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Correction Slip for correction in NEET UG 2017 Application Form

Registration No. 80685374

Candidates may take print of correction slip and retained the same with them for reference and record.
Correction Date & Time: 14-2-2017 Time: 23:22:01 Ip Address: 116.68.102.152
(Choice of Examination Centre)
Particulars Old Value New Value
(Medium of Question Paper): English English

(1st Choice of Examination Centre) : ERNAKULAM THRISSUR (Changed by candidate)

(2nd Choice of Examination Centre) : KOZHIKODE ERNAKULAM (Changed by candidate)

(3rd Choice of Examination Centre) COIMBATORE KOZHIKODE (Changed by candidate)

(Personal Details)

(Candidate's Name) : LINCY JOY LINCY JOY

(Mother's Name) : LISSY JOY LISSY JOY

(Father's Name) : JOY K L JOY K L

(Date of Birth) : 04/11/1999 04/11/1999

/
Kerala Kerala
(State/Country of Eligibility) :
(Nationality) : Indian Indian

(Gender) : FEMALE FEMALE

, - ?
No No
In case of Girl candidate, Are you only child of your parents? :

No No
(Status of Locomotor Disability of Lower Limbs) :
(Category): UR UR

(Identification Type) : Aadhaar Enrollment Number Aadhaar Enrollment Number

(Identification Number) : 20033113145911 20033113145911

(Residential Address)

(House/ Door Number) : 15/41 15/41

(Locality) : MUKKATTUKARA MUKKATTUKARA

(Land Mark): ST.JOHNS STREET ST.JOHNS STREET

/ / (Village / Town / City): NETTISSERY NETTISSERY

(District) : Thrissur Thrissur

(State) : Kerala Kerala

/ (Pin/Zip Code) : 680651 680651

(Email Address) : lincyjoy444@gmail.com lincyjoy444@gmail.com

(Mobile No.) : 91-8606605169 91-8606605169

(Land Line Number with STD Code) : 0487-2375010 0487-2375010

/ (Details of Parents/Guardian)

/ (Father's/Guardians Qualification) Graduate-BA/B.Sc/B.Com/BCA Graduate-BA/B.Sc/B.Com/BCA

/ (Father's/Guardians Occupation) Business Business

/ (Father's/Guardians Annual Income) Rs. 75001-100000 Rs. 75001-100000

Mother's Qualification ( ) : Graduate-BA/B.Sc/B.Com/BCA Graduate-BA/B.Sc/B.Com/BCA

Mother's Occupation ( ) Others Others

Mother's Annual Income ( ) Rs. 75001-100000 Rs. 75001-100000

10th {Academic Details (CLASS 10th or Equivalent)}

/ /
HOLY FAMILY CGHS,THRISSUR HOLY FAMILY CGHS,THRISSUR
(Name of the School / College / Open School Study Center):
/ / HOLY FAMILY CGHSS,CHEMBUKKAVU,THRISSUR-
HOLY FAMILY CGHSS,CHEMBUKKAVU,THRISSUR-680020
(Address of the School / College/ Study Center): 680020

(Name of School Education Board) : KERALA BOARD OF PUBLIC EXAMINATIONS KERALA BOARD OF PUBLIC EXAMINATIONS

(Year of Passing) : 2015 2015

(Percentage of Marks obtained in Class 10th) : 90 90

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12th {Academic Details (CLASS 12th or Equivalent}

(Qualifying Examination Code) : 01 01

KERALA BOARD OF PUBLIC EXAMINATIONS KERALA BOARD OF PUBLIC EXAMINATIONS
(School Board of Class 12th/Qualifying Examination) :
/ /
2017 2017
(Year of Passing/Appearing Class-XII/Qualifying Exam) :
/ / ( / )
{Name of the School / College / Open School Study Center (Passed/ St.CLARES CGHSS,THRISSUR St.CLARES CGHSS,THRISSUR
Appearing)}:
/ /
St.CLARES CGHSS,EASTFORT,THRISSUR-680005 St.CLARES CGHSS,EASTFORT,THRISSUR-680005
(Address of the School / College/ Study Center):
/ /
Thrissur Thrissur
(District where Class XII School/College / Study Center is located):
/ /
Kerala Kerala
(State where Class XII School /College / Study Center is located) :
( % of Marks obtained in Class 12th/Qualifying
Examination)
12 (Enter Roll Number of Class 12th) : 4199891 4199891

(Dress Code)
Do you intend to wear Customary Dress contrary to the Dress Code while
appearing in NEET (UG) 2017
No No
( ) 2017
:

Particulars in which Changes are occurrred

1. (1st Choice of Examina on Centre), 2. (2nd Choice of Examina on Centre), 3. (3rd Choice of Examina on
Centre),

Signature of Candidate with date

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