Click Here to Print This Page Home

You have successfully submitted On-line Application. Please preserve this page alongwith proof of fee payment for future reference.

CONFIRMATION PAGE - NEET (UG) - 2019

Application No. 190410069786

अ यथ का नाम (Candidate's Name) AJAY ज म त थ (Date of Birth) 22/09/2000

माता का नाम (Mother's Name) ANGREJO DEVI लंग (Gender) Male

पता का नाम (Father's Name) RANDHIR SINGH वग (Category) OBC (NCL)

क ा बारहवीं / यो यता पर ा उ तीण करने /पर ा का वष

द यांग यि त
(Year of Passing/Appearing Class-XII/Qualifying 2018 No
(Person with Disability)
Exam)

पा ता का रा य/दे श
Haryana रा यता (Nationality) Indian
(State/Country of Eligibility)

ा तांक का तशत ( % of Marks obtained in Class

न प का मा यम (Medium of Question Paper))# English 80.40
12th)

मोबाइल नंबर (Mobile No.) 91xxxxxx6502 ईमेल पता (Email Address) saxxxxxxxxxxxx@gmail.com

पर ा शहर के वक प (Choice of Examination City)

(1) CHANDIGARH/MOHALI/PANCHKULA (
(2) DELHI/NEW DELHI ( 2001) (3) GURUGRAM ( 2302) (4) FARIDABAD ( 2301)
1601)

DECLARATION: - I hereby affirm that all the particulars stated by me in the Application Form are true and correct. Even the spelling of names and category
are also correct. I have not concealed any information. However, if any information furnished herein is found fraudulent, incorrect or untrue, I will be liable for
criminal prosecution which will result in cancellation of my candidature. Further that the selection and admission to the course is liable to be cancelled. I agree
to abide by the Rules and Regulations governing the Examination as contained in the Information Bulletin for NEET (UG) - 2019 which I have gone through
carefully. I further declare that I have not submitted any other application for NEET (UG) -2019 and mobile number and email address given in the form are
correct and my own or of my parents.

Signature

Photo

Complete mailing address:

Address 1169, Rural, Near Basnti Mata

City BALLAH ,KARNAL

State /Country Haryana Pin Code 132040

Details of Transaction(HDFC Bank).

Transaction ID.: 7732385777 Total Amount: 1400 Date of Transaction: 12/5/2018 5:09:47 PM

Card Type : VISA/Master Card

Application No: 190410069786 Printed On : 05/12/2018 05:09:57

Note : - Kindly check following details in Confirmation Page :

Candidate’s Name, Mother’s Name, Father’ s Name, Date of Birth, Gender, Category, PwD, Choice of Examination Cities and Medium of Question Paper. In case of any
discrepancy, these may please be corrected during 14th January, 2019 to 31st January, 2019. No corrections shall be allowed under any circumstances after this date.