सं युत वे श परीा (मु य)

Joint Entrance Examination (Main)

JEE(Main)
APPLICATION
240310393109
NUMBER
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) RAI VILLAGE ईमेल पता (Email Address) RAJNEESHKUMARKASHYAP31@GMAIL.COM
उप-थानीयता (Sub-
थानीयता (Locality) SONIPAT NA
Locality)(Optional)
दे श कोड (Country Code) 91 दे श (Country) INDIA
राय (State) HARYANA िजला (District) Sonipat
वै किपक संपक सू (Alternate
मोबाइल नंबर (Mobile Number) 91 - 9882406339 NA
Contact No.) (Optional)
िपन कोड (Pin Code) 131029
थायी पता (Permanent Address)
पता (Premises No/ Name) KHUDEPUR थानीयता (Locality) GONDA
उप-थानीयता (Sub-
NA दे श (Country) INDIA
Locality)(Optional):
राय (State) UTTAR PRADESH िजला (District) Gonda
िपन कोड (Pin Code) 271403
यितगत योरा (PERSONAL DETAILS)
अयथी का नाम (Candidate's RAJNEESH KUMAR अयथी की जम ितिथ
31-07-2004
Name) KASHYAP (Candidate's Date of Birth)
िपता / अिभभावक का नाम (Father / माता / अिभभावक का नाम
RAM DHOKH SUMAN DEVI
Guardian Name) (Mother / Guardian Name)
िलंग (Gender) MALE राटीयता (Nationality ) INDIAN
ANY OTHER VALID
पहचान संया (Identification
पहचान के कार (Identity Type) GOVT IDENTITY 357344675768
Number)
WITH PHOTOGRAPH
राय / केद शािसत दे श जहाँ से
12वीं / समक उीण / उपिथत HIMACHAL
े णी (Category ) OBC-(NCL) AS PER CENTRAL LIST
(State/ UT from where 12th/ PRADESH
Equivalent Passed/ Appearing)
या आपको मधुमेह ह  (Are You िनवास की जगह ( Place of
NO RURAL
Diabetic ? ) Residence )
यिद आप एक Pwd उमीदवार ह , तो
या आपके पास ब चमाक िवकलांगता है वािषक पािरवािरक आय ( Annual
NA 100001-200000
(If you are a Pwd Candidate, do Family Income )
you have benchmark disability)?
योयता परीा म कू ली िशा का
तैयारी का तरीका ( Mode of
Self-Study मायम ( Medium of schooling in English
Preparation )
qualifying exam )
परीा कद िववरण (Exam centre Details)
परीा के स के िलए आवे दन कर
के िलए आवे दन (Apply For) B.E./B.Tech Session 1
(Session Of Exam Apply For)
िपता / अिभभावक यवसाय (Father / िपता / अिभभावक योयता (Father
PRIVATE SERVICE Matriculate
Guardian Occupation) / Guardian Qualification)
माता / अिभभावक योयता
माता / अिभभावक यवसाय (Mother
Others (Mother / Guardian MATRICULATE
/ Guardian Occupation)
Qualification)
परीा राय-पहला िवकप (Exam परीा शहर-पहला िवकप (Exam
DELHI DELHI/NEW DELHI
State 1st Choice ) City 1st Choice )
परीा राय-दूसरा िवकप (Exam परीा शहर-दूसरा िवकप (Exam
UTTAR PRADESH NOIDA/GREATER NOIDA
State 2nd Choice ) City 2nd Choice )
परीा राय-तीसरा िवकप (Exam परीा शहर-तीसरा िवकप (Exam
HARYANA AMBALA
State 3rd Choice ) City 3rd Choice )
परीा राय-चौथा िवकप (Exam परीा शहर-चौथा िवकप (Exam
HARYANA HISAR
State 4th Choice ) City 4th Choice )
न प मायम (Question Paper Medium) English
10वीं या समक योयता िववरण (10th or equivalent Qualification Details)
उीण / सिमिलत होने का वष
उीण की िथित (Pass Status) Passed 2021
(Year of Passing/Appearing)
कू िलंग का थान (Place of
योयता परीा (Qualifying Exam) 10 th or equivalent Rural
Schooling)
कू ल / कॉलेज का कार (Type of योयता परीा राय (Qualifying
Private Unaided HIMACHAL PRADESH
School / College) Examination State)
योयता परीा िजला (Qualifying
Sirmaur कू ल बोड (School Board) CENTRAL BOARD OF SECONDARY EDUCATION
Examination District)
का 10वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम doon valley school
कू ल / कॉलेज का पता (School /
(School/College name should be as bhattanwali paonta sahib bhattanwali,paontasahib
College Address)
per Class 10th Mark hp
sheet/certificate)
रोल नंबर 10वीं माणप के अनुसार
कू ल / कॉलेज िपनकोड (School /
173025 (Roll number as per 10th 17111817
College Pincode)
certificate)
पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 500.0
ातांक (Obtain Marks) 464.0 ितशत (Percentage) 92.80
th
12वीं या समक योयता िववरण (12 or equivalent Qualification Details)
उीण / सिमिलत होने का वष
उीण की िथित (Pass Status) Passed 2023
(Year of Passing/Appearing)
The final examination of
the 10+2 system,
conducted by any
recognized Central/ State
Board, such as the
Central Board of कू िलंग का थान (Place of
योयता परीा (Qualifying Exam) Rural
Secondary Education, Schooling)
New Delhi; Council for
the Indian School
Certificate
Examinations, New
Delhi etc.
कू ल / कॉलेज का कार (Type of योयता परीा राय (Qualifying
Private Unaided HIMACHAL PRADESH
School / College) Examination State)
योयता परीा िजला (Qualifying
Solan कू ल बोड (School Board) CENTRAL BOARD OF SECONDARY EDUCATION
Examination District)
का 12वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम
alpine public school कू ल / कॉलेज का पता (School /
(School/College name should be as chowkiwala nalagrh
chowkiwala nalagarh College Address)
per Class 12th Mark
sheet/certificate)
रोल नंबर 12वीं माणप के अनुसार
कू ल / कॉलेज िपनकोड (School /
174101 (Roll number as per 12th 17753141
College Pincode)
certificate)
पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 500.0
ातांक (Obtain Marks) 433.0 ितशत (Percentage) 86.60
अितिरत जानकािरयां (Additional Details)
या आप जु ड़वा ह और दोनों जे ईई (मे न) - 2024 के िलए आवे दन
कर रहे ह (Are you a Twin and both applying for JEE NO
(MAIN) – 2024)?
आपातकालीन संपक िववरण प (Emergency Contact Details)
दे श (Country) INDIA दे श कोड (Country Code) +91
मोबाइल नंबर (Mobile Number) 7807818283 ईमेल आईडी (Email ID) santoshkkashyap25@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) CPADGHQAO9
लेन-दे न की ितिथ (Date of
परीा शु क (Exam Fee) 900.0 01-01-1900 00:00:00 AM
Transaction)
शु क जमा िकया गया (Fee 14-11-2023 14:09:02
Submitted On) PM
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 : 49.14.97.160 Date of Downloading : 15-11-2023 11:07:33 AM