Personal Details

Registration Number N19038632

Applicant Full Name AJAY GURJAR

Father's / Husband's Name MOHAR SINGH GURJAR

Date of Birth 04/Apr/2000

Gender Male

Category OBC

X/10th Roll No./Registration No. 164730571

Mobile No. 8463888635

Email ID Ajaygurjar048@gmail.com

Person with Disability? No

Disability Category
Address Details
Full Address AGAR MALAWA

State/U.T. of Domicile MADHYA PRADESH

District/City Agar Malwa

Pincode 465441

Details of guardian
Name of the guardian MOHAR SINGH GURJAR

The guardian is your FATHER

Guardian's Mobile No 7697609893

Exam City Preference

Preference 1 Indore

Preference 2 Gwalior

Preference 3 Bhopal

Preference 4 Jaipur

Preference 5 New Delhi

10th / Equivalent Details

Name of the Board/Council MP BOARD

Year Of Passing 2016

Percentage of Marks 80.30

12th / Equivalent Details
Name of the Board/Council MP BOARD

Year Of Passing 2018

Percentage of Marks 80.44

Payment Details
Exam Fee Amount 1200

Payment Transaction No 108521814958

Payment Receipt No 524305

Payment Mode Debit Card

Declaration

"I hereby certify that the particulars given by me in this Application Form are true to my knowledge and be lief. I certify that I fulfill
the eligibility criteria and undertake to produce original documents whenever necessary and I will not demand any reschedule of
exam. In case, any of the details provided by me found incorrect / false at stage of the admissio n, my candidature will stand
cancelled."

Signature of Candidate