
Title MR First Name PRASHANT Middle Name
Last Name KUMAR Email Address PKSUMAN1998@GMAIL.COM Mobile Number +91-6206433282
Date of Birth 17/09/1998 Gender MALE Nationality INDIAN
Aadhaar Card Facebook User ID/
972003707534 Instagram Id NHJJ
Number Login ID
Do You Require Hostel
Category OBC NO
Accommodation?
Passport Details
Passport Number Country Place of Issue
Date of Issue Date of Expiry

Parent's Details
Father's Details
Father's Email
Father's Title MR Father's Name SS MANDAL
Address
Father's Mobile
+91-6206433282 Father Occupation GOVERNMENT SECTOR Father's Qualification POST GRADUATE
Number
Mother's Details
Mother's Email
Mother's Title MS. Mother's Name JAIKALA DEVI
Address
Mother's Mobile Mother's
+91-6206433282 Mother Occupation HOMEMAKER 10TH
Number Qualification

Address Details
Address for Correspondence
Country INDIA State DELHI District NEW DELHI
CSIR SCIENTIST APPARTMENT
City NEW DELHI Address Line 1 Address Line 2
MAHARANI BAGH NEW DELHI
Is Permanent Address
Pincode 110065 Same As Address For YES
Communication?
Permanent Address
Country INDIA State DELHI District NEW DELHI
CSIR SCIENTIST APPARTMENT
City NEW DELHI Address Line 1 Address Line 2
MAHARANI BAGH NEW DELHI
Pincode 110065

Educational Qualification Details

Academic Details
Xth Details

Obtained CGPA /
School Name Board Year of Passing Marking Scheme
Percentage
DE NOBILI SCHOOL - C.M.R.I. COUNCIL OF INDIAN SCHOOL CERTIFICATE
X 2015 PERCENTAGE 72.83
DHANBAD EXAMINATION (CISCE/ICSE)

XIIth Details

Year of Obtained CGPA /

School Name Board / University Stream Result Status Marking Scheme
Passing Percentage
DELHI PUBLIC SCHOOL CENTRAL BOARD OF SECONDARY
XII SCIENCE DECLARED 2017 PERCENTAGE 70.66
DHANBAD EDUCATION (CBSE)

Graduation Details

Year of Marking Obtained CGPA /

Institute Name University Degree Result Status
Passing Scheme Percentage
 FUTURE INSTITUTE OF MAULANA ABUL KALAM AZAD
UG B.TECH DECLARED 2022 CGPA 8.53
ENGINEERING AND MANAGEMENT UNIVERSITY OF TECHNOLOGY

Have you
appeared in any
YES
entrance
examination ?
Entrance Test Details

Exam Exam Roll No. Year of Appearing Result status Score/Percentile All India Rank
1 CAT 23201851 2023 DECLARED 40 40
2
3

Do you Have Work

NO
Experience ?
Professional Work Experience & Company Name
Work Experiance

Company Name Designation From Year To Year Monthly Rumenration Reason For Leave
1
2
3

Total Period of
Work Experience
(In Months)
Referral Details
Referrer Mobile
Referrer Is ALUMANI REFERRAL Referrer Name
Number

Upload Documents
Upload Files

Upload Your Recent

Upload Your Upload Your Xth
Passport Size YES
Signature : Certificate :
Photograph :

Upload Your
Upload Your XIIth Upload Your Entrance
YES Graduation NO YES
Certificate : Exam Scorecard :
Certificate :

Upload Your Aadhaar Upload the front side Upload the back side
YES NO NO
Card : of your passport : of your passport :

Declaration
I hereby declare
that the entries
made by me in the
Application Form
are complete and
true to the best of
my knowledge,
belief and
information. I I AGREE Applicant Name PRASHANT KUMAR Parent Name SS MANDAL
acknowledge that
the college has
the authority for
taking punitive
actions against
me for violation or
non-compliance of
the same
Date 19/03/2024