NATIONAL ELIGIBILITY CUM ENTRANCE TEST (UG)

CONFIRMATION PAGE - NEET(UG)-2020

You have successfully submitted On-line Application. Please preserve this pagealong withproof of fee payment for future
reference.
Application No. : 200411309753

Candidate's Name AJAY KUMAR Date of Birth 27/08/2002

Mother's Name AMBILI Gender Male
Father's Name JAYAPRAKASAN Category OBC (NCL)
Year of Passing/Appearing Class 2020 Person with Disability: No
XII
State/Country to which Applicant Kerala Nationality Indian
belongs
Question Paper Medium English Class XII Marks(%) -
Mobile No. 91xxxxxx2059 Email Id ajxxxxxxxxxxxxxxx@gm
ail.com
Choice of Exam Cities
PALAKKAD ( 2810) MALAPPURAM ( 2809) KOZHIKODE/CALICUT ( 2808) THRISSUR ( 2812)

DECLARATION :- I hereby solemnly and sincerely 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
including information about previous attempts in AIPMT/NEET. However, if any information furnished herein is found
fraudulent, incorrect or untrue, I understand that I will be liable for criminal prosecution which will result incancellation 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, 2020 which I have
gone through carefully. I further declare that I have not submitted any other application for NEET, 2020 and mobile no
and email address given in the form are correct and my own or of my parents.

Photo Signature Left Hand Thumb Impression

Permanent Address
Address KUZHIKKALTHODI HOUSE, ARAYANGODE, MANNARKKAD PO
City PALAKKAD ,PALAKKAD
State/Country Kerala Pin Code 678582
Details of Transaction(SBI Bank)
Transaction ID.: IGAHSUWKD9 Total Amount: 1400 Date of Transaction: 26/12/2019
Application No: 200411309753 Printed On : 26/12/2019 10:32:54
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 15th January, 2020 to
31st January, 2020. No corrections shall be allowed under any circumstances after this date.