JOINT ENTRANCE EXAMINATION (Main) - APRIL 2020

Confirmation Page

Application No. 200310116267 -

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 PRINCE PATEL Candidate's Date of Birth 02-11-2002
Mother's Name TARUNABEN PATEL Category General
Father's Name BHUPENDRAKUMAR PATEL 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 GUJARAT
Are You Diabetic? NO Medium of Instructions/Study English
- Physics, Chemistry and
Mathematics in Class
11th/12th/equivalent
Mode of Preparation Self Study

Apply For
Apply For B.E./B.Tech. Only Question Paper Medium English
Exam City 1st GUJARAT - MEHSANA Exam City 2nd GUJARAT - AHMEDABAD/GANDHINAGAR
Exam City 3rd GUJARAT - HIMATNAGAR Exam City 4th GUJARAT - VADODARA

Additional Details
Are you a Twin No

Contact Details
Address B-22,SONA BANGLOW Locality
City/Town/Village VISNAGAR District MEHSANA
State GUJARAT Pin Code 384315
Email Address pat************@gmail.com Mobile Number 992****850
Land Line No. with --
STD code or any
other Contact No.

Fee Payment Details

Payment Mode: Pay through HDFC Bank Transaction ID: 9896020115
Exam Fee: 650 /- Date of Transaction: 21/02/2020 04:18:29
Fee Submitted On: 21/02/2020
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. No
Candidate should adopt any unfair means, or indulge in any unfair examination practices. If at any stage, it is found that the candidate has submitted multiple
Applications and/or appeared in more than one date/shift, then the candidature will be cancelled and legal action will be taken including debarring in all future
examinations conducted by NTA

Images Uploaded by Candidate

Photograph Signature

List of Document Uploaded

Photograph,Signature,12th Admit Card/Marksheet/Certificate

IP Address : 157.32.203.120 Date of Downloading : 20/05/2020 10:14:06 AM