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    JEE (Main) AcknowledgementPage

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    Devaraj Sj
    This document is an acknowledgement page for a candidate named Sachin Nargund who is applying to take the Joint Entrance Examination (Main) in 2014. It provides key details about the candidate including personal information, examination details, academic qualifications, contact information, guardian details, payment details, and uploaded images. The candidate declares that all information provided is true to the best of their knowledge.

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    JEE (Main) AcknowledgementPage

    Uploaded by

    Devaraj Sj
    74 views1 page
    This document is an acknowledgement page for a candidate named Sachin Nargund who is applying to take the Joint Entrance Examination (Main) in 2014. It provides key details about the candidate including personal information, examination details, academic qualifications, contact information, guardian details, payment details, and uploaded images. The candidate declares that all information provided is true to the best of their knowledge.

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    JEE(Main) AcknowledgementPage

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    JEE(Main) AcknowledgementPage

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    This document is an acknowledgement page for a candidate named Sachin Nargund who is applying to take the Joint Entrance Examination (Main) in 2014. It provides key details about the candidate including personal information, examination details, academic qualifications, contact information, guardian details, payment details, and uploaded images. The candidate declares that all information provided is true to the best of their knowledge.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    74 views1 page

    JEE (Main) AcknowledgementPage

    Uploaded by

    Devaraj Sj
    This document is an acknowledgement page for a candidate named Sachin Nargund who is applying to take the Joint Entrance Examination (Main) in 2014. It provides key details about the candidate including personal information, examination details, academic qualifications, contact information, guardian details, payment details, and uploaded images. The candidate declares that all information provided is true to the best of their knowledge.

    Copyright:

    Attribution Non-Commercial (BY-NC)
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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): SACHIN NARGUND SHANTA SURESH KARNATAKA MALE INDIAN 741650488291

    40287045
    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 ?:

    12/03/1996 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 HUBLI PANAJI Question Paper Medium: 2nd Choice of Exam Centre: 4th Choice of Exam Centre: ENGLISH KOLHAPUR MANGALORE

    Academic Details
    Year of passing class 10th: School Board of class 12th/Qualifying Exam: Name of the Qualifying Examination passed / appearing: 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: 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

    KARNATAKA BOARD OF PRE UNIVERSITY EDUCATION Intermediate or two-year Pre-University examination conducted by a recognized Board/ University. -NO Roll Number of Class 12th/Qualifying Exam: Mode of preperation: -SELF STUDY

    DVEA CHETAN PU SCIENCE COLLEGE Extn.Off 80 FT. Road, Akshay Colony, Hubli - 580 021. Karnataka India.

    Candidate's Mailing Address


    Address: City/Town/Village: State: Email Address: Land Line Number: shivalli plot M nagar dharwad dharwad KARNATAKA sushmitasn18@gmail.com -Locality: District: Pin Code: Mobile Number: shivalli plot M nagar dharwad dharwad 580008 9480028462

    Guardian Details
    Qualification Father's/Guardian's: Mother's: POST GRADUATE GRADUATE Occupation BUSINESS GOVERNMENT SERVICE Annual Income UPTO 100000 RS. 300001 -400000

    Payment Details
    Payment Mode: Exam Fee: Deposit Date: Canara Bank e-Challan 1000 /26/11/2013 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. 16282611130017 NA --

    Images Uploaded by Candidate Photograph Signature Thumb Impression

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