JANUARY JEE(MAIN) 2020

Confirmation Page

Application No. 2003 1030 8285 -

DO NOT SEND THIS PAGE TO NATIONAL TESTING AGENCY (NTA).
CANDIDATE IS REQUESTED TO RETAIN THE PRINTOUT OF CONFIRMATION PAGE FOR FUTURE REFERENCE.

Personal Details
Candidate's Name NEEL BOTHARA Date of Birth 24-10-2002
Mother's Name ARCHANA BOTHARA Category General
Father's Name RASIK BOTHARA Gender Male
If you are a PwD Candidate, do you have No Nationality Indian
benchmark disability (40% or more /
“Severe” where percentage is not defined)
?
Place of Residence Urban State Code of Eligibility MAHARASHTRA
Are You Diabetic? NO Mode of Preparation Self Study

Apply For
Apply For B. Arch Only Question Paper Medium English
Exam City 1st MAHARASHTRA - NASHIK Exam City 2nd MAHARASHTRA - MUMBAI/NAVI MUMBAI
Exam City 3rd MAHARASHTRA - PUNE Exam City 4th MAHARASHTRA - NAGPUR

Additional Details
Are you a Twin No

Contact Details
Address HARI VED Locality P AND T COLONY
City/Town/Village NASHIK District NASHIK
State/UT MAHARASTRA Pin Code 422002
Email Address nee**********@gmail.com Mobile Number (+91) 702****555
Land Line No. with 7755916255
STD code or any
other Contact No.

Fee Payment Details

Payment Mode: Pay through PAYTM Transaction ID: 20190918111212800110168362388495
709
Exam Fee: 650 /- Date of Transaction: 18/09/2019 12:00:00
Fee Submitted On: 18/09/2019
DECLARATION
I hereby declare that all the particulars given by me in this form are true to the best of my knowledge and belief and any mistake / misinformation, detected at the time
of admission or at any stage in future, will result in the cancellation of admission/candidature. I have read the information bulletin and understood all the procedures. In
case I furnish any false information, my result will not be declared/ my candidature will automatically stand cancelled. I shall abide by terms and conditions therein.

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Photograph Signature

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Photograph,Signature

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