Joint Entrance Examination (Main) - 2017

CENTRAL BOARD OF SECONDARY EDUCATION

ACKNOWLEDGEMENT PAGE

Application No.

70953405
DO NOT SEND THIS PAGE TO CBSE.

CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.

Personal Details
Name:

AYUSH YADAV

Date of Birth:

11/02/1998

Mother's Name:

REKHA YADAV

Category

OBC- NCL (CENTRAL LIST)

Father's Name:

VISHAL YADAV

Person with Disability(PwD):

NO

State of Eligibility:

UTTAR PRADESH

Percentage of Disability:

--

Gender:

MALE

In case of girl candidate, Are

you the only child of your
parents?:

NO

Nationality:

INDIAN

Place of Residence:

URBAN

Aadhaar Number

209826255260

You need scribe/reader ?:

NO

Examination Details
Applying For:

JEE(Main) Paper - 1 (B.E./B.Tech.) Only

Mode of Examination:

PEN AND PAPER BASED EXAMINATION

Question Paper Medium:

ENGLISH

1st Choice of Exam Centre:

VARANASI

2nd Choice of Exam Centre:

ALLAHABAD

3rd Choice of Exam Centre:

GORAKHPUR

4th Choice of Exam Centre:

AGRA

Academic Details
Year of passing class 10th:

2014

Year of Passing or Appearing class 12th/Qualifying Exam: 2016

Place of 12th class schooling:

CITY

Type of Institution of Class 12th/Qualifying Exam:

GOVERNMENT

School Board of class 12th/Qualifying Exam:

CENTRAL BOARD OF SECONDARY EDUCATION

Name of the Qualifying Examination passed / appearing:

The final examination of the 10+2 system, conducted by any recognized central/ state Board, such as Central
Board of Secondary Education, New Delhi; Council for the Indian School Certificate Examinations, New Delhi;
etc.

Percentage of Marks in Class 12th/Qualifying Exam:

80.20

Roll No. of Class 12th/Qualifying Exam:

5694221

Appeared/Appearing for Improvement of Class

12th/Qualifying Exam:

NO

Mode of preperation:

SELF STUDY

Roll Number of Class 12th/Qualifying Examination of

Improvement Examination:
Name and Address of the School/College from where
passed/appearing:

central hindu boys school kamachcha varanasi ,221010

Candidate's Mailing Address

Country:

India

State:

UTTAR PRADESH

District:

VARANASI

Address:

k-66/23 narharpura

Locality:

lohatia

City/Town/Village:

varanasi

Pin Code:

221001

Email Address:

ayushyadav1010@gmail.com

Mobile Number:

7668579471

Land Line Number:

--

Guardian Details
Qualification

Occupation

Annual Income

Father's/Guardian's:

MATRICULATE

PRIVATE SERVICE

RS. 200001 - 300000

Mother's:

MATRICULATE

OTHERS (INCLUDING HOUSE WIFE)

--

Provider Name:

HDFC Bank Payment Gateway

Payment Mode:

e-Challan

Fee Type:

Examination Fee

Transaction Amount:

1000 /-

Transaction ID:

70953405

Date of Transaction:

2016-12-30

Payment Details

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) - 2017. I shall abide by the terms and conditions thereon.

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