Personal Details:

User ID 23005354

Candidate's Name JAYESH JAISWAL

Candidate's First Name JAYESH

Candidate's Middle Name

Candidate's Last Name JAISWAL

Date of Birth 24/May/1998

Country India

Email ID [email protected]

Alternate Email ID [email protected]

Mobile No 91 8789727060

Other Personal Details:

Father's/Guardian's Name JAYANT KUMAR

Mother's/Guardian's Name SEEMA JAISWAL

Spouse's Name

Candidate Gender Male Category NC-OBC

Nationality Indian Other Nationality

State/Union Territory of Bihar Serial/Entry 124 A

Category Number of the
Caste
Caste/Tribe Name Kalwar

Do you belong to Persons No Is the disability

with Disabilities (PwD) measurable?
category as per RPwD Act
2016?
Percentage of Disability PwD UDID
Number

PwD Category

Do you require wheelchair Would you be

support at the test centre? using a scribe for
the Test?
First Covid Vaccination Second Covid
Date Vaccination Date
Communication Address :
Address Line1 SJ Enterprises, Raj Mandir Campus

Address Line2 Main Road

Address Line3
Country India Other Country
State/Union
Territory
District East Champaran Other District
Town/City Ghorasahan Pincode 845303

Emergency Contact Details :

Emergency 9931292809 Relationship with Father
Mobile Number Candidate
SSC/10th/Equivalent Details :
SSC/10th/Equivalent Board Name Central Board of Secondary Education

Other Board Name

Month/Year of Completion May 2014

Maximum Marks (Inclusive of all subjects): 600

Total Marks Obtained 570 Aggregate 95

(Inclusive of all subjects) Percentage (%)
HSC/12th/Equivalent/Diploma Course Details:
Course Type 12th/Equivalent

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

12th/Equivalent Other Board

Name
Duration of Diploma Course (In
Year)
Discipline Science

12th/Equivalent Other Discipline Month/Year of Course

Commencement

Month/Year of Completion May 2016 Aggregate Marks or

Promotion/Pass
without Marks?
Maximum Marks (Inclusive of all Total Marks Obtained 452
subjects) 500 (Inclusive of all subjects)

Aggregate Percentage (%) 90.40

I declare that I have not been awarded

any marks due to Covid-19 and if this
information found to be incorrect,
CAT 2023 holds right to cancel my
application.
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

Type of Private University Other Type of
University/Institution University/Institution
State/Union Territory of Uttarakhand Other State/Union Territory
University of University

University/Institute Name Others Other University/Institute Dehradun Institute of Technology

University
Name
Name of College/Institution Dehradun Institute of Degree Name BTECH
Technology

Other Degree Name Discipline Computer Science

Graduation Stream Engineering

Other Discipline Name

Month/Year of Course August 2016 Probable Month/Year of May 2020

Commencement Course Completion

Aggregate Marks or Promotion/Pass without Marks? Aggregate Marks

Aggregate Marks (%) 68

I declare that I have not been awarded any marks due to Covid-19 and if this
information found to be incorrect, CAT 2023 holds right to cancel my application.

Do you have or are you undergoing dual or 5 year integrated course? No

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 Bachelor's Degree?
Total Duration of Degree Current Semester

Type of Other Type of

University/Institution University/Institution
State/Union Territory of Other State/Union Territory
University of University

University/Institute Other University/Institute

Name Name

Name of College/ Degree Name

Institution

Other Degree Name Discipline

Other Discipline Name

 Graduation Stream: Month/Year of Course
Commencement
Probable Month/Year Aggregate Marks or
of Completion: Promotion/Pass without
Marks?
Aggregate Marks (%)

I declare that I have not been awarded any marks due to Covid-19 and if this
information found to be incorrect, CAT 2023 holds right to cancel my application.
Master's Degree Details:
Do you want to enter Master's Degree details? No
Master's Degree Completion Status Total Duration of Degree

