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ISA] Commissioner of Technical Education, Admission Committee for Professional ISA Courses (ACPC), Gujarat ACP’ ACPC BEIB.Tech Counselling 2023 ACP el Document Verification Certicate Verified By: PROF BRIJESH SOLANKI Verification Date: May 122023 11:57AM Personal Details User id mange ‘Application number [ 2511901003346 ‘Candidate's Name | Gadara Umang jaysukibhal Fathor's Name Jaysukhibhal Gender Male ‘Mother's Name ‘Gaunben Date of Birth (06-02-2008 Gategory (Genera EWS Domicile ‘Gujarat ‘Sub Category List [Physically Handicapped No FExiIN-Serviceman, No Tuition Fee Waiver ves. ‘Other informations: [Eamiy Anna income. Tot tanto 2.5 tn ‘Qualification Details ‘Glass 12th or Equivalent Marks Details [Passing Year [e023 [Group [Group A [Quaifcation Exam State [Gujarat [Quaication Exam District, JAMNAGAR, Passing Board [GUJARAT SECONDARY & HIGHER SECONDARY EDUGATION BOARD Seat No/Rolt No [223622 [SID No lasv-r20017 [School index Number [os.0084 ‘Competitive Exam, Details (GUJCET - 2023 Examination Details [GUJGET Roll No. [az5015 [GUJCET Application No. 1031678 Name of Candidate as per GUJCET Exam [GADARA UMANG JAYSUKHBHAL ‘Contact Detaits Correspondence Address [Promises NoJVilage Name [216 Dwarakadhish soot [Sub LocalityiColonyiPolice Station(Optional) Patel pan bajuma Lecalty/CityTown!Vilage!Post Office Dhol [Country india Stato [Gujarat District JAMNAGAR Pin Code 361210 Mobile Number lsesr502 Ema mar rere Co [Alternate Contact Number (Optional) [soo691 Alternate Email id (Optional) umarrrersreeertcom Permanent Address [Premises NoJVillage Name. [216 Dwarakadhish soot [Sub LocalityiColonyiPolice Station(Optional) Patel pan bajuma Localty/CityrTown/Vilage/Post Office Dhol [Country nia Stato Gujarat [District JAMNAGAR Pin Code [361210 Fee Payment Details Registration Fee [Transaction Number [Transaction Amount [Transaction Date fyro41871496222 350 foainsy2023 13:19:12 Registration Detal [Activity [bate & Time IP Address Reg'sration Form Submission IMay 3 2029 &:58PM 157.32.93.154 [Apolicaton Form Submission IMay 4 2023 &:52AM f97.228.115.39 |Uploded Documents SA Commissioner of Technical Education, Admission Committee for Professional 5 ] Courses (ACPC), Gujarat ACP APC B.EIB.Tech Counselling 2023 ACP [Economicaly weaker section (FS) Geriicate [Date of Brh’School Leaving Certfeate hereby declare tat al the particulars given by me in this form are true tothe best of my knowledge and belt. Any mistake misinformation. detecied at the timo of acmission or at any sage In uture, wil suk in the cancatation of admission. | have read the information bulletin ard Understood al the proseduras. Ramarks = None [b.eve. Tech [Eligible for Counseling Signature of Candidate (GADARA UMANG JAYSUKHBHAN)

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