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    JEE (Main) AcknowledgementPage PDF

    Uploaded by

    Laman Ansari
    This document is an acknowledgement page for Laman Ansari's application to the Joint Entrance Examination (Main) - 2017. It provides personal details for Laman such as name, date of birth, gender, address, school and academic details. It also lists the exam details including the paper being applied for, medium, exam center choices. Payment details such as transaction amount and ID are included, as well as guardian details and a declaration by the candidate.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    JEE (Main) AcknowledgementPage PDF

    Uploaded by

    Laman Ansari
    121 views1 page
    This document is an acknowledgement page for Laman Ansari's application to the Joint Entrance Examination (Main) - 2017. It provides personal details for Laman such as name, date of birth, gender, address, school and academic details. It also lists the exam details including the paper being applied for, medium, exam center choices. Payment details such as transaction amount and ID are included, as well as guardian details and a declaration by the candidate.

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    JEE(Main)_AcknowledgementPage.pdf

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    This document is an acknowledgement page for Laman Ansari's application to the Joint Entrance Examination (Main) - 2017. It provides personal details for Laman such as name, date of birth, gender, address, school and academic details. It also lists the exam details including the paper being applied for, medium, exam center choices. Payment details such as transaction amount and ID are included, as well as guardian details and a declaration by the candidate.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    121 views1 page

    JEE (Main) AcknowledgementPage PDF

    Uploaded by

    Laman Ansari
    This document is an acknowledgement page for Laman Ansari's application to the Joint Entrance Examination (Main) - 2017. It provides personal details for Laman such as name, date of birth, gender, address, school and academic details. It also lists the exam details including the paper being applied for, medium, exam center choices. Payment details such as transaction amount and ID are included, as well as guardian details and a declaration by the candidate.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Joint Entrance Examination (Main) - 2017

    CENTRAL BOARD OF SECONDARY EDUCATION


    ACKNOWLEDGEMENT PAGE

    Application No.

    70243844
    DO NOT SEND THIS PAGE TO CBSE.

    CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.

    Personal Details
    Name:

    LAMAN ANSARI

    Date of Birth:

    02/02/1999

    Mother's Name:

    FARHA ANSARI

    Category

    GENERAL

    Father's Name:

    LAIQ AHMAD ANSARI

    Person with Disability(PwD):

    NO

    State of Eligibility:

    RAJASTHAN

    Percentage of Disability:

    --

    Gender:

    MALE

    Are you the only child?:

    NO

    Nationality:

    INDIAN

    Place of Residence:

    URBAN

    Aadhaar Number

    563606220828

    You need scribe/reader ?:

    NO

    Examination Details
    Applying For:

    JEE(Main) Paper - 1 (B.E./B.Tech.) Only

    Mode of Examination:

    PEN AND PAPER BASED EXAMINATION

    Question Paper Medium:

    ENGLISH

    1st Choice of Exam Centre:

    JAIPUR

    2nd Choice of Exam Centre:

    AJMER

    3rd Choice of Exam Centre:

    DELHI/NEW DELHI

    4th Choice of Exam Centre:

    KOTA

    Academic Details
    Year of passing class 10th:

    2015

    Year of Passing or Appearing class 12th/Qualifying Exam: 2017

    Place of 12th class schooling:

    CITY

    Type of Institution of Class 12th/Qualifying Exam:

    PRIVATE

    School Board of class 12th/Qualifying Exam:

    CENTRAL BOARD OF SECONDARY EDUCATION

    Name of the Qualifying Examination passed / appearing:

    The final examination of the 10+2 system, conducted by any recognized central/ state Board, such as Central
    Board of Secondary Education, New Delhi; Council for the Indian School Certificate Examinations, New Delhi;
    etc.

    Percentage of Marks in Class 12th/Qualifying Exam:

    --

    Roll No. of Class 12th/Qualifying Exam:

    --

    Appeared/Appearing for Improvement of Class


    12th/Qualifying Exam:

    NO

    Mode of preperation:

    COACHING

    Roll Number of Class 12th/Qualifying Examination of


    Improvement Examination:
    Name and Address of the School/College from where
    passed/appearing:

    Jayshree Periwal high school Chitrakoot, Jaipur, Rajasthan, 302021

    Candidate's Mailing Address


    Country:

    India

    State:

    RAJASTHAN

    District:

    JAIPUR

    Address:

    560, udai Path, Vivek Vihar

    Locality:

    Shyam Nagar

    City/Town/Village:

    Jaipur

    Pin Code:

    302019

    Email Address:

    [email protected]

    Mobile Number:

    9460336555

    Land Line Number:

    1412290930

    Guardian Details
    Qualification

    Occupation

    Annual Income

    Father's/Guardian's:

    GRADUATE

    BUSINESS

    RS. 800001 AND ABOVE

    Mother's:

    GRADUATE

    OTHERS (INCLUDING HOUSE WIFE)

    UPTO 100000

    Provider Name:

    Syndicate Bank Payment Gateway

    Payment Mode:

    Electronic Payment Gateway

    Fee Type:

    Examination Fee

    Transaction Amount:

    1000 /-

    Transaction ID:

    HAXG4964619897

    Date of Transaction:

    12-12-2016 14:16:31

    Payment Details

    DECLARATION
    I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. I have read and understood the JEE procedures for both
    JEE(Main) and JEE(Advanced) - 2017. I shall abide by the terms and conditions thereon.

    Images Uploaded by Candidate


    Photograph

    Signature

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