INDIAN INSTITUTE OF TECHNOLOGY ROORKEE APPLICATION NO
ROORKEE - 247 667 (Uttarakhand) India 1500259
APPLICATION FORM
FOR ADMISSION TO MBA PROGRAMME-2015
Affix your
DEPARTMENT OF MANAGEMENT STUDIES recent
passport size
photograph
here
CAT REGISTRATION NO CAT SCORE CAT PERCENTILE
4142625 119.05 85.24
CATEGORY GEN
PHYSICALLY DISABLED N
NAME OF THE CANDIDATE DIMPLE GARG
D.O.B. 03-Jul-1992
NATIONALITY INDIAN
GENDER F
FATHER'S NAME Naersh Garg
MOTHER'S NAME Savita Garg
ADDRESS
Garg Traders Sugar Merchant,
Main Bazar, Jaitu
Pincode - 151202
Dist - Faridkot
PHONE 9417732517
FAX
EMAIL dimplegarg333@gmail.com
Page 1 of 3
EDUCATIONAL DETAILS
EXAMS SUBJECTS DISCIPLINE BOARD/ SCHOOL/COLLEGE YEAR CGPA/PERCENTAGE
PASSED UNIVERSITY
10th Mathematics, CBSE Pattern Central Board of Delhi Public School 2008 79.60
Science, Secondary Bathinda
English, Social Education
Studies &
Punjabi
12th Mathematics, Non Medical Central Board of Rose Mary Convent 2010 63.00
Physics, Secondary School Balluana
Chemistry, Education Bathinda
English &
Physical
Education
B.Tech. Computer Punjab Technical Swami Vivekanand 2014 79.41
Science & University Institute of Engineering
Engineering and Technology Ram
Nagar Banur
WORK EXPERIENCE IF ANY
POST NAME OF ORGANISATION FROM NATURE OF DUTIES
TO
DURATION
ANY OTHER INFORMATION IF ANY
LIST OF DOCUMENT WHICH SHOULD BE ATTACHED WITH THE APPLICATION FORM
(I) PHOTOCOPY OF RELEVENT EDUCATIONAL CERTIFICATES/MARKSHEETS
(II) PHOTOCOPY OF CAT SCORE CARD
DECLARATION
I Dimple Garg hereby solemnly affirm that,
I have carefully read the Information Brochure and agree by the terms and conditions for admission to the MBA
program as laid down therein.
I understand that my application will stand rejected, if it is found to be incomplete or reaches late.
I certify that the particulars given by me in this application form are true to the best of my knowledge and belief .I
certify that, in the past I have not taken the admission in the IIT Roorkee for the same course.
I am eligible for interview/counseling for admission to the MBA program. It is my responsibility to prove my
eligibility as required by the Institute at the time of group discussion/interview.
I shall produce degree/mark sheet in original, special category certificate for verification at the time of group
discussion/interview/counseling as may be required by the Institute.
CAT Registration No. 4142625 Name of the candidate Dimple Garg
Place : ........................................
Date : .......................................... (Signature of the Candidate)
Page 2 of 3
APPLICATION NO
SUMMARY OF INFORMATION
1500259
CAT REGISTRATION NO. CAT SCORE CAT PERCENTILE
4142625 119.05 85.24
Affix your
NAME OF THE CANDIDATE DIMPLE GARG
recent
Mobile No. 9417732517 passport size
photograph
E-mail dimplegarg333@gmail.com here
Academic Qualifications
EXAMS SUBJECTS DISCIPLINE BOARD/ SCHOOL/COLLEGE YEAR CGPA/PERCENTAGE
PASSED UNIVERSITY
10th Mathematics, CBSE Pattern Central Board of Delhi Public School 2008 79.60
Science, Secondary Bathinda
English, Social Education
Studies &
Punjabi
12th Mathematics, Non Medical Central Board of Rose Mary Convent 2010 63.00
Physics, Secondary School Balluana
Chemistry, Education Bathinda
English &
Physical
Education
B.Tech. Computer Punjab Technical Swami Vivekanand 2014 79.41
Science & University Institute of Engineering
Engineering and Technology Ram
Nagar Banur
Work Experience
POST NAME OF ORGANISATION FROM NATURE OF DUTIES
TO
DURATION
Any other Information
Place : ........................................
Date : .......................................... (Signature of the Candidate)
Page 3 of 3
