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    JEEMAINJAN ConfirmationPage PDF

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    M
    This document is a confirmation page for Mohit Doraiburu's January 2020 JEE(Main) application. It provides his personal details like name, date of birth, category, and contact information. It also lists the exam cities he selected, that he paid his application fee of 325 rupees, and includes his uploaded photograph and signature.

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    Download as PDF, TXT or read online from Scribd

    JEEMAINJAN ConfirmationPage PDF

    Uploaded by

    M
    29 views1 page
    This document is a confirmation page for Mohit Doraiburu's January 2020 JEE(Main) application. It provides his personal details like name, date of birth, category, and contact information. It also lists the exam cities he selected, that he paid his application fee of 325 rupees, and includes his uploaded photograph and signature.

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    JEEMAINJAN_ConfirmationPage.pdf

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    This document is a confirmation page for Mohit Doraiburu's January 2020 JEE(Main) application. It provides his personal details like name, date of birth, category, and contact information. It also lists the exam cities he selected, that he paid his application fee of 325 rupees, and includes his uploaded photograph and signature.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    29 views1 page

    JEEMAINJAN ConfirmationPage PDF

    Uploaded by

    M
    This document is a confirmation page for Mohit Doraiburu's January 2020 JEE(Main) application. It provides his personal details like name, date of birth, category, and contact information. It also lists the exam cities he selected, that he paid his application fee of 325 rupees, and includes his uploaded photograph and signature.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    JANUARY JEE(MAIN) 2020

    Confirmation Page

    Application No. 2003 1067 0050 -


    DO NOT SEND THIS PAGE TO NATIONAL TESTING AGENCY (NTA).
    CANDIDATE IS REQUESTED TO RETAIN THE PRINTOUT OF CONFIRMATION PAGE FOR FUTURE REFERENCE.

    Personal Details
    Candidate's Name MOHIT DORAIBURU Date of Birth 28-08-2001
    Mother's Name BINA MARYANTI DORAIBURU Category ST
    Father's Name BASANT CHANDRA DORAIBURU Gender Male
    If you are a PwD Candidate, do you have No Nationality Indian
    benchmark disability (40% or more /
    “Severe” where percentage is not defined)
    ?
    Place of Residence Urban State Code of Eligibility JHARKHAND
    Are You Diabetic? NO Mode of Preparation Tutorial Classes

    Apply For
    Apply For B.E./B.Tech. Only Question Paper Medium English
    Exam City 1st JHARKHAND - JAMSHEDPUR Exam City 2nd JHARKHAND - DHANBAD
    Exam City 3rd JHARKHAND - BOKARO STEEL CITY Exam City 4th JHARKHAND - RANCHI

    Additional Details
    Are you a Twin No

    Contact Details
    Address HOUSE NO-102B, ROAD NO-4, ZONE NO-2, Locality
    BIRSANAGAR
    City/Town/Village JAMSHEDPUR District EAST SINGHBHUM
    State/UT JHARKHAND Pin Code 831019
    Email Address moh*******@gmail.com Mobile Number (+91) 821****183
    Land Line No. with --
    STD code or any
    other Contact No.

    Fee Payment Details


    Payment Mode: Pay through SBI(MOPS) Transaction ID: CPU9406696
    Exam Fee: 325 /- Date of Transaction: 23/09/2019 22:43:44
    Fee Submitted On: 23/09/2019
    DECLARATION
    I hereby declare that all the particulars given by me in this form are true to the best of my knowledge and belief and any mistake / misinformation, detected at the time
    of admission or at any stage in future, will result in the cancellation of admission/candidature. I have read the information bulletin and understood all the procedures. In
    case I furnish any false information, my result will not be declared/ my candidature will automatically stand cancelled. I shall abide by terms and conditions therein.

    Images Uploaded by Candidate


    Photograph Signature

    List of Document Uploaded


    Photograph,Signature

    IP Address : 47.29.109.96 Date of Downloading : 23/09/2019 10:45:56 PM

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