COMPLETE APPLICATION FORM : JEE B.Ed.

- 2021

A - Registration Details
Registration Number BED202110181532
Candidate Name SHIVANGI MITTAL
Candidate's Father Name PRAVEEN KUMAR MITTAL
Candidate's Mother Name ALKA MITTAL
Candidate's Date of Birth 24/Aug/1996
Email Address mshivangi240896@gmail.com
Primary Mobile Number 9910496129

B - Personal Details
Gender Female Marital Status Married
Spouse Name aakash goel Nationality Indian
Category General Category Certificate Number
State Domicile UP Is 10 From Up Yes
Is 12 From Up Yes Is UG From Up No
Is Person with Disability No Disability Type
Disability Percentage Is Economically Weaker No
Id Proof Aadhar Card Id Proof No 360445661043B
Alternate Email mittal24shivangi@gmail.com Alternate Mobile Number 9818934861
Do you belong to non creamy layer ?

C - Communication Address
R242 NANDGRAM Ghaziabad Uttar Pradesh 201003

D - Permanent Address
R242 NANDGRAM Ghaziabad Uttar Pradesh 201003

E - Opted Stream Details

Stream opted for B.Ed. Science

F - SSC / 10th Std / Equivalent Details

Board Name CBSE
Marks Obtained 950 Maximum Marks 1000
Year Of Passing 2011 Percentage 95
G - HSC / 12th Std / Equivalent Details
Board Name CBSE
Marks Obtained 440 Maximum Marks 500
Year Of Passing 2013 Percentage 88

H - Graduation Details
Is Graduation complete Pass Stream of Graduation Science/Engineering
Specified Stream Have you done BE/BTech No
Name of University UNIVERITY OFDELHI
Marks Obtained 2935 Maximum Marks 3500
Percentage 83.86 Year Of Passing 2016
Roll Number 4121439071 Expected Year of Passing

I - Post Graduation Details

Is Post Graduation complete
Name of University
Marks Obtained Maximum Marks
Percentage Year Of Passing
Roll Number Expected Year of Passing

J - Weightage Details
TOTAL WEIGHTAGE : 0
A. Have you participated in National or State level or Inter University Sports Competition No
A.1. In the individual items by the Candidate

A.2. In the team items by the Candidate

A.3. In other college tournaments or sports run by a university

B. Candidates of National Cadet Corps and National Service Scheme

C. Do you need reservation of dependents of freedom fighters No

D. Are you in active service / immersed / retired defense personnel or son/daughter of such personnel, or related
No
to a disabled, missing or dead defensive personnel as their son/daughter/wife

E. Is your father or husband is serving in/retired from police or PAC or BSF or SSB or ITBP or CRPF or service in
home guards or disabled / dead in such services
No

F. Female Candidate who is Widowed, Divorced or Abandoned

K - Center Details
Center Choice 1 Ghaziabad Center Choice 2 Gautam Buddha Nagar Center Choice 3 Meerut
Center Choice 4 Agra Center Choice 5 Mathura

L - Payment Details
Payment Status Success Payment Date 05/Mar/2021
Transaction Number VHDF9804375449 Receipt Number 20210305
Order Id BED20211018153220210305135354785 Total Amount 1500

M - Declaration
I understand that it is my responsibility to check the eligibility criterion and other conditions of the J.E.E. B.Ed. 2021 – 23. I also am aware that the University of Lucknow,
Lucknow is not verifying the eligibility at the time of submission of online application form. I, hereby, certify that the particulars given by me in this B.Ed. 2021 – 23 online
application form are true to best of my knowledge and belief and only I will be responsible for any mismatch or incorrect information. I also certify that I fulfil the eligibility
criteria laid down by University of Lucknow, Lucknow for J.E.E. B.Ed. 2021 – 23 and undertake to produce original documents whenever necessary. I will follow all instruction
given by University of Lucknow, Lucknow in this regard. I understand all disputes will be subjected to territorial jurisdiction of LUCKNOW City only.