Current Semester Type of University/

Institution

Other Type of University/Institution State/Union Territory of

University

Other State/Union Territory University/Institute Name

of University

Other Name of College/

University/ Institution
Institute Name
Degree Name Other Degree Name

Discipline

Other Discipline Name Month/Year of

Commencement
Probable Month/Year of Completion Aggregate Marks or
Promotion/Pass without
Marks?
Aggregate Marks (%)
I declare that I have not been awarded any marks due to Covid-19 and if this information found
to be incorrect, CAT 2023 holds right to cancel my application.
Other Professional Degree Details:
Are you a Fellow of the Institute of Actuaries of India (FIAI) ? No
FIAI Final Aggregate Month/Year of
Marks (%) Commencement
Month/Year of Do you want to enter any No
Completion professional degree details
such as CA/CS/ICWA?
Degree Completion Degree Completion Status
Status
Degree Completion Specify Other Professional
Status Degree

Professional Inter Professional Final Marks

Marks (%) (%)
Professional Final Aggregate Marks Month/Year of Course
(%) Commencement
Month/Year of Probable Month/Year of
Completion Completion
Work Experience (If any):
Industry Type Work Experience Work Experience Gap in work Work Experience
Start Date End Date experience (In days as on
31st July 2023)
Automobiles/Auto-
ancillaries

Banking/Financial Services

Durables

Engineering/Industrial

Fast Moving Consumer

Goods (FMCG)

27/10/2020 31/07/2023 314 694

Information Technology

Pharmaceuticals/Healthcare

Retail

Telecommunications

Others

694
Total Work Experience (In days as on 31st July 2023)
Total Work Experience(In Month and days as on July 31, 2023) 23 Month(s) 04 Day(s)

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

Mumbai
IIM Ahmedabad PGP- Selected
FABM Ahmedabad
IIM Ahmedabad ePGD-ABA Selected Ahmedabad

IIM Ahmedabad Doctoral Selected Ahmedabad

Programme in Management
Mumbai
Selected
IIM Amritsar MBA
Bengaluru

Mumbai

IIM Amritsar PhD Selected

Bengaluru

Mumbai
IIM Amritsar Executive Selected

MBA Bengaluru

Mumbai
IIM Amritsar Selected
MBA-Business Analytics Bengaluru

Mumbai
IIM Amritsar MBA-Human Selected
Bengaluru
Resource Management
Mumbai
IIM Amritsar M.Sc. In Data
Selected
Science(MSDSM) jointly
Bengaluru
offered with IIT Ropar

Mumbai
IIM Bangalore PGP Selected
Bengaluru

IIM Bangalore PGPEM Selected Bengaluru

Selected Bengaluru
IIM Bangalore PhD
Mumbai

IIM Bangalore PGPBA Selected

Bengaluru

Mumbai
Selected
IIM Bodh Gaya MBA
Bengaluru

IIM Bodh Gaya PhD Selected Bodh Gaya

Mumbai
IIM Bodh Gaya MBA (Digital Selected
Business Management) Bengaluru

IIM Bodh Gaya MBA (Hospital Mumbai

Selected
and Healthcare Management) Bengaluru

Mumbai
Selected
IIM Calcutta MBA
Bengaluru

IIM Calcutta Doctoral Programme Selected Kolkata

(PhD)
Selected Mumbai
IIM Indore PGP
Bengaluru
Mumbai
IIM Indore PGP-HRM Selected
Bengaluru
 IIM Indore MSDSM Selected Indore

IIM Indore FPM Selected Indore

Mumbai
IIM Jammu MBA Selected
Bengaluru

IIM Jammu PhD Selected Delhi (NCR)

IIM Jammu MBA(Hospital Mumbai

Selected
Administration & Healthcare
Management) Bengaluru

Delhi (NCR)
IIM Jammu Ph.D(Working Selected
Professionals) Chandigarh

Delhi (NCR)
Selected
IIM Jammu Executive MBA
Chandigarh

Mumbai
Selected
IIM Kashipur MBA Bengaluru

Selected Dehradun
IIM Kashipur EMBA
Kashipur

IIM Kashipur EMBAA Selected Kashipur

IIM Kashipur PhD Selected Kashipur

IIM Kashipur MBA Selected Mumbai

(Analytics) Bengaluru

Selected Mumbai
IIM Kozhikode PGP
Bengaluru

Selected Mumbai
IIM Kozhikode PGP-F
Bengaluru
Mumbai
IIM Kozhikode PGP-LSM Selected
Bengaluru
Mumbai
IIM Kozhikode PGP-BL Selected
Bengaluru

Selected Kozhikode
IIM Kozhikode EPGP Kochi
Kochi
Selected Kozhikode
IIM Kozhikode PhD
IIM Kozhikode Fellow Online
Programmes in Management
Selected

