सं युत वे श परीा (मु य)

Joint Entrance Examination (Main)

JEE(Main)

APPLICATION NUMBER 240310285604

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)
C/O-PARMANAND
पता (Premises No/ Name) ईमेल पता (Email Address) SAKETANAND2019@GMAIL.COM
SINGH
उप-थानीयता (Sub- VILL-AMDAHA KALA PO-BARI
थानीयता (Locality) AMDAHA KALA
Locality)(Optional) MANJHGAIN PS-HAVELI KHARAGPUR
दे श कोड (Country Code) 91 दे श (Country) INDIA
राय (State) BIHAR िजला (District) Munger
वै किपक संपक सू (Alternate
मोबाइल नंबर (Mobile Number) 91 - 9263544142 7991163930
Contact No.) (Optional)
िपन कोड (Pin Code) 811213
थायी पता (Permanent Address)
C/O-PARMANAND
पता (Premises No/ Name) थानीयता (Locality) AMDAHA KALA
SINGH
VILL-AMDAHA KALA
उप-थानीयता (Sub- PO-BARI MANJHGAIN
दे श (Country) INDIA
Locality)(Optional): PS-HAVELI
KHARAGPUR
राय (State) BIHAR िजला (District) Munger
िपन कोड (Pin Code) 811213
यितगत योरा (PERSONAL DETAILS)
अयथी की जम ितिथ (Candidate's
अयथी का नाम (Candidate's Name) ARPIT SINGH 09-01-2007
Date of Birth)
िपता / अिभभावक का नाम (Father / माता / अिभभावक का नाम (Mother /
PARMANAND SINGH PUSHPA DEVI
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 265772286533
Number)
PHOTOGRAPH
राय / केद शािसत दे श जहाँ से 12वीं /
समक उीण / उपिथत (State/ UT
BIHAR े णी (Category ) OBC-(NCL) AS PER CENTRAL LIST
from where 12th/ Equivalent Passed/
Appearing)
या आपको मधुमेह ह  (Are You िनवास की जगह ( Place of Residence
NO 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 2
(Session Of Exam Apply For)
िपता / अिभभावक यवसाय (Father / िपता / अिभभावक योयता (Father /
OTHERS Graduate
Guardian Occupation) Guardian Qualification)
माता / अिभभावक यवसाय (Mother / माता / अिभभावक योयता (Mother /
Others MATRICULATE
Guardian Occupation) Guardian Qualification)
परीा राय-पहला िवकप (Exam State परीा शहर-पहला िवकप (Exam City
BIHAR BHAGALPUR
1st Choice ) 1st Choice )
परीा राय-दूसरा िवकप (Exam State परीा शहर-दूसरा िवकप (Exam City
nd BIHAR nd PATNA
2 Choice ) 2 Choice )
परीा राय-तीसरा िवकप (Exam State परीा शहर-तीसरा िवकप (Exam City
BIHAR SAMASTIPUR
3rd Choice ) 3rd Choice )
परीा राय-चौथा िवकप (Exam State परीा शहर-चौथा िवकप (Exam City
BIHAR MUZAFFARPUR
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)
कू िलंग का थान (Place of
योयता परीा (Qualifying Exam) 10 th or equivalent Rural
Schooling)
कू ल / कॉलेज का कार (Type of School / योयता परीा राय (Qualifying
Government School BIHAR
College) Examination State)
योयता परीा िजला (Qualifying BIHAR SCHOOL EXAMINATION
Munger कू ल बोड (School Board)
Examination District) BOARD
का 10वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम UTKRAMIT M S कू ल / कॉलेज का पता (School /
JAMUHAT MUNGER
(School/College name should be as per JAMUHAT MUNGER College Address)
Class 10th Mark sheet/certificate)
रोल नंबर 10वीं माणप के अनुसार
कू ल / कॉलेज िपनकोड (School / College
811213 (Roll number as per 10th 2200064
Pincode)
certificate)
पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 500.0
ातांक (Obtain Marks) 390.0 ितशत (Percentage) 78.00
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)
Intermediate or two-year
Pre-University examination कू िलंग का थान (Place of
योयता परीा (Qualifying Exam) Urban
conducted by a recognized Schooling)
Board/ University.
कू ल / कॉलेज का कार (Type of School / योयता परीा राय (Qualifying
Government School BIHAR
College) Examination State)
योयता परीा िजला (Qualifying BIHAR SCHOOL EXAMINATION
Munger कू ल बोड (School Board)
Examination District) BOARD
का 12वीं की माकशीट/माणप के
GOVT PLUS TWO HIGH
अनुसार िवालय/कॉलेज का नाम कू ल / कॉलेज का पता (School /
SCHOOL HAVELI HAVELI KHARAGPUR MUNGER
(School/College name should be as per College Address)
KHARAGPUR
Class 12th Mark sheet/certificate)
रोल नंबर 12वीं माणप के अनुसार
कू ल / कॉलेज िपनकोड (School / College
811213 (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) 7739796476 ईमेल आईडी (Email ID) arpitsingh7295831899@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) IGAQLADVF4
लेन-दे न की ितिथ (Date of
परीा शु क (Exam Fee) 1800.0 01-01-1900 00:00:00 AM
Transaction)
शु क जमा िकया गया (Fee Submitted
11-11-2023 14:25:43 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 : 223.182.164.152 Date of Downloading : 11-11-2023 14:27:28 PM