सं युत वे श परीा (मु य)

Joint Entrance Examination (Main)

JEE(Main)

APPLICATION NUMBER 240310392921

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यितगत योरा (Contact Details) वतमान पता (Present Address)
पता (Premises No/ Name) 19B/5/1C ईमेल पता (Email Address) EMPERORVINEET7@GMAIL.COM
HARWARA,
DHOOMANGANJ,
उप-थानीयता (Sub-
थानीयता (Locality) PREETAM NAGAR, NA
Locality)(Optional)
NEAR UNION BANK OF
INDIA
दे श कोड (Country Code) 91 दे श (Country) INDIA
राय (State) UTTAR PRADESH िजला (District) Prayagraj
वै किपक संपक सू (Alternate
मोबाइल नंबर (Mobile Number) 91 - 9685066506 9236577537
Contact No.) (Optional)
िपन कोड (Pin Code) 211011
थायी पता (Permanent Address)
HARWARA, DHOOMANGANJ,
पता (Premises No/ Name) 19B/5/1C थानीयता (Locality) PREETAM NAGAR, NEAR UNION BANK
OF INDIA
उप-थानीयता (Sub-
NA दे श (Country) INDIA
Locality)(Optional):
राय (State) UTTAR PRADESH िजला (District) Prayagraj
िपन कोड (Pin Code) 211011
यितगत योरा (PERSONAL DETAILS)
अयथी की जम ितिथ (Candidate's
अयथी का नाम (Candidate's Name) VINEET SETH 25-11-2005
Date of Birth)
िपता / अिभभावक का नाम (Father / MAHEESH KUMAR माता / अिभभावक का नाम (Mother /
SHIKHA SETH
Guardian Name) SETH 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 986935715606
Number)
PHOTOGRAPH
राय / केद शािसत दे श जहाँ से 12वीं /
समक उीण / उपिथत (State/ UT
UTTAR PRADESH े णी (Category ) GENERAL
from where 12th/ Equivalent Passed/
Appearing)
या आपको मधुमेह ह  (Are You िनवास की जगह ( Place of Residence
NO URBAN
Diabetic ? ) )
यिद आप एक Pwd उमीदवार ह , तो या
आपके पास ब चमाक िवकलांगता है (If you वािषक पािरवािरक आय ( Annual
NA 800000 AND ABOVE
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
Online Coaching 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 2
(Session 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
UTTAR PRADESH ALLAHABAD/PRAYAGRAJ
1st Choice ) 1st Choice )
परीा राय-दूसरा िवकप (Exam State परीा शहर-दूसरा िवकप (Exam City
UTTAR PRADESH PRATAPGARH
2nd Choice ) 2nd Choice )
परीा राय-तीसरा िवकप (Exam State परीा शहर-तीसरा िवकप (Exam
UTTAR PRADESH GHAZIABAD
3rd Choice ) City 3rd Choice )
परीा राय-चौथा िवकप (Exam State परीा शहर-चौथा िवकप (Exam City
UTTAR PRADESH VARANASI
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
उीण की िथित (Pass Status) Passed 2022
of Passing/Appearing)
कू िलंग का थान (Place of
योयता परीा (Qualifying Exam) 10 th or equivalent Urban
Schooling)
कू ल / कॉलेज का कार (Type of School योयता परीा राय (Qualifying
Private Unaided UTTAR PRADESH
/ College) Examination State)
योयता परीा िजला (Qualifying COUNCIL FOR THE INDIAN SCHOOL
Prayagraj कू ल बोड (School Board)
Examination District) CERTIFICATE EXAMINATIONS
का 10वीं की माकशीट/माणप के
SRINIVASA
अनुसार िवालय/कॉलेज का नाम कू ल / कॉलेज का पता (School / 31 MAHATMA GANDHI MARG, CIVIL
rAMANUJAN PUBLIC
(School/College name should be as College Address) LINES, PRAYAGRAJ
SCHOOL PRAYAGRAJ
per Class 10th Mark sheet/certificate)
रोल नंबर 10वीं माणप के अनुसार
कू ल / कॉलेज िपनकोड (School / College
211001 (Roll number as per 10th 7660149
Pincode)
certificate)
पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 600.0
ातांक (Obtain Marks) 562.0 ितशत (Percentage) 93.67
th
12वीं या समक योयता िववरण (12 or equivalent Qualification Details)
उीण / सिमिलत होने का वष (Year
उीण की िथित (Pass Status) Appearing 2024
of Passing/Appearing)
The final examination of the
10+2 system, conducted by
any recognized Central/
State Board, such as the
Central Board of Secondary कू िलंग का थान (Place of
योयता परीा (Qualifying Exam) Urban
Education, New Delhi; Schooling)
Council for the Indian
School Certificate
Examinations, New Delhi
etc.
कू ल / कॉलेज का कार (Type of School योयता परीा राय (Qualifying
Private Unaided UTTAR PRADESH
/ College) Examination State)
योयता परीा िजला (Qualifying CENTRAL BOARD OF SECONDARY
Prayagraj कू ल बोड (School Board)
Examination District) EDUCATION
का 12वीं की माकशीट/माणप के PANDIT RAM
अनुसार िवालय/कॉलेज का नाम CHANDRA MISHRA कू ल / कॉलेज का पता (School / JHALWA, SAHA URF PIPALGAON,
(School/College name should be as MEMORIAL PUBLIC College Address) PRAYAGRAJ
per Class 12th Mark sheet/certificate) SCHOOL
रोल नंबर 12वीं माणप के अनुसार
कू ल / कॉलेज िपनकोड (School / College
211012 (Roll number as per 12th NA
Pincode)
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) 8840884596 ईमेल आईडी (Email ID) manishseth1971@gmail.com
उमीदवार ारा अपलोड की गई छिवयां (IMAGES UPLOADED BY THE CANDIDATE)

PHOTO

SIGNATURE

शु क भु गतान िववरण (Fee Payment Details)

भु गतान का कार (Payment Mode) Online लेन-दे न आईडी (Transaction ID) CPADGHQDY9
लेन-दे न की ितिथ (Date of
परीा शु क (Exam Fee) 2000.0 14-11-2023 14:11:22 PM
Transaction)
शु क जमा िकया गया (Fee Submitted
14-11-2023 14:10:18 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 : 203.81.241.198 Date of Downloading : 26-11-2023 15:23:52 PM