Joint Entrance Examination (Main) 2019

NATIONAL TESTING AGENCY

CONFIRMATION PAGE

Application No. 190310363247

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Personal Details
Name: AVDHOOT KUMAR GAUTAM Date of Birth: 26/09/2002
Mother's Name: VIBHA RAI Category: GENERAL
Caste Name: NA Father's Name: NITYANAND RAI
Person with Disability(PwD): NO State of Eligibility: BIHAR
Percentage of Disability: -- Gender: MALE
Are you Diabetic: NO Nationality: INDIAN
Place of Residence: RURAL Do you need scribe: NO

Examination Details
Applying For: JEE(Main) Paper - 1 (B.E./B.Tech.) Only
Mode of Examination: COMPUTER BASED EXAMINATION Question Paper Medium: ENGLISH
1st Choice of Exam City: VARANASI 2nd Choice of Exam City: PATNA
3rd Choice of Exam City: ALLAHABAD 4th Choice of Exam City: AGRA

Academic Details
Year of passing class 10th: 2017 Place of 12th class schooling: CITY
Year of Passing or Appearing class 12th/Qualifying Exam: 2019 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 Exam 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 NO Mode of preperation: COACHING
12th/Qualifying Exam:
Roll Number of Class 12th/Qualifying Exam of --
Improvement Exam:
Name and Address of the School/College from where New Delhi Public School Veer Kumar Singh colony buxar
passed/appearing:

Candidate's Mailing Address

Country: India State: BIHAR
District: BUXAR Address: Jail road sumeshwar sthan charitravan ,bxr
Locality: Balliya City/Town/Village: Tutuwari
Pin Code: 802101 Email Address: avd*******@gmail.com
Mobile Number: 798****114

Guardian Details
Qualification Occupation Annual Income
Father's/Guardian's: POST GRADUATE GOVERNMENT SERVICE --
Mother's: POST GRADUATE OTHERS --

Payment Details
Provider Name: State Bank of India (MOPS) Payment Mode: Electronic Payment Gateway
Fee Type: Examination Fee Transaction Amount: 500 /-
Transaction ID: CPJ8370033 Date of Transaction: 15/09/2018 16:48:11
DECLARATION
I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief.
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