JANUARY JEE(MAIN) 2020

Confirmation Page

Application No. 2003 1081 1582 -

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 MRIDUL DHINGRA Date of Birth 30-01-2002
Mother's Name SURBHI DHINGRA Category General
Father's Name KESHAV DHINGRA 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 DELHI (NCT)
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 DELHI (NCT) - DELHI/NEW DELHI Exam City 2nd HARYANA - GURUGRAM
Exam City 3rd HARYANA - SONIPAT Exam City 4th HARYANA - FARIDABAD

Additional Details
Are you a Twin No

Contact Details
Address 113,SUNEHRI BAGH APPT,ROHINI,SEC-13 Locality
City/Town/Village NEW DELHI District NORTH WEST DELHI
State/UT DELHI Pin Code 110085
Email Address mri************@gmail.com Mobile Number (+91) 729****183
Land Line No. with 01127552579
STD code or any
other Contact No.

Fee Payment Details

Payment Mode: Pay through HDFC Bank Transaction ID: 9121820229
Exam Fee: 650 /- Date of Transaction: 28/09/2019 12:07:55
Fee Submitted On: 28/09/2019
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 : 115.97.157.248 Date of Downloading : 03/12/2019 11:23:26 PM