JANUARY JEE(MAIN) 2020

Confirmation Page

Application No. 2003 1015 5385 -

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 AMAN GUPTA Date of Birth 14-04-2001
Mother's Name KIRAN DEVI Category OBC- NCL (Central List)
Father's Name KRISHNA KUMAR PRASAD 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 Rural State Code of Eligibility JHARKHAND
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 JHARKHAND - RANCHI Exam City 2nd JHARKHAND - HAZARIBAGH
Exam City 3rd JHARKHAND - DHANBAD Exam City 4th JHARKHAND - JAMSHEDPUR

Additional Details
Are you a Twin No

Contact Details
Address GANDHINAGAR BHURKUNDA , RAMGARH Locality GANDHINAGAR,RANCHI
City/Town/Village RAMGARH District RAMGARH
State/UT JHARKHAND Pin Code 829106
Email Address kri****************@gmail.com Mobile Number (+91) 707****726
Land Line No. with 9934179170
STD code or any
other Contact No.

Fee Payment Details

Payment Mode: Pay through SBI(MOPS) Transaction ID: CPU8465756
Exam Fee: 650 /- Date of Transaction: 20/09/2019 14:39:35
Fee Submitted On: 20/09/2019
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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