सं युत वे श परीा (मु य)

Joint Entrance Examination (Main)

JEE(Main)

APPLICATION NUMBER 240310488766

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)
R-2/226 RAJNAGAR
पता (Premises No/ Name) ईमेल पता (Email Address) RJYADAVCR7@GMAIL.COM
GHAZIABAD
थानीयता (Locality) RAJNAGAR उप-थानीयता (Sub-Locality)(Optional) NA
दे श कोड (Country Code) 91 दे श (Country) INDIA
राय (State) UTTAR PRADESH िजला (District) Ghaziabad
वै किपक संपक सू (Alternate Contact
मोबाइल नंबर (Mobile Number) 91 - 9910395214 NA
No.) (Optional)
िपन कोड (Pin Code) 201002
थायी पता (Permanent Address)
R-2/226 RAJNAGAR
पता (Premises No/ Name) थानीयता (Locality) RAJNAGAR
GHAZIABAD
उप-थानीयता (Sub-
NA दे श (Country) INDIA
Locality)(Optional):
राय (State) UTTAR PRADESH िजला (District) Ghaziabad
िपन कोड (Pin Code) 201002
यितगत योरा (PERSONAL DETAILS)
अयथी की जम ितिथ (Candidate's
अयथी का नाम (Candidate's Name) RANJEET YADAV 18-02-2006
Date of Birth)
िपता / अिभभावक का नाम (Father / माता / अिभभावक का नाम (Mother /
SHYAM LAL YADAV ASHA DEVI
Guardian Name) Guardian Name)
िलंग (Gender) MALE राटीयता (Nationality ) INDIAN
ANY OTHER VALID
पहचान के कार (Identity Type) GOVT IDENTITY WITH पहचान संया (Identification Number) 21173647
PHOTOGRAPH
राय / केद शािसत दे श जहाँ से 12वीं /
समक उीण / उपिथत (State/ UT
UTTAR PRADESH े णी (Category ) OBC-(NCL) AS PER CENTRAL LIST
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 Family
NA 300001-400000
are a Pwd Candidate, do you have Income )
benchmark disability)?
योयता परीा म कू ली िशा का मायम
तैयारी का तरीका ( Mode of Preparation
Online Coaching ( Medium of schooling in qualifying English
)
exam )
परीा कद िववरण (Exam centre Details)
परीा के स के िलए आवे दन कर (Session
के िलए आवे दन (Apply For) B.E./B.Tech Session 1 & Session 2
Of Exam Apply For)
िपता / अिभभावक यवसाय (Father / िपता / अिभभावक योयता (Father /
OTHERS Illiterate
Guardian Occupation) Guardian Qualification)
माता / अिभभावक यवसाय (Mother / माता / अिभभावक योयता (Mother /
Others ILLITERATE
Guardian Occupation) Guardian Qualification)
परीा राय-पहला िवकप (Exam State परीा शहर-पहला िवकप (Exam City 1st
UTTAR PRADESH GHAZIABAD
1st Choice ) Choice )
परीा राय-दूसरा िवकप (Exam State परीा शहर-दूसरा िवकप (Exam City 2nd
UTTAR PRADESH NOIDA/GREATER NOIDA
2nd Choice ) Choice )
परीा राय-तीसरा िवकप (Exam State परीा शहर-तीसरा िवकप (Exam City
UTTAR PRADESH MEERUT
3rd Choice ) 3rd Choice )
परीा राय-चौथा िवकप (Exam State परीा शहर-चौथा िवकप (Exam City 4th
UTTAR PRADESH LUCKNOW
4th Choice ) 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 (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
Private Unaided UTTAR PRADESH
College) Examination State)
योयता परीा िजला (Qualifying
Ghaziabad कू ल बोड (School Board) CBSE I (CBSE INTERNATIONAL)
Examination District)
का 10वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम dehradun pub sch sec 23 कू ल / कॉलेज का पता (School / College Raj Nagar, Block N, Sector 23, Sanjay
(School/College name should be as per sanjay ngr ghaziabad up Address) Nagar, Ghaziabad, Uttar Pradesh 201001
Class 10th Mark sheet/certificate)
कू ल / कॉलेज िपनकोड (School / College रोल नंबर 10वीं माणप के अनुसार (Roll
201001 21173647
Pincode) number as per 10th certificate)
पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 500.0
ातांक (Obtain Marks) 363.0 ितशत (Percentage) 72.60
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)
The final examination of
the 10+2 system, conducted
by any recognized Central/
State Board, such as the
Central Board of Secondary
योयता परीा (Qualifying Exam) कू िलंग का थान (Place of Schooling) Rural
Education, New Delhi;
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
Ghaziabad कू ल बोड (School Board) CBSE I (CBSE INTERNATIONAL)
Examination District)
का 12वीं की माकशीट/माणप के
DEHRADUN PUB SCH
अनुसार िवालय/कॉलेज का नाम कू ल / कॉलेज का पता (School / College Raj Nagar, Block N, Sector 23, Sanjay
SEC 23 SANJAY NGR
(School/College name should be as per Address) Nagar, Ghaziabad, Uttar Pradesh 201001
GHAZIABAD UP
Class 12th Mark sheet/certificate)
कू ल / कॉलेज िपनकोड (School / College रोल नंबर 12वीं माणप के अनुसार (Roll
201001 NA
Pincode) 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) 8789371075 ईमेल आईडी (Email ID) yshyam206@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) ZIC51556107400
परीा शु क (Exam Fee) 1800.0 लेन-दे न की ितिथ (Date of Transaction) 23-11-2023 22:20:40 PM
शु क जमा िकया गया (Fee Submitted
23-11-2023 22:19:44 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 : 139.5.197.236 Date of Downloading : 23-11-2023 22:21:17 PM