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All India Engineering/Architecture Entrance

Examination 2010
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Date of Submission: Request no.: M - 245597 Application Form No. :
19/4/2010 (dd/mm/yyyy) 0181452

S.No Particulars Particulars as per Database Correctio Credentials where the


. prepared through Image n correction desired
Scanning of Application Mention your Correction
Form (Col 1) in the given box (Col 2
1 Candidate’s Name JUBHANSHU KANOJIA YES SUBHANSHU
KANOJIA
2 Mother’s Name KUSUM KANOJIA NO
3 Father’s Name BMAGWANDAS YES BHAGWANDAS
KANOJIA KANOJIA
4 Centre 1 JABALPUR NO
5 Centre 2 BHOPAL NO
6 Centre 3 INDORE NO
7 Centre 4 NAGPUR NO
8 State code of MADHYA PRADESH NO
Eligibility
9 Sex MALE NO
10 Date of Birth 02/12/91 NO
11 Question Paper ENGLISH NO
Medium
12 Category OBC NO
13 Physically NO NO
Handicapped
14 Course Applied BE/B TECH ONLY NO
15 Photo CANDIDATE’S PHOTO NO

(Signature of Candidate)

NOTE:Please check the particulars mentioned above in Col 1 with photocopy of the
Application Form in which all the information is filled by you. In case of discrepancy, in
any of the above particulars, same may please be corrected in Col 2 (by hand) after
taking printout of this page and send to the Board within a week from the date of
submission. It may be noted that no change in particulars filled in Application Form
will be permitted.

SPEED /REGISTERED POST TO:

The Assistant Secretary (AIEEE Unit),


Central Board of Secondary Education,
PS 1-2 ,Institutional Area,
IP Extension,Patparganj,
New Delhi - 110092

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