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Joint Entrance Examination (Main) 2019 NATIONAL TESTING AGENCY CONFIRMATION PAGE Application No.    

Joint Entrance Examination (Main) 2019 NATIONAL TESTING AGENCY CONFIRMATION PAGE

(Main) 2019 NATIONAL TESTING AGENCY CONFIRMATION PAGE Application No.     190310009731  

Application No.

   

190310009731

 
Application No.     190310009731  
 

DO NOT SEND THIS PAGE TO NATIONAL TESTING AGENCY(NTA).

 

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

 

Personal Details

Name:

JATIN VERMA

 

Date of Birth:

 

08/08/2000

Mother's Name:

ANJU VERMA

 

Category:

 

SC

Caste Name:

Khatik

 

Father's Name:

 

MANOJ KUMAR VERMA

Person with Disability(PwD):

 

NO

State of Eligibility:

 

UTTARAKHAND

Percentage of Disability:

--

Gender:

MALE

Are you Diabetic:

NO

Nationality:

 

INDIAN

Place of Residence:

URBAN

 

Do you need scribe:

 

NO

Examination Details

 

Applying For:

JEE(Main) Paper - 1 and Paper - 2 Both

 

Mode of Examination:

COMPUTER BASED EXAMINATION

 

Question Paper Medium:

 

ENGLISH

 

1st Choice of Exam City:

DEHRADUN

 

2nd Choice of Exam City:

 

HARIDWAR

 

3rd Choice of Exam City:

ROORKEE

 

4th Choice of Exam City:

 

MUZAFFARNAGAR

 

Academic Details

Year of passing class 10th:

 

2016

Place of 12th class schooling:

 

CITY

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:

 

77

Roll No. of Class 12th/Qualifying Exam:

 

5804592

Appeared/Appearing for Improvement of Class 12th/Qualifying Exam:

 

NO

Mode of preperation:

 

COACHING

Roll Number of Class 12th/Qualifying Exam of Improvement Exam:

 

--

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

 

Jaswant Modern Sr. Sec. School 91, Rajpur Road, Dehradun

 

Candidate's Mailing Address

 

Country:

India

State:

UTTARAKHAND

 

District:

DEHRADUN

 

Address:

Lane 3, Pocket 3, Vivek Vihar, G.M.S. Road

Locality:

Balliwala Chowk

 

City/Town/Village:

Dehradun

 

Pin Code:

248001

Email Address:

jat*******@gmail.com

 

Mobile Number:

902****546

     

Guardian Details

 

Qualification

Occupation

Annual Income

 

Father's/Guardian's:

OTHERS

SELF EMPLOYMENT

 

RS. 200001 - 300000

 

Mother's:

POST GRADUATE

 

GOVERNMENT SERVICE

 

RS. 400001 -500000

 

Payment Details

Provider Name:

State Bank of India (MOPS)

 

Payment Mode:

Electronic Payment Gateway

Fee Type:

Examination Fee

 

Transaction Amount:

 

450 /-

Transaction ID:

CPJ4982498

Date of Transaction:

 

01/09/2018 13:29:39

 
 

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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Candidate Photograph

   

Candidate Signature