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TBJEE - Application Acknowledgment PDF

This document is an application acknowledgment for the Tripura Joint Entrance Examination 2023. It provides details of the applicant such as name, date of birth, address, school information, category, and exam group preference. The applicant declares that they have satisfied all eligibility conditions and that their candidature could be cancelled if any information is found to be incorrect.

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Arun kumar Tripura
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104 views1 page

TBJEE - Application Acknowledgment PDF

This document is an application acknowledgment for the Tripura Joint Entrance Examination 2023. It provides details of the applicant such as name, date of birth, address, school information, category, and exam group preference. The applicant declares that they have satisfied all eligibility conditions and that their candidature could be cancelled if any information is found to be incorrect.

Uploaded by

Arun kumar Tripura
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Application Acknowledgment for Tripura Joint Entrance Examination - 2023

Registration Number: U20234024333

Name: PRIYASHI CHAKMA Date of Birth: 12/12/2003


Email: [email protected] Mobile: 8798054868
Father's Name: DIPAN CHAKMA Mother's Name: ALO CHAKMA
Gender: Female Category: ST
Category Card Number: SDM/LT Category Card Issue Date: 2015-06-04
Valley/STC/201530050004310
Nationality: INDIAN Physically Handicapped: No
Below Poverty Level: Yes Ex-Service Man: No
Ration Card Number: 161000798615
PRTC: Yes PRTC Card Number: SDM/LT
Valley/PRTC/201530020032768
PRTC Card Issue Date: 2015-06-04
Permanent Address: LT VALLEY,CHAILENGTA Address for Communication: LT VALLEY,CHAILENGTA
GAINAMA GAINAMA
MAINAMA MAINAMA
District: Dhalai District: Dhalai
PIN: 799275 PIN: 799275

Name of H.S. or Equivalent AISSCE Examination Status: Appearing


Qualifying Examination:
Year of Passing / Appearing: 2023 Name of The Board: CBSE
Name of the School: EKLAVYA MODEL RESIDENTIAL Address of the School: KUMARGHAT
SCHOOL DARCHAWI
UNAKOTI,TRIPURA
799264

Residency Category: If candidate is STUDYING IN Residency Category Option: A. At least last (10) TEN years or
TRIPURA, mention the period of above
residing of candidate in the state
of Tripura
uninterruptedly/continuously
immediately before the date of
making application for Joint
Entrance Examination, 2023 (tick
in the appropriate box)
Select Residency Certificate / PRTC (NOT CITIZENSHIP CERTIFICATE) of candidate/father/mother must be produced during counselling.
PRTC Option:

I Agree that I shall submit the documents required by TBJEE regarding my / my parents residency during counseling. My candidature will liable to be canceled
on my failure to produce the documents.

Whether Appeared for TBJEE Earlier: No

I solemnly declare that I have not availed any seat in the past through Tripura Board of Joint Entrance Examination.

Group in Which Candidate Wants B (Physics/Chemistry/Biology) Examination Center Choice: Agartala


To Appear:

I solemnly declare that all the above statements are true and I have satisfied all the eligibility conditions for admission to the courses and understand that my
candidature will be canceled if any of the statements found to be incorrect and if I cannot produce relevant documents in support of my eligibility condition.
Place:Dhalai
Date:

Applicant's Signature:

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