CENTRAL BOARD OF SECONDARY EDUCATION

CONFIRMATION PAGE - NEET(UG)-2018

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Application / Registration No. : 41226435

Candidate's Name ROJA BASKAR Date of Birth 23/12/2000

Mother's Name KUMARI Gender Female
Father's Name BASKAR Category OBC
Year of Passing/Appearing Class 2018 Person with Disability: No
XII
State/Country to which Applicant Tamil Nadu Nationality Indian
belongs
Question Paper Medium Tamil Class XII Marks(%) -
Mobile No. 91xxxxxx8222 Email Id jaxxxxxxxxxxx@gmail.c
om
Choice of Exam Centres KANCHEEPURAM ( THIRUVALLUR ( 5121) CHENNAI ( 5115)
5117)

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, 2018 which I have
gone through carefully. I further declare that I have not submitted any other application for NEET, 2018 and mobile no
and email address given in the form are correct and my own or of my parents.

Photo Signature
Complete Mailing Address
Address 113, SUNAMBU KOTTAI STREET, NEERVALUR
City NEERVALUR ,KANCHEEPURAM
State/Country Tamil Nadu Pin Code 631561
Details of Transaction(SBI Bank)
Transaction ID.: CPE4503524 Total Amount: 1400 Date of Transaction: 3/7/2018 2:58:33 PM
Card Type: VISA/Master Card
Registration No: 41226435 Printed On : 07/03/2018