Mat Registration

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  • Topic: Signature, Digital signature, Degree
  • Pages : 3 (487 words )
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  • Published : January 16, 2011
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MAT REGISTRATION FORM (Feb. 2011)|

*| Registration/Form No.|
*529559*| |
*| Choice of Test Taking Option| Offline (Paper Based Test)| | *| Test Centre City| Choice I.   503-KARNATAKA: BANGALORE| |  |  | Choice II.  505-KARNATAKA: MANGALORE| |
Personal Particulars|
*| Name of Candidate| Mr.  BHUPESH DASGUPTA|  |  |  | *| Date of Birth| 20-Jun-1989| *| Gender| Male|
*| Nationality| Indian| *| Category| GEN|
*| Address for Communication| SO2,58 LANGFORD ROAD|  |  |  |  |  | RICHMOND TOWN|  |  |  |
 |  | SHANTINAGAR|  |  |  |
*| City| BANGALORE| *| Pin Code| 560025|
 | Email-ID| BHUPESH.DASGUPTA@GMAIL.COM|
 | Contact No.| |  | Mobile No.| 9663887192|

Qualifications & Experience Details|
*| Status of Degree| PASSED|  |  |  |
*| Percentage at 10+2| 53| *| Percentage at Degree| 62| *| Stream/Discipline in Degree| COMMERCE|  | Experience in Months| | | Have you earlier appeared in| GMAT : -| | CAT : -| XAT : -|

Mode of Payment     --> Credit/Debit Card|
*| Transaction No./Receipt No.| 38030
101602211900| *| Payment Date| 15-1-2011|

Declaration| |
I hereby affirm that the particulars filled by me in this form are true and correct. I have read and understood the terms and conditions of the test and agree to abide by those.| | Registration/Form No.  529559|

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Place| |
Date| Signature of Applicant|
| (To be signed prior to despatch)|
Kindly save this page by using   'SAVE AS' function given in the 'FILE' menu of this window before taking the print out.| | |
| (Please Print the form for Further Reference)|
 Important Instruction for Candidates: 1. Affix your passport size photograph (without attestation) in the space provided below. 2. Endorse your signatures in the space provided below. 3....
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