सं युत वे श परीा (मु य)

Joint Entrance Examination (Main)

JEE(Main)

APPLICATION NUMBER 240310586174

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यितगत योरा (Contact Details) वतमान पता (Present Address)
HOUSE NO. 15, ROAD
पता (Premises No/ Name) NO. 69, WEST PUNJABI ईमेल पता (Email Address) SHUCHI.ORG@GMAIL.COM
BAGH
थानीयता (Locality) WEST PUNJABI BAGH उप-थानीयता (Sub-Locality)(Optional) NA
दे श कोड (Country Code) +91 दे श (Country) INDIA
राय (State) DELHI िजला (District) West Delhi
वै किपक संपक सू (Alternate Contact
मोबाइल नंबर (Mobile Number) +91 - 7988121605 NA
No.) (Optional)
िपन कोड (Pin Code) 110026
थायी पता (Permanent Address)
HOUSE NO. 15, ROAD
पता (Premises No/ Name) NO. 69, WEST PUNJABI थानीयता (Locality) WEST PUNJABI BAGH
BAGH
उप-थानीयता (Sub-
NA दे श (Country) INDIA
Locality)(Optional):
राय (State) DELHI िजला (District) West Delhi
िपन कोड (Pin Code) 110026
यितगत योरा (PERSONAL DETAILS)
अयथी की जम ितिथ (Candidate's Date
अयथी का नाम (Candidate's Name) PRAKHAR SANAN 21-03-2006
of Birth)
िपता / अिभभावक का नाम (Father / माता / अिभभावक का नाम (Mother /
LALIT SANAN SHUCHI KUKREJA
Guardian Name) Guardian Name)
िलंग (Gender) MALE राटीयता (Nationality ) INDIAN
पहचान के कार (Identity Type) PAN CARD पहचान संया (Identification Number) KBXPS7857B
राय / केद शािसत दे श जहाँ से 12वीं /
समक उीण / उपिथत (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 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
Self-Study 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 /
LAW PRACTICE Graduate
Guardian Occupation) Guardian Qualification)
माता / अिभभावक यवसाय (Mother / माता / अिभभावक योयता (Mother /
Teaching / Research DOCTORATE
Guardian Occupation) Guardian Qualification)
परीा राय-पहला िवकप (Exam State परीा शहर-पहला िवकप (Exam City 1st
DELHI DELHI/NEW DELHI
1st Choice ) Choice )
परीा राय-दूसरा िवकप (Exam State परीा शहर-दूसरा िवकप (Exam City 2nd
HARYANA FARIDABAD
2nd Choice ) Choice )
परीा राय-तीसरा िवकप (Exam State परीा शहर-तीसरा िवकप (Exam City 3rd
UTTAR PRADESH GHAZIABAD
3rd Choice ) Choice )
परीा राय-चौथा िवकप (Exam State परीा शहर-चौथा िवकप (Exam City 4th
UTTAR PRADESH NOIDA/GREATER NOIDA
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) Urban
कू ल / कॉलेज का कार (Type of School / योयता परीा राय (Qualifying
Private Unaided HARYANA
College) Examination State)
योयता परीा िजला (Qualifying CENTRAL BOARD OF SECONDARY
Sonipat कू ल बोड (School Board)
Examination District) EDUCATION
का 10वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम Jankidas kapur public कू ल / कॉलेज का पता (School / College
sector 14, sonipat, haryana
(School/College name should be as per school Address)
Class 10th Mark sheet/certificate)
कू ल / कॉलेज िपनकोड (School / College रोल नंबर 10वीं माणप के अनुसार (Roll
131001 17239512
Pincode) number as per 10th certificate)
पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 500.0
ातांक (Obtain Marks) 484.0 ितशत (