सं युत वे श परीा (मु य)

Joint Entrance Examination (Main)

JEE(Main)

APPLICATION NUMBER 240310010605

DO NOT SEND THIS PAGE TO NATIONAL TESTING AGENCY (NTA).
THE CANDIDATE IS REQUESTED TO RETAIN THE PRINTOUT OF THE CONFIRMATION PAGE FOR FUTURE REFERENCE.
यितगत योरा (Contact Details) वतमान पता (Present Address)
पता (Premises No/ Name) 2271 SECTOR 12 ईमेल पता (Email Address) MPULKIT2007@GMAIL.COM
थानीयता (Locality) SONIPAT उप-थानीयता (Sub-Locality)(Optional) SONIPAT
दे श कोड (Country Code) 91 दे श (Country) INDIA
राय (State) HARYANA िजला (District) Sonipat
वै किपक संपक सू (Alternate Contact
मोबाइल नंबर (Mobile Number) 91 - 9354231000 9034140900
No.) (Optional)
िपन कोड (Pin Code) 131001
थायी पता (Permanent Address)
पता (Premises No/ Name) 2271 SECTOR 12 थानीयता (Locality) SONIPAT
उप-थानीयता (Sub-
SONIPAT दे श (Country) INDIA
Locality)(Optional):
राय (State) HARYANA िजला (District) Sonipat
िपन कोड (Pin Code) 131001
यितगत योरा (PERSONAL DETAILS)
अयथी की जम ितिथ (Candidate's Date
अयथी का नाम (Candidate's Name) PULKIT MALHOTRA 10-01-2007
of Birth)
िपता / अिभभावक का नाम (Father / माता / अिभभावक का नाम (Mother /
PANKAJ MALHOTRA SANDHYA
Guardian Name) Guardian Name)
िलंग (Gender) MALE राटीयता (Nationality ) INDIAN
पहचान के कार (Identity Type) PAN CARD पहचान संया (Identification Number) HEKPP3959C
राय / केद शािसत दे श जहाँ से 12वीं /
समक उीण / उपिथत (State/ UT from
HARYANA े णी (Category ) GENERAL
where 12th/ Equivalent Passed/
Appearing)
या आपको मधुमेह ह  (Are You
NO िनवास की जगह ( Place of Residence ) URBAN
Diabetic ? )
यिद आप एक Pwd उमीदवार ह , तो या
आपके पास ब चमाक िवकलांगता है (If you वािषक पािरवािरक आय ( Annual Family
NA 700001-800000
are a Pwd Candidate, do you have Income )
benchmark disability)?
योयता परीा म कू ली िशा का मायम
तैयारी का तरीका ( Mode of Preparation ) Self-Study ( Medium of schooling in qualifying NA
exam )
परीा कद िववरण (Exam centre Details)
परीा के स के िलए आवे दन कर (Session
के िलए आवे दन (Apply For) B.E./B.Tech Session 1 & Session 2
Of Exam Apply For)
िपता / अिभभावक यवसाय (Father / िपता / अिभभावक योयता (Father /
BUSINESS Graduate
Guardian Occupation) Guardian Qualification)
माता / अिभभावक यवसाय (Mother / माता / अिभभावक योयता (Mother /
Government Service POST GRADUATE
Guardian Occupation) Guardian Qualification)
परीा राय-पहला िवकप (Exam State परीा शहर-पहला िवकप (Exam City 1st
DELHI DELHI/NEW DELHI
1st Choice ) Choice )
परीा राय-दूसरा िवकप (Exam State परीा शहर-दूसरा िवकप (Exam City 2nd
HARYANA AMBALA
2nd Choice ) Choice )
परीा राय-तीसरा िवकप (Exam State परीा शहर-तीसरा िवकप (Exam City 3rd
HARYANA HISAR
3rd Choice ) Choice )
परीा राय-चौथा िवकप (Exam State परीा शहर-चौथा िवकप (Exam City 4th
HARYANA FARIDABAD
4th Choice ) Choice )
न प मायम (Question Paper Medium) English
th
10वीं या समक योयता िववरण (10 or equivalent Qualification Details)
उीण / सिमिलत होने का वष (Year of
उीण की िथित (Pass Status) Passed 2022
Passing/Appearing)
योयता परीा (Qualifying Exam) 10 th or equivalent कू िलंग का थान (Place of Schooling) Urban
कू ल / कॉलेज का कार (Type of School / योयता परीा राय (Qualifying
Private Unaided HARYANA
College) Examination State)
