XAT 2011

XAT PP Form ‐ Online Payment  

Note: Please paste your photograph and put your signatures in space provided and send this form to XAT Office.
XAT ID: XAT430791
 
XAT 2011 

XAT ID :  XAT430791

Please Affix your latest

photograph here NAME OF THE CANDIDATE:  Ankur Bhardwaj  

TEST CITY OF THE CANDIDATE :  Bangalore  

   
Please sign here

PAYMENT DETAILS :     
Transaction ID : 2000007830 Dated : 12‐Nov‐2010 Amount : Rs.974.18
     
PERSONAL DETAILS :      
Name of the candidate :   Ankur Bhardwaj  
Date of Birth:   23‐Jul‐1987  
Test City :   Bangalore  
Mailing Address(valid upto 31 May 2011)    
House No230 , 4th Main 4th Cross , 1st Block Koramangala    

City :  Bangalore State : Karnataka  

Pincode :  560034 Phone No: 7760497046  
Primary Email Id : urbuddyankur@gmail.com    
     
I hereby certify that the information provided by me in this application as well
DECLARATION :
as in the online registration form,is accurate and complete .I also agree to
abide by the decision of the institute's authorities on all matters regarding this
 
application.
 Date : 

 
Signature of the
candidate: