JANUARY JEE(MAIN) 2020

Confirmation Page

Application No. 2003 1032 1944 -

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 NIVESH CHOUHAN Date of Birth 10-04-2002
Mother's Name BHARTI Category SC
Father's Name RAVI KUMAR CHOUHAN 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 Code of Eligibility RAJASTHAN
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 RAJASTHAN - JODHPUR Exam City 2nd RAJASTHAN - JAIPUR
Exam City 3rd RAJASTHAN - AJMER Exam City 4th RAJASTHAN - UDAIPUR

Additional Details
Are you a Twin No

Contact Details
Address 101,INSIDE JALORI GATE, INDIRA CHOWK Locality
City/Town/Village JODHPUR District JODHPUR
State/UT RAJASTHAN Pin Code 342001
Email Address niv**************@gmail.com Mobile Number (+91) 730****938
Land Line No. with --
STD code or any
other Contact No.

Fee Payment Details

Payment Mode: Pay through SBI(MOPS) Transaction ID: IGAGZPPMU5
Exam Fee: 325 /- Date of Transaction: 13/09/2019 21:16:58
Fee Submitted On: 13/09/2019
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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Photograph Signature

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Photograph,Signature

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