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  • ConfirmationPage 210310374585 PDF

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    Rahil Shamsi
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    Mohammad Afnan Shamsi from Bareilly, Uttar Pradesh has applied for JEE(Main) 2021 to appear for B.E./B.Tech. He has applied for the April session and has chosen Bareilly as his first choice exam city. He is a general category candidate born on December 31, 2003 studying in self-study mode. He has paid Rs. 650 as exam fee through SBI MOPS and submitted his application on January 3, 2021 along with uploading his photograph and signature.

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    Mohammad Afnan Shamsi from Bareilly, Uttar Pradesh has applied for JEE(Main) 2021 to appear for B.E./B.Tech. He has applied for the April session and has chosen Bareilly as his first choice exam city. He is a general category candidate born on December 31, 2003 studying in self-study mode. He has paid Rs. 650 as exam fee through SBI MOPS and submitted his application on January 3, 2021 along with uploading his photograph and signature.

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    © All Rights Reserved
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    23 views1 page

    ConfirmationPage 210310374585 PDF

    Uploaded by

    Rahil Shamsi
    Mohammad Afnan Shamsi from Bareilly, Uttar Pradesh has applied for JEE(Main) 2021 to appear for B.E./B.Tech. He has applied for the April session and has chosen Bareilly as his first choice exam city. He is a general category candidate born on December 31, 2003 studying in self-study mode. He has paid Rs. 650 as exam fee through SBI MOPS and submitted his application on January 3, 2021 along with uploading his photograph and signature.

    Copyright:

    © All Rights Reserved
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    of 1

    JEE(Main) 2021

    Confirmation Page

    Application No. 210310374585 -


    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 MOHAMMAD AFNAN SHAMSI Candidate Date of Birth 31-12-2003
    Mother's Name FAINAZ SHAMSI Category General
    Father's Name NADEEM SHAMSI 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/ UT from where 12th/ UTTAR PRADESH
    Equivalent Passed/ Appearing
    Are You Diabetic? NO Mode of Preparation Self Study
    Medium of Schooling in Qualifying English
    Examination

    Applied For
    Apply For B.E./B.Tech. Only Question Paper Medium English
    Session(s) of Exam Apply For April Exam State/ City-1st choice UTTAR PRADESH - BAREILLY
    Exam State/ City-2nd choice UTTAR PRADESH - MORADABAD Exam State/ City-3rd choice UTTAR PRADESH - RAEBAREILI
    Exam State/ City-4th choice UTTAR PRADESH - LUCKNOW

    Additional Details
    Are you a Twin No

    Present Address
    Address 210 PEELI KOTHI Locality HUSAIN BAGH QILA
    City/Town/Village BAREILLY Country India
    State UTTAR PRADESH District BAREILLY
    Pin Code 243003 Email Address moa*************@gmail.com
    Mobile Number 904****554 Alternate Contact No. --

    Fee Payment Details


    Payment Mode: Pay through SBI(MOPS) Transaction ID: CPAANLZWG9
    Exam Fee: 650 /- Date of Transaction: 03/01/2021 19:37:41
    Fee Submitted On: 03/01/2021
    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 (with 80% face without mask),Signature

    IP Address : 132.154.107.172 Date of Downloading : 03/01/2021 07:37:56 PM

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