Joint Entrance Examination (Main) 2019

NATIONAL TESTING AGENCY

CONFIRMATION PAGE

Application No. 190310138708

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Personal Details
Name: AMAN KUMAR Date of Birth: 15/04/2001
Mother's Name: MAMTA DEVI Category: OBC- NCL (CENTRAL LIST)
Caste Name: BARBER Father's Name: PRAVEEN KUMAR
Person with Disability(PwD): NO State of Eligibility: UTTAR PRADESH
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 Centre: KANPUR 2nd Choice of Exam Centre: LUCKNOW
3rd Choice of Exam Centre: ALLAHABAD 4th Choice of Exam Centre: VARANASI

Academic Details
Year of passing class 10th: 2016 Place of 12th class schooling: TOWN
Year of Passing or Appearing class 12th/Qualifying Exam: 2018 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: 95.6 Roll No. of Class 12th/Qualifying Exam: 5719445
Appeared/Appearing for Improvement of Class NO Mode of preperation: SELF STUDY
12th/Qualifying Exam:
Roll Number of Class 12th/Qualifying Exam of --
Improvement Exam:
Name and Address of the School/College from where S J S PUBLIC SCHOOL LALGANJ RAEBARELI
passed/appearing:

Candidate's Mailing Address

Country: India State: UTTAR PRADESH
District: RAEBARELI Address: VILLAGE JASMAU POST SENI
Locality: TAHSIL LALGANJ City/Town/Village: RAEBARELI
Pin Code: 229206 Email Address: ama*******@gmail.com
Mobile Number: 888****216

Guardian Details
Qualification Occupation Annual Income
Father's/Guardian's: -- -- --
Mother's: -- -- --

Payment Details
Provider Name: State Bank of India (MOPS) Payment Mode: Electronic Payment Gateway
Fee Type: Examination Fee Transaction Amount: 500 /-
Transaction ID: CPJ6949473 Date of Transaction: 10/09/2018 11:43:21
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) - 2019. I shall abide by the terms and conditions thereon.

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