JANUARY JEE(MAIN) 2020

Confirmation Page

Application No. 2003 1015 4852 C

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 ANGAD NAYAK Date of Birth 05-08-2001
Mother's Name BASUMATI NAYAK Category SC
Father's Name BUDHESWAR NAYAK 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 - JAMSHEDPUR Exam City 2nd JHARKHAND - DHANBAD
Exam City 3rd JHARKHAND - BOKARO STEEL CITY Exam City 4th JHARKHAND - RANCHI

Additional Details
Are you a Twin No

Contact Details
Address JAMSHEDPUR Locality
City/Town/Village GAMHARIA District SERAIKELA KHARSAWAN
State/UT JHARKHAND Pin Code 832402
Email Address gud**********@gmail.com Mobile Number (+91) 620****940
Land Line No. with --
STD code or any
other Contact No.

Fee Payment Details

Payment Mode: Pay through SBI(MOPS) Transaction ID: IGAGZQYPH9
Exam Fee: 325 /- Date of Transaction: 14/09/2019 07:39:55
Fee Submitted On: 14/09/2019
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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