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. यितगत योरा (Contact Details) वतमान पता (Present Address) पता (Premises No/ Name) RAMPUR ISMAIL ईमेल पता (Email Address) RUHANSHUKUMAR8@GMAIL.COM उप-थानीयता (Sub- थानीयता (Locality) RAMPUR ISMAIL BAHPURA Locality)(Optional) दे श कोड (Country Code) +91 दे श (Country) INDIA राय (State) BIHAR िजला (District) Patna वै किपक संपक सू (Alternate मोबाइल नंबर (Mobile Number) +91 - 8340566398 7764052315 Contact No.) (Optional) िपन कोड (Pin Code) 801103 थायी पता (Permanent Address) पता (Premises No/ Name) RAMPUR ISMAIL थानीयता (Locality) RAMPUR ISMAIL उप-थानीयता (Sub- BAHPURA दे श (Country) INDIA Locality)(Optional): राय (State) BIHAR िजला (District) Patna िपन कोड (Pin Code) 801103 यितगत योरा (PERSONAL DETAILS) अयथी की जम ितिथ (Candidate's अयथी का नाम (Candidate's Name) RUHANSHU KUMAR 15-10-2007 Date of Birth) िपता / अिभभावक का नाम (Father / माता / अिभभावक का नाम (Mother / UMASHANKAR SAH GEETA DEVI Guardian Name) Guardian Name) िलंग (Gender) MALE राटीयता (Nationality ) INDIAN ANY OTHER VALID पहचान संया (Identification पहचान के कार (Identity Type) GOVT IDENTITY WITH 673956943149 Number) PHOTOGRAPH राय / केद शािसत दे श जहाँ से 12वीं / समक उीण / उपिथत (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 उमीदवार ह , तो या आपके पास ब चमाक िवकलांगता है (If you वािषक पािरवािरक आय ( Annual NA 0-100000 are a Pwd Candidate, do you have Family Income ) benchmark disability)? योयता परीा म कू ली िशा का तैयारी का तरीका ( Mode of Preparation Correspondence Courses मायम ( Medium of schooling in English ) qualifying exam ) परीा कद िववरण (Exam centre Details) परीा 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 योयता (Father / BUSINESS Matriculate Guardian Occupation) Guardian Qualification) माता / अिभभावक यवसाय (Mother / माता / अिभभावक योयता (Mother / Others MATRICULATE Guardian Occupation) Guardian Qualification) परीा राय-पहला िवकप (Exam State परीा शहर-पहला िवकप (Exam City BIHAR PATNA 1st Choice ) 1st Choice ) परीा राय-दूसरा िवकप (Exam State परीा शहर-दूसरा िवकप (Exam City BIHAR ARRAH 2nd Choice ) 2nd Choice ) परीा राय-तीसरा िवकप (Exam State परीा शहर-तीसरा िवकप (Exam BIHAR MUZAFFARPUR 3rd Choice ) City 3rd Choice ) परीा राय-चौथा िवकप (Exam State परीा शहर-चौथा िवकप (Exam City BIHAR AURANGABAD 4th Choice ) 4th Choice ) न प मायम (Question Paper Medium) English 10वीं या समक योयता िववरण (10th or equivalent Qualification Details) उीण / सिमिलत होने का वष (Year उीण की िथित (Pass Status) Passed 2021 of Passing/Appearing) कू िलंग का थान (Place of योयता परीा (Qualifying Exam) 10 th or equivalent Rural Schooling) कू ल / कॉलेज का कार (Type of School / योयता परीा राय (Qualifying Private Unaided BIHAR College) Examination State) योयता परीा िजला (Qualifying CENTRAL BOARD OF SECONDARY Patna कू ल बोड (School Board) Examination District) EDUCATION का 10वीं की माकशीट/माणप के अनुसार िवालय/कॉलेज का नाम कू ल / कॉलेज का पता (School / south point public school vill lodipur, maner, patna (School/College name should be as per College Address) Class 10th Mark sheet/certificate) रोल नंबर 10वीं माणप के अनुसार कू ल / कॉलेज िपनकोड (School / College 801111 (Roll number as per 10th 22206091 Pincode) certificate) पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 500.0 ातांक (Obtain Marks) 465.0 ितशत (Percentage) 93.00 th 12वीं या समक योयता िववरण (12 or equivalent Qualification Details) उीण / सिमिलत होने का वष (Year उीण की िथित (Pass Status) Appearing 2024 of Passing/Appearing) Intermediate or two-year Pre-University कू िलंग का थान (Place of योयता परीा (Qualifying Exam) examination conducted by Rural Schooling) a recognized Board/ University. कू ल / कॉलेज का कार (Type of School / योयता परीा राय (Qualifying Government School BIHAR College) Examination State) योयता परीा िजला (Qualifying Patna कू ल बोड (School Board) BIHAR SCHOOL EXAMINATION BOARD Examination District) का 12वीं की माकशीट/माणप के अनुसार िवालय/कॉलेज का नाम raj kunwar vidya mandir कू ल / कॉलेज का पता (School / vill gopalpur, maner (School/College name should be as per gopalpur College Address) Class 12th Mark sheet/certificate) रोल नंबर 12वीं माणप के अनुसार कू ल / कॉलेज िपनकोड (School / College 801111 (Roll number as per 12th NA Pincode) certificate) अितिरत जानकािरयां (Additional Details) या आप जु ड़वा ह और दोनों जे ईई (मे न) - 2024 के िलए आवे दन कर रहे NO ह (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) 9631545037 ईमेल आईडी (Email ID) ussah786@gmail.com उमीदवार ारा अपलोड की गई छिवयां (IMAGES UPLOADED BY THE CANDIDATE)
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भु गतान का कार (Payment Mode) Online लेन-दे न आईडी (Transaction ID) CPADGIYFR5 लेन-दे न की ितिथ (Date of परीा शु क (Exam Fee) 900.0 01-01-1900 00:00:00 AM Transaction) शु क जमा िकया गया (Fee Submitted 15-11-2023 11:51:08 AM 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 : 202.142.68.43 Date of Downloading : 15-11-2023 11:52:49 AM