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    This document contains Gargee Mehta's application form for the Joint Entrance Examination (JEE) 2012. It includes her personal details like name, date of birth, address, educational qualifications, nationality, category, and parent/guardian details. She is appearing for her first attempt at JEE in 2012 after passing 10th grade in 2010 from a school in Mumbai and is seeking admission to one of the IITs or similar institutions. The form contains her declaration and signatures agreeing to the exam terms and conditions.

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    Binder 1

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    This document contains Gargee Mehta's application form for the Joint Entrance Examination (JEE) 2012. It includes her personal details like name, date of birth, address, educational qualifications, nationality, category, and parent/guardian details. She is appearing for her first attempt at JEE in 2012 after passing 10th grade in 2010 from a school in Mumbai and is seeking admission to one of the IITs or similar institutions. The form contains her declaration and signatures agreeing to the exam terms and conditions.

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    This document contains Gargee Mehta's application form for the Joint Entrance Examination (JEE) 2012. It includes her personal details like name, date of birth, address, educational qualifications, nationality, category, and parent/guardian details. She is appearing for her first attempt at JEE in 2012 after passing 10th grade in 2010 from a school in Mumbai and is seeking admission to one of the IITs or similar institutions. The form contains her declaration and signatures agreeing to the exam terms and conditions.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    18 views2 pages

    Binder 1

    Uploaded by

    Vishal Nair
    This document contains Gargee Mehta's application form for the Joint Entrance Examination (JEE) 2012. It includes her personal details like name, date of birth, address, educational qualifications, nationality, category, and parent/guardian details. She is appearing for her first attempt at JEE in 2012 after passing 10th grade in 2010 from a school in Mumbai and is seeking admission to one of the IITs or similar institutions. The form contains her declaration and signatures agreeing to the exam terms and conditions.

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    Auth Code: 554a0c77b2c7dfee82d1a55d460516ef 1. Candidate Name: Gargee Mehta 2. Parent/Guardian Name: Gulshan Kumar Mehta 3.

    Date of Birth: 10-11-1994 6. Nationality: Indian 9. First Attempt at JEE: In 2012 12. Enlarged Font Paper Required: No 15. Address: Flat No. D-21, 4th Floor, Block D-3, New Chandra Co-Op. Group Housing Society, Above Northern Tadka Restaurant, Off Veera Desai Road, Andheri West,Mumbai 16. PIN Code: 400053 21. Type of Preparation: Other 23. Board of QE: CBSE 25. Parents' Educational Background: Only One Graduate 27. Annual Income of Parent/Guardian: Above Rs. 4,50,000 DECLARATION BY THE CANDIDATE
    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 IIT-JEE 2012 Information Brochure (given on IIT-JEE Website) and I shall abide by the terms and conditions therein. I also certify that I have not appeared in JEE in 2010 or earlier and neither taken admission nor paid the registration fee at any of the IITs / IT-BHU / ISM-Dhanbad. In the event of suppression or distortion of any fact regarding the eligibility criteria, nationality etc., in my application form, I understand that I will be denied the opportunity to appear in IIT-JEE 2012 and if already admitted, my admission / degree acquired is liable for cancellation. I also understand that the decision of the Joint Admission Board regarding my admission to IITs / IT-BHU / ISM-Dhanbad is final and I shall abide by the decision. Further, if admitted, I promise to abide by the rules and norms of discipline of the Institute I join.

    4. Gender: Female 7. Year of Passing 10th Class: 2010 10. Question Paper Language: English 13. Entitled for DS Seat: No 17. Email ID: gargeemehta@gmail.com 18. Mobile No: 09220923753 19. Landline No: 02224173535

    5. Category: GE 8. Year of Passing QE: Appearing in 2012 11. Physically Disabled: No 14. Choice of Exam Cities: I. Mumbai (110) II. Thane (117)

    20. PIN Code of Permanent Residence: 401303 22. Place of 10th Class Schooling: City 24. Mother Tongue: Hindi 26. Occupation of Parent/Guardian: Engineering

    PASTE RECENT COLOR PHOTOGRAPH HERE 3.5 cm x 4.5 cm with the face covering about 75% of the photo

    Place : ...................... Date : ........................ Name of Parent/Guardian: .............................................................................. Cut Here (Signature of the Candidate)

    Candidate Signature (Sign within the box only)

    (Countersigned by Parent/Guardian) Cut Here

    SEND THE UPPER PART TO JEE OFFICE IIT BOMBAY TO COMPLETE YOUR APPLICATION

    JEE COPY

    IIT-JEE 2012

    INDIAN INSTITUTES OF TECHNOLOGY JOINT ENTRANCE EXAMINATION - 2012

    Application Form No.

    C21304485

    IIT-JEE 2012
    Indian Institutes of Technology

    BY REGISTERED POST / SPEED POST ONLY

    Application Form No.

    Choice - I Your Choice of Examination Cities

    Choice - II

    110

    117

    APPLICATION FORM NO :

    C21304485
    To

    From Name :
    Gargee Mehta

    The Chairman Joint Entrance Examination 2012

    Address : Flat No. D-21, 4th Floor, Block D-3,


    New Chandra Co-Op. Group Housing Society, Above Northern Tadka Restaurant, Off Veera Desai Road, Andheri West,Mumbai

    Indian Institute of Technology Bombay Powai, Mumbai PIN Code - 400076

    PIN Code : 400053 Landline : 02224173535 Email : Mobile : 09220923753

    gargeemehta@gmail.com

    CUT HERE AND PASTE THE UPPER PART ON A5 ENVELOPE

    PLEASE INSERT THE APPLICATION FORM IN THE ENVELOPE IN SUCH MANNER THAT THE BARCODE ON THE APPLICATION FORM IS NOT FOLDED. CHECKLIST FOR THE CANDIDATE
    1. Tick the box if you have enclosed the following documents:
    a. Completed Application Form with your and parent / guardian's signature. b. Your colour photograph (of size 3.5 cm x 4.5 cm) affixed on application appropriately. c. Attested copy of 10th class certifiate for Date of Birth. d. Attested copy of category certificate if you belong to SC/ST/OBC(NCL). e. Request letter for enlarged font question paper if you have poor vision.

    2. Retain a photocopy of the completed application form with you. 3. Send your application form to the IIT as mentioned on the address slip.

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