सं युत वे श परीा (मु य)

Joint Entrance Examination (Main)

JEE(Main)

APPLICATION NUMBER 240310551003

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यितगत योरा (Contact Details) वतमान पता (Present Address)
DIC ROAD, KAKADE
पता (Premises No/ Name) PLOT. DATT NAGAR ईमेल पता (Email Address) PIYUSH60SP@GMAIL.COM
OSMANABAD
उप-थानीयता (Sub-
थानीयता (Locality) OSMANABAD OSMANABAD
Locality)(Optional)
दे श कोड (Country Code) 91 दे श (Country) INDIA
राय (State) MAHARASHTRA िजला (District) Osmanabad
वै किपक संपक सू (Alternate
मोबाइल नंबर (Mobile Number) 91 - 8605834201 NA
Contact No.) (Optional)
िपन कोड (Pin Code) 413501
थायी पता (Permanent Address)
DIC ROAD, KAKADE
पता (Premises No/ Name) PLOT. DATT NAGAR थानीयता (Locality) OSMANABAD
OSMANABAD
उप-थानीयता (Sub-
OSMANABAD दे श (Country) INDIA
Locality)(Optional):
राय (State) MAHARASHTRA िजला (District) Osmanabad
िपन कोड (Pin Code) 413501
यितगत योरा (PERSONAL DETAILS)
SHENDGE PIYUSH अयथी की जम ितिथ (Candidate's
अयथी का नाम (Candidate's Name) 23-11-2006
SUBHASH Date of Birth)
िपता / अिभभावक का नाम (Father / माता / अिभभावक का नाम (Mother /
SUBHASH SONALI
Guardian Name) Guardian Name)
िलंग (Gender) MALE राटीयता (Nationality ) INDIAN
ANY OTHER VALID
पहचान संया (Identification
पहचान के कार (Identity Type) GOVT IDENTITY WITH 39357008616
Number)
PHOTOGRAPH
राय / केद शािसत दे श जहाँ से 12वीं /
समक उीण / उपिथत (State/ UT
MAHARASHTRA े णी (Category ) GENERAL
from where 12th/ Equivalent Passed/
Appearing)
या आपको मधुमेह ह  (Are You
NO िनवास की जगह ( Place of Residence ) RURAL
Diabetic ? )
यिद आप एक Pwd उमीदवार ह , तो या
आपके पास ब चमाक िवकलांगता है (If you वािषक पािरवािरक आय ( Annual
NA 0-100000
are a Pwd Candidate, do you have Family Income )
benchmark disability)?
योयता परीा म कू ली िशा का
तैयारी का तरीका ( Mode of Preparation
Self-Study मायम ( Medium of schooling in English
)
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 /
NOT APPLICABLE Not Applicable
Guardian Occupation) Guardian Qualification)
माता / अिभभावक यवसाय (Mother / माता / अिभभावक योयता (Mother /
Others OTHERS
Guardian Occupation) Guardian Qualification)
परीा राय-पहला िवकप (Exam State परीा शहर-पहला िवकप (Exam City
MAHARASHTRA LATUR
1st Choice ) 1st Choice )
परीा राय-दूसरा िवकप (Exam State परीा शहर-दूसरा िवकप (Exam City
nd MAHARASHTRA nd SOLAPUR
2 Choice ) 2 Choice )
परीा राय-तीसरा िवकप (Exam State परीा शहर-तीसरा िवकप (Exam City
MAHARASHTRA PUNE
3rd Choice ) 3rd Choice )
परीा राय-चौथा िवकप (Exam State परीा शहर-चौथा िवकप (Exam City
MAHARASHTRA AURANGABAD(MAHARASHTRA)
4th Choice ) 4th 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) Rural
कू ल / कॉलेज का कार (Type of School / योयता परीा राय (Qualifying
Government Aided Private MAHARASHTRA
College) Examination State)
योयता परीा िजला (Qualifying MAHARASHTRA STATE BOARD OF
Osmanabad कू ल बोड (School Board)
Examination District) SEC. & HR. SECONDARY EDUCATION
का 10वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम Chh shivaji high school कू ल / कॉलेज का पता (School /
osmanabad
(School/College name should be as per Osmanabad College Address)
Class 10th Mark sheet/certificate)
कू ल / कॉलेज िपनकोड (School / College रोल नंबर 10वीं माणप के अनुसार
413501 l088944
Pincode) (Roll number as per 10th certificate)
पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 500.0
ातांक (Obtain Marks) 457.0 ितशत (Percentage) 91.40
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)
Higher Secondary
योयता परीा (Qualifying Exam) Certificate Vocational कू िलंग का थान (Place of Schooling) Urban
Examination.
कू ल / कॉलेज का कार (Type of School / योयता परीा राय (Qualifying
Government Aided Private MAHARASHTRA
College) Examination State)
योयता परीा िजला (Qualifying MAHARASHTRA STATE BOARD OF
Osmanabad कू ल बोड (School Board)
Examination District) SEC. & HR. SECONDARY EDUCATION
का 12वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम Shri shri ravi shnkar कू ल / कॉलेज का पता (School /
osmanabad
(School/College name should be as per mahavidyalaya osmanaabd College Address)
Class 12th Mark sheet/certificate)
कू ल / कॉलेज िपनकोड (School / College रोल नंबर 12वीं माणप के अनुसार
413501 NA
Pincode) (Roll 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) 9356901922 ईमेल आईडी (Email ID) shendgesonali1@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) CPADGNBDL3
लेन-दे न की ितिथ (Date of
परीा शु क (Exam Fee) 1000.0 17-11-2023 13:22:40 PM
Transaction)
शु क जमा िकया गया (Fee Submitted
17-11-2023 13:22:27 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 : 152.57.72.48 Date of Downloading : 17-11-2023 19:49:30 PM