Joint Entrance Examination (Main) - 2014

CENTRAL BOARD OF SECONDARY EDUCATION

ACKNOWLEDGEMENT PAGE
Application No. 40048367
DO NOT SEND THIS PAGE TO CBSE.
CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.
Personal Details
Name: YASH KUMAR CHOUDHARY Date of Birth: 01/03/1997
Mother's Name: MEETA CHOUDHARY Category GENERAL
Father's Name: SUNIL KUMAR CHOUDHARY Person with Disability(PwD): NO
State of Eligibility: GUJARAT Percentage of Disability: --
Gender: MALE Are you the only child?: NO
Nationality: INDIAN Place of Residence: URBAN
Aadhaar Number (UIDAI): -- 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: AHMEDABAD 2nd Choice of Exam Centre: GANDHINAGAR
3rd Choice of Exam Centre: VADODARA 4th Choice of Exam Centre: RAJKOT
Academic Details
Year of passing class 10th: 2012 Place of 12th class schooling: CITY
Year of Passing or Appearing class 12th/Qualifying Exam: 2014 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 Number of Class 12th/Qualifying Exam: --
Appearing for Improvement of Class 12th/Qualifying
Exam:
NO Mode of preperation: SELF STUDY
Name and Address of the School/College from where
passed / appearing:
DELHI PUBLIC SCHOOL DELHI PUBLIC SCHOOL,BOPAL,AHMEDABAD,GUJARAT,INDIA
Candidate's Mailing Address
Address: A508- SHAPATH HEXA, OPP. GUJARAT HIGH COURT Locality: ABOVE AUDI SHOWROOM, S.G HIGHWAY,
City/Town/Village: NEAR SOLA BRIDGE District: AHMEDABAD
State: GUJARAT Pin Code: 380015
Email Address: yash.choudhary131997@gmail.com Mobile Number: 8000817967
Land Line Number: --
Guardian Details
Qualification Occupation Annual Income
Father's/Guardian's: GRADUATE BUSINESS RS. 200001 - 300000
Mother's: POST GRADUATE BUSINESS RS. 300001 -400000
Payment Details
Payment Mode: Credit / Debit Card Transaction ID: MSPD3167536875
Exam Fee: 1000 /- Date of Transaction: 17-11-2013 20:12:32
Card Type: VISA/Master Card -- --
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) - 2014. I shall abide by the terms and conditions thereon.
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