JANUARY JEE(MAIN) 2020

Confirmation Page

Application No. 2003 1080 3521 -

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 MANU GUPTA Date of Birth 12-09-2001
Mother's Name PRITI GUPTA Category General
Father's Name SAMIR GUPTA 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 RAJASTHAN
Are You Diabetic? NO Mode of Preparation Self Study

Apply For
Apply For B.E./B.Tech. Only Question Paper Medium English
Exam City 1st RAJASTHAN - JAIPUR Exam City 2nd RAJASTHAN - AJMER
Exam City 3rd RAJASTHAN - UDAIPUR Exam City 4th RAJASTHAN - SIKAR

Additional Details
Are you a Twin No

Contact Details
Address 14 SHARMA COLONY Locality 22 GODAM, NANDPURI
City/Town/Village JAIPUR District JAIPUR
State/UT RAJASTHAN Pin Code 302019
Email Address pri******@gmail.com Mobile Number (+91) 941****355
Land Line No. with 09414648695
STD code or any
other Contact No.

Fee Payment Details

Payment Mode: Pay through SBI(MOPS) Transaction ID: CPV0758169
Exam Fee: 650 /- Date of Transaction: 27/09/2019 22:52:40
Fee Submitted On: 27/09/2019
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.

Images Uploaded by Candidate

Photograph Signature

List of Document Uploaded

Photograph,Signature

IP Address : 182.68.247.104 Date of Downloading : 27/09/2019 11:12:43 PM