PhD (PT)
IIM Kozhikode Executive Post
Graduate Programme in Selected Online
Management through Interactive
Learning (EPGP-IL)
Mumbai
IIM Lucknow MBA Selected
Bengaluru
Mumbai
IIM Lucknow MBA-ABM Selected
Bengaluru

IIM Lucknow PGPWE Selected Delhi (NCR)

Mumbai
IIM Lucknow MBA-SM
Selected
Bengaluru
 IIM Lucknow PhD Selected Lucknow

Mumbai
Selected
IIM Lucknow MBA-EandI Bengaluru
Selected Mumbai
IIM Nagpur MBA
Bengaluru

IIM Nagpur MBA Selected Pune

(Executive) Nagpur

IIM Nagpur PhD Selected Nagpur

(Executive)
IIM Nagpur PhD Selected Nagpur

Mumbai
IIM Raipur PGP Selected
Bengaluru

IIM Raipur FPM/PhD Selected Raipur

IIM Raipur EFPM Selected Raipur

Selected Mumbai
IIM Ranchi MBA
Bengaluru

IIM Ranchi MBA Selected Mumbai

(Business Analytics) Bengaluru

Mumbai
IIM Ranchi MBA-HRM Selected
Bengaluru

IIM Ranchi PhD Selected Ranchi

IIM Ranchi EPhD Selected Ranchi

Selected Mumbai
IIM Rohtak PGP
Bengaluru

IIM Rohtak PGPX Selected Rohtak

Selected Rohtak
IIM Rohtak EPGDSM
IIM Rohtak PhD Selected Rohtak

Mumbai
IIM Sambalpur MBA Selected
Bengaluru

IIM Sambalpur Executive Selected Mumbai

MBA Bengaluru

IIM Sambalpur PhD Selected Mumbai

Bengaluru

IIM Sambalpur Executive Selected Mumbai

PhD
Mumbai
IIM Sambalpur MBA for Selected
Working Professional Bengaluru

Mumbai
Selected
IIM Shillong PGP
Bengaluru

Selected Mumbai
IIM Shillong PGPEX Bengaluru

IIM Shillong PGP (WE) Selected Online

 Mumbai
IIM Shillong Doctoral Program Selected
Bengaluru

IIM Shillong Doctoral Selected

Mumbai

Program (WP) Bengaluru

Selected Bengaluru
IIM Sirmaur MBA
Mumbai

IIM SirmaurMBA (Tourism Selected

Bengaluru
Management) Delhi

IIM Sirmaur ExMBA Selected Sirmaur

IIM Sirmaur PhD Selected Sirmaur

Delhi
IIM Sirmaur PhD(Executive) Selected
Sirmaur

Mumbai
IIM Tiruchirappalli PGPM Selected
Bengaluru

IIM Tiruchirappalli PGPM- Selected Mumbai

HR Bengaluru

IIM Tiruchirappalli PhD

Selected Trichy

IIM Tiruchirappalli Executive Selected Trichy

PhD
Mumbai
IIM Udaipur MBA Selected
Bengaluru

IIM Udaipur MBA-DEM Selected Udaipur

IIM Udaipur MBA-GSCM Selected Udaipur

IIM Udaipur PGDBAWE Selected Udaipur

IIM Udaipur PhD Selected Udaipur

Selected Mumbai
IIM Visakhapatnam PGP
Bengaluru

IIM Visakhapatnam PhD Selected Visakhapatnam

IIM Visakhapatnam EMBA Selected Visakhapatnam

IIM Visakhapatnam Selected Visakhapatnam

PGPDGM
Test State-City Preferences:
Maharashtra - Thane Maharashtra - Navi Mumbai
Preferred Test State- Preferred Test State-
City 1 City 2

Preferred Test State-

Maharashtra - Mumbai Preferred Test State- Maharashtra - Pune

City 3 City 4

Preferred Test State-

Maharashtra - Vasai
Preferred Test State- Maharashtra - Raigad

City 5 City 6
Payment Details :
Transaction Number 5294918262113 Payment Mode online

Applicable Registration 2400 Payment Status S

Fee (Rs)
Declaration:
I have previewed the Application Form by clicking on the Preview Application Button and
confirm that all the data reflecting in the Preview are correct.

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 2023 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 2023 application & scores. I understand that all disputes will be subject
to the territorial jurisdiction of city of Lucknow only.