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THE CANDIDATE IS REQUESTED TO RETAIN THE PRINTOUT OF THE CONFIRMATION PAGE FOR FUTURE REFERENCE. यितगत योरा (Contact Details) वतमान पता (Present Address) A-26, TAPESHWAR पता (Premises No/ Name) NAGAR, ARRAH ईमेल पता (Email Address) ABHINAVRAG777@GMAIL.COM GARDEN उप-थानीयता (Sub- थानीयता (Locality) JAGDEO PATH NA Locality)(Optional) दे श कोड (Country Code) 91 दे श (Country) INDIA राय (State) BIHAR िजला (District) Patna वै किपक संपक सू (Alternate Contact मोबाइल नंबर (Mobile Number) 91 - 7070470562 8210838465 No.) (Optional) िपन कोड (Pin Code) 800014 थायी पता (Permanent Address) A-26, TAPESHWAR पता (Premises No/ Name) NAGAR, ARRAH थानीयता (Locality) JAGDEO PATH GARDEN उप-थानीयता (Sub- NA दे श (Country) INDIA Locality)(Optional): राय (State) BIHAR िजला (District) Patna िपन कोड (Pin Code) 800014 यितगत योरा (PERSONAL DETAILS) अयथी की जम ितिथ (Candidate's अयथी का नाम (Candidate's Name) ABHINAV RAG 03-02-2006 Date of Birth) िपता / अिभभावक का नाम (Father / माता / अिभभावक का नाम (Mother / KAMAL NAYAN SADHNA Guardian Name) Guardian Name) िलंग (Gender) MALE राटीयता (Nationality ) INDIAN ANY OTHER VALID पहचान के कार (Identity Type) GOVT IDENTITY WITH पहचान संया (Identification Number) 613302693368 PHOTOGRAPH राय / केद शािसत दे श जहाँ से 12वीं / समक उीण / उपिथत (State/ UT DELHI े णी (Category ) GENERAL from where 12th/ Equivalent Passed/ Appearing) या आपको मधुमेह ह (Are You NO िनवास की जगह ( Place of Residence ) URBAN Diabetic ? ) यिद आप एक Pwd उमीदवार ह , तो या आपके पास ब चमाक िवकलांगता है (If you वािषक पािरवािरक आय ( Annual NA 800000 AND ABOVE are a Pwd Candidate, do you have Family Income ) benchmark disability)? योयता परीा म कू ली िशा का तैयारी का तरीका ( Mode of Preparation Self-Study 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 2 (Session Of Exam Apply For) िपता / अिभभावक यवसाय (Father / GOVERNMENT िपता / अिभभावक योयता (Father / Post Graduate Guardian Occupation) SERVICE Guardian Qualification) माता / अिभभावक यवसाय (Mother / माता / अिभभावक योयता (Mother / Teaching / Research POST GRADUATE 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 nd BIHAR nd GAYA 2 Choice ) 2 Choice ) परीा राय-तीसरा िवकप (Exam State परीा शहर-तीसरा िवकप (Exam City BIHAR AURANGABAD 3rd Choice ) 3rd Choice ) परीा राय-चौथा िवकप (Exam State परीा शहर-चौथा िवकप (Exam City BIHAR ARRAH 4th Choice ) 4th Choice ) न प मायम (Question Paper Medium) English th 10वीं या समक योयता िववरण (10 or equivalent Qualification Details) उीण / सिमिलत होने का वष (Year of उीण की िथित (Pass Status) Passed 2022 Passing/Appearing) योयता परीा (Qualifying Exam) 10 th or equivalent कू िलंग का थान (Place of Schooling) Urban 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 / DELHI PUBLIC SCHOOL chandmari village, danapur cantonment (School/College name should be as per College Address) Class 10th Mark sheet/certificate) कू ल / कॉलेज िपनकोड (School / College रोल नंबर 10वीं माणप के अनुसार 801502 22199040 Pincode) (Roll number as per 10th certificate) पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 600.0 ातांक (Obtain Marks) 572.0 ितशत (Percentage) 95.33 th 12वीं या समक योयता िववरण (12 or equivalent Qualification Details) उीण / सिमिलत होने का वष (Year of उीण 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 योयता परीा (Qualifying Exam) Board of Secondary कू िलंग का थान (Place of Schooling) Urban Education, New Delhi; Council for the Indian School Certificate Examinations, New Delhi etc. कू ल / कॉलेज का कार (Type of School / योयता परीा राय (Qualifying Private Unaided DELHI College) Examination State) योयता परीा िजला (Qualifying CENTRAL BOARD OF SECONDARY New Delhi कू ल बोड (School Board) Examination District) EDUCATION का 12वीं की माकशीट/माणप के अनुसार िवालय/कॉलेज का नाम NEW SAINIK PUBLIC कू ल / कॉलेज का पता (School / hanuman chowk, qutub vihar phase 2, goyla (School/College name should be as per SCHOOL College Address) village Class 12th Mark sheet/certificate) कू ल / कॉलेज िपनकोड (School / College रोल नंबर 12वीं माणप के अनुसार 110071 NA Pincode) (Roll number as per 12th certificate) अितिरत 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) 9973352191 ईमेल आईडी (Email ID) kamal.bas43@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) CPADGIHDZ3 लेन-दे न की ितिथ (Date of परीा शु क (Exam Fee) 2000.0 01-01-1900 00:00:00 AM Transaction) शु क जमा िकया गया (Fee Submitted 14-11-2023 19:26:58 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 : 103.120.59.97 Date of Downloading : 14-11-2023 19:39:42 PM