सं युत वे श परीा (मु य)

Joint Entrance Examination (Main)

JEE(Main)

APPLICATION NUMBER 240310985694

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)
A-206, THE ADDRESS
पता (Premises No/ Name) ईमेल पता (Email Address) KATURI41@GMAIL.COM
CHS LTD
NEAR WAKAD BRIDGE,
थानीयता (Locality) उप-थानीयता (Sub-Locality)(Optional) NA
WAKAD, PUNE
दे श कोड (Country Code) 91 दे श (Country) INDIA
राय (State) MAHARASHTRA िजला (District) Pune
वै किपक संपक सू (Alternate Contact
मोबाइल नंबर (Mobile Number) 91 - 9881190574 7387651307
No.) (Optional)
िपन कोड (Pin Code) 411057
थायी पता (Permanent Address)
A-206, THE ADDRESS NEAR WAKAD BRIDGE, WAKAD,
पता (Premises No/ Name) थानीयता (Locality)
CHS LTD PUNE
उप-थानीयता (Sub-
NA दे श (Country) INDIA
Locality)(Optional):
राय (State) MAHARASHTRA िजला (District) Pune
िपन कोड (Pin Code) 411057
यितगत योरा (PERSONAL DETAILS)
SREE SAI VENKATA अयथी की जम ितिथ (Candidate's Date
अयथी का नाम (Candidate's Name) 13-07-2006
KHUSHAL KATURI of Birth)
िपता / अिभभावक का नाम (Father / RV SATYAKIRAN माता / अिभभावक का नाम (Mother /
SREE LALITHA KATURI
Guardian Name) KATURI Guardian Name)
िलंग (Gender) MALE राटीयता (Nationality ) INDIAN
CLASS XII ADMIT
पहचान के कार (Identity Type) CARD ISSUED BY THE पहचान संया (Identification Number) 7656635
BOARD
राय / केद शािसत दे श जहाँ से 12वीं /
समक उीण / उपिथत (State/ UT
MAHARASHTRA े 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 उमीदवार ह , तो या
आपके पास ब चमाक िवकलांगता है (If you वािषक पािरवािरक आय ( Annual Family
NA 800000 AND ABOVE
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 /
PRIVATE SERVICE Post Graduate
Guardian Occupation) Guardian Qualification)
माता / अिभभावक यवसाय (Mother / माता / अिभभावक योयता (Mother /
Not Applicable POST GRADUATE
Guardian Occupation) Guardian Qualification)
परीा राय-पहला िवकप (Exam State परीा शहर-पहला िवकप (Exam City 1st
MAHARASHTRA PUNE
1st Choice ) Choice )
परीा राय-दूसरा िवकप (Exam State परीा शहर-दूसरा िवकप (Exam City 2nd
MAHARASHTRA MUMBAI/NAVI MUMBAI
2nd Choice ) Choice )
परीा राय-तीसरा िवकप (Exam State परीा शहर-तीसरा िवकप (Exam City 3rd
MAHARASHTRA KOLHAPUR
3rd Choice ) Choice )
परीा राय-चौथा िवकप (Exam State परीा शहर-चौथा िवकप (Exam City 4th
MAHARASHTRA THANE
4th Choice ) 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)
योयता परीा (Qualifying Exam) 10 th or equivalent कू िलंग का थान (Place of Schooling) Urban
कू ल / कॉलेज का कार (Type of School योयता परीा राय (Qualifying
Private Unaided MAHARASHTRA
/ College) Examination State)
COUNCIL FOR THE INDIAN
योयता परीा िजला (Qualifying
Pune कू ल बोड (School Board) SCHOOL CERTIFICATE
Examination District)
EXAMINATIONS
का 10वीं की माकशीट/माणप के Survey No 187, Near, Datta Mandir Rd,
अनुसार िवालय/कॉलेज का नाम कू ल / कॉलेज का पता (School / College adjacent to Palash Complex, Shankar
EURO SCHOOL
(School/College name should be as per Address) Kalat Nagar, Wakad, Pune, Pimpri-
Class 10th Mark sheet/certificate) Chinchwad, Maharashtra 411057
कू ल / कॉलेज िपनकोड (School / College रोल नंबर 10वीं माणप के अनुसार (Roll
411057 7656635
Pincode) number as per 10th certificate)
पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 1000.0
ातांक (Obtain Marks) 897.0 ितशत (Percentage) 89.70
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) Urban
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 MAHARASHTRA
/ College) Examination State)
योयता परीा िजला (Qualifying CENTRAL BOARD OF SECONDARY
Pune कू ल बोड (School Board)
Examination District) EDUCATION
का 12वीं की माकशीट/माणप के
Bharati vidyapeeth
अनुसार िवालय/कॉलेज का नाम कू ल / कॉलेज का पता (School / College Balewadi,dasara chowk,tal-haveli,dist-
secondary and senior
(School/College name should be as per Address) pune
secondary school
Class 12th Mark sheet/certificate)
कू ल / कॉलेज िपनकोड (School / College रोल नंबर 12वीं माणप के अनुसार (Roll
411045 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) 9652018893 ईमेल आईडी (Email ID) sreesatya123@yahoo.com
उमीदवार ारा अपलोड की गई छिवयां (IMAGES UPLOADED BY THE CANDIDATE)

PHOTO

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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) 233299992978
परीा शु क (Exam Fee) 2000.0 लेन-दे न की ितिथ (Date of Transaction) 25-11-2023 11:01:41 AM
शु क जमा िकया गया (Fee Submitted
25-11-2023 11:01:22 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 : 116.75.25.169 Date of Downloading : 07-12-2023 15:00:10 PM