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JEE (Main) AcknowledgementPage

This document is an acknowledgement page for Vandita Gupta's application to the 2014 Joint Entrance Examination (Main). It provides her personal details like name, date of birth, category, address, as well as details about the exam such as her choice of exam centers and medium. It also includes her academic qualifications, family details, and payment information for the application fee.

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Parvesh Jakhar
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222 views

JEE (Main) AcknowledgementPage

This document is an acknowledgement page for Vandita Gupta's application to the 2014 Joint Entrance Examination (Main). It provides her personal details like name, date of birth, category, address, as well as details about the exam such as her choice of exam centers and medium. It also includes her academic qualifications, family details, and payment information for the application fee.

Uploaded by

Parvesh Jakhar
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Joint Entrance Examination (Main) - 2014 CENTRAL BOARD OF SECONDARY EDUCATION ACKNOWLEDGEMENT PAGE

Application No.
Personal Details
Name: Mother's Name: Father's Name: State of Eligibility: Gender: Nationality: Aadhaar Number (UIDAI): VANDITA GUPTA KIRAN GUPTA D.P. GUPTA HARYANA FEMALE INDIAN --

40020493
DO NOT SEND THIS PAGE TO CBSE.

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

Date of Birth: Category Person with Disability(PwD): Percentage of Disability: Are you the only child?: Place of Residence: You need scribe/reader ?:

08/10/1997 GENERAL NO -NO URBAN NO

Examination Details
Applying For: Mode of Examination: 1st Choice of Exam Centre: 3rd Choice of Exam Centre: JEE(Main) Paper - 1 (B.E./B.Tech.) Only PEN AND PAPER BASED EXAMINATION FARIDABAD GURGAON Question Paper Medium: 2nd Choice of Exam Centre: 4th Choice of Exam Centre: ENGLISH DELHI/NEW DELHI (NCR) KARNAL

Academic Details
Year of passing class 10th: School Board of class 12th/Qualifying Exam: Name of the Qualifying Examination passed / appearing: 2012 Place of 12th class schooling: Type of Institution of Class 12th/Qualifying Exam: CITY PRIVATE Year of Passing or Appearing class 12th/Qualifying Exam: 2014

CENTRAL BOARD OF SECONDARY EDUCATION 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. -NO Roll Number of Class 12th/Qualifying Exam: Mode of preperation: -SELF STUDY

Percentage of Marks in Class 12th/Qualifying Exam: Appearing for Improvement of Class 12th/Qualifying Exam: Name and Address of the School/College from where passed / appearing:

K.L.mehta dayanand public school sector-16,faridabad

Candidate's Mailing Address


Address: City/Town/Village: State: Email Address: Land Line Number: House no-581,Sector-16,Faridabad faridabad HARYANA [email protected] 01292221177 Locality: District: Pin Code: Mobile Number: sector-16 faridabad 121002 9654544581

Guardian Details
Qualification Father's/Guardian's: Mother's: POST GRADUATE MATRICULATE Occupation OTHERS (INCLUDING HOUSE WIFE) OTHERS (INCLUDING HOUSE WIFE) Annual Income RS. 200001 - 300000 UPTO 100000

Payment Details
Payment Mode: Exam Fee: Deposit Date: ICICI Bank e-Challan 500 /18/11/2013 Transaction ID: Branch Name/Code: -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. M399968 NA --

Images Uploaded by Candidate Photograph Signature Thumb Impression

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