योयता परीा िजला (Qualifying CENTRAL BOARD OF SECONDARY
Sonipat कू ल बोड (School Board)
Examination District) EDUCATION
का 10वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम SWARNPRASTHA PUB कू ल / कॉलेज का पता (School / College
GT KARNAL RD SONIPAT
(School/College name should be as per SCH Address)
Class 10th Mark sheet/certificate)
कू ल / कॉलेज िपनकोड (School / College रोल नंबर 10वीं माणप के अनुसार (Roll
131001 17232395
Pincode) number as per 10th certificate)
पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 500.0
ातांक (Obtain Marks) 427.0 ितशत (Percentage) 85.40
th
12वीं या समक योयता िववरण (12 or equivalent Qualification Details)
उीण / सिमिलत होने का वष (Year of
उीण की िथित (Pass Status) Appearing 2024
Passing/Appearing)
Any Public School/ Board/
University examination in
India or any foreign
country is recognized as
योयता परीा (Qualifying Exam) कू िलंग का थान (Place of Schooling) Urban
equivalent to the 10+2
system by the Association
of Indian Universities
(AIU).
कू ल / कॉलेज का कार (Type of School / योयता परीा राय (Qualifying
Private Unaided HARYANA
College) Examination State)
योयता परीा िजला (Qualifying CENTRAL BOARD OF SECONDARY
Sonipat कू ल बोड (School Board)
Examination District) EDUCATION
का 12वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम LITTLE ANGELS SR कू ल / कॉलेज का पता (School / College
PATEL NAGAR SONIPAT
(School/College name should be as per SEC SCHOOL Address)
Class 12th Mark sheet/certificate)
कू ल / कॉलेज िपनकोड (School / College रोल नंबर 12वीं माणप के अनुसार (Roll
131001 NA
Pincode) number as per 12th certificate)
अितिरत जानकािरयां (Additional Details)
या आप जु ड़वा ह और दोनों जे ईई (मे न) - 2024 के िलए आवे दन कर रहे ह
NO
(Are you a Twin and both applying for JEE (MAIN) – 2024)?
आपातकालीन संपक िववरण प (Emergency Contact Details)
दे श (Country) INDIA दे श कोड (Country Code) +91
मोबाइल नंबर (Mobile Number) 9034140800 ईमेल आईडी (Email ID) pkmalhotra2000@gmail.com
उमीदवार ारा अपलोड की गई छिवयां (IMAGES UPLOADED BY THE CANDIDATE)

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शु क भु गतान िववरण (Fee Payment Details)

भु गतान का कार (Payment Mode) Online लेन-दे न आईडी (Transaction ID) 156213963
परीा शु क (Exam Fee) 2000.0 लेन-दे न की ितिथ (Date of Transaction) 02-11-2023 21:23:13 PM
शु क जमा िकया गया (Fee Submitted
02-11-2023 21:22:38 PM
On)
घोषणा (Declaration)
I declare that information furnished by me in the application form is true in all respect and nothing is concealed. In case any entry or information is found to
be false, this shall entail automatic cancellation of my admission besides rendering me liable to such actions as deemed fit by the University. I hereby
undertake that I have carefully gone through the eligibility conditions prescribed in the prospectus for the programme. I am applying after satisfying that I
meet the eligibility conditions. If at any stage it is found that I do not fullfill the minimum prescribed criteria, my admission, if granted, shall stand cancelled
and I shall have no right to admission whatsoever.
IP Address : 223.178.213.30 Date of Downloading : 02-11-2023 21:24:47 PM