Government of Maharashtra

State Common Entrance Test Cell,Maharashtra, Mumbai

NEET UG-2021
Personal Details:
Application No : 211015751
Full name of the Candidate (Name show be on Printed in the NEET UG 2021 Score card) : MASKE OM DNYANDEV
Father Name ( Middle ) : DNYANDEV
Mother's Name : SEEMA
Date of Birth : 21/07/2000
Gender : MALE
Nationality : INDIAN
I am OCI/PIO Candidate ( Refer 4.1.2 ) : NO
I want to apply for: : STATE QUOTA
Address for Communication/Correspondance : MASKE HOUSE
Address 2 : NEAR VIDHYA VIKAS VIDHYALYA
Address 3 : SHREE NAGAR LATUR
Town/City : LATUR
District : LATUR
State : MAHARASHTRA
Pincode : 413512
Region of Residence : Mahanagarpalika
Family Income : less than 100000
STD-Code : --
Phone No : --
Mobile No. : 86******01
Email Address : omma**********l.com
Religion : HINDU
Whether candidate is Domicile of Maharashtra State : YES
I want to claim linguistic Minority Quota in : NONE
Reservation states of the candidate : EWS
Select Specified Reservation : NONE
Hilly Area Village : --
Are you person with with Disability? : NO
I want to claim Orphan Reservation Quota ? : NO
Parent is Employee of Government of Maharashtra/Government of India and
:
Transfered/Posted/Deputed in Maharashtra before Preference Form Filling
NEET UG Roll No : 3109009039
NEET UG Appliction No : 210411061647
NEET All India Rank : 67560
Physics Percentile Score Obtained : 96.1682941
Chemistry Percentile Score Obtained : 96.7468835
Biology Percentile Score Obtained : 90.3793565
Total Percentile Score Obtained : 95.6197512
PCB Total (out of 720) : 521
SSC/10th or Equivalent Examination Year of passing : 2016
State from which SSC Or equivalents Examination is Qualified : MAHARASHTRA
One of the Languagess. SSC or Equivalent : NONE
HSC/12th or Equivalent Examination Passing Year : 2018
State of HSC/12th Std.Passing : MAHARASHTRA
District of HSC/12th Std.Passing : 16-PUNE
HSC/12th Std : PASS
Maharashtra State Board of
HSC/12th or Equivalent Board : Secondary and Higher Secondary
Education, Pune (HSC)
HSC MARK (12th or Equavalent)
PHYSICS : 63 / 100
CHEMISTRY : 55 / 100
BIOLOGY : 61 / 100
ENGLISH : 74 / 100
PCB TOTAL : 179
PCBE Total : 253
PCB PERCENTAGE : 59.67%
PCBE PERCENTAGE : 63.25%
Upload Documents Status :
1. Admit Card/Hall Ticket of NEET UG 2021 :  Pending

2. NEET-UG 2021 Marksheet :  Pending

3. National Certificate / Valid Indian Pasport / School Leaving Certificate H.S.C (or Equivalent ) :  Pending

4. Domicile Certificate of the Candidate :  Pending

5. H.S.C (or Equivalent ) Examination Marksheet :  Pending

6. SSC (or equivalent) Passing Certificate (For Date of Birth) :  Pending

7. Medical fitness certificate (Annexure -H) :  Pending

8. EWS Certificate issued by competentAuthority. :  Pending

Declaration :
I, hereby, solemnly and sincerely affirm that each and every statement made and the entire information filled in the above online application form is true and correct to
the best of my knowledge.
I have not concealed any material information, however if any information submitted herein is found fraudulent, incorrect or untrue, I understand that I am liable to
criminal prosecution and I also agree to forgo my seat in Medical Postgraduate course. I also understand that my selection and admission to the course is also liable to
be cancelled.
I have carefully read the rules & regulations of NEET - UG 2021 brochure and I agree to abide by them. I hereby accept in entirely the legality, validity and correctness
of these rules. I understand by submitting this application I have accepted the correctness, validity and/or justifiability of all these and that. Had I not accepted the
correctness and validity of these rules I would not have submitted this application and further that it will not be open hereinafter to challenge and / or question validity
and / or correctness of any rule or part thereof.
I undertake to upload all the required Documents at the time of Registration, failing which I understand that my claim for selection shall not be granted.
I undertake to submit all the required original certificates at the time of Document Verification as well as at the time of admission to a course/college as per the rules,
failing which I understand that my claim for selection shall not be granted.
I am ready to bear the payment gateway charges for making online payment of centralized Online Admission process (CAP) Application fees.
I agree to aforesaid conditions

Pyament Bank Reference No.: 211015751_3721 Signature of Applicant

Application Date and Time: 31/12/2021 16:01:40