JEE (Main) AcknowledgementPage PDF
JEE (Main) AcknowledgementPage PDF
Application No.
60441924
DO NOT SEND THIS PAGE TO CBSE.
CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.
Personal Details
Name:
Date of Birth:
28/09/1997
Mother's Name:
BIJAMANI TUDU
Category
ST
Father's Name:
NO
State of Eligibility:
ODISHA
Percentage of Disability:
--
Gender:
MALE
NO
Nationality:
INDIAN
Place of Residence:
URBAN
--
NO
Examination Details
Applying For:
Mode of Examination:
ENGLISH
BHUBANESWAR
CUTTACK
BALASORE
BERHAMPUR
Academic Details
Year of passing class 10th:
2013
CITY
GOVERNMENT
61.66
303MA356
NO
Mode of preperation:
SELF STUDY
BJB JUNIOR COLLEGE, BHUBANESWAR Kalpana Road, Infront Of Court, Bhubaneswar, Odisha 751014
Locality:
Acharya Vihar
City/Town/Village:
Bhubaneswar
District:
Khurda
State:
ODISHA
Pin Code:
751013
Email Address:
Mobile Number:
9776973476
06742379274
Guardian Details
Qualification
Occupation
Annual Income
Father's/Guardian's:
GRADUATE
GOVERNMENT SERVICE
RS. 500001-600000
Mother's:
GRADUATE
UPTO 100000
Payment Mode:
Transaction ID:
60441924
Exam Fee:
500 /-
Branch Name/Code:
1252
Deposit Date:
22/12/2015
--
--
Payment Details
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) - 2016. I shall abide by the terms and conditions thereon.
Signature
Thumb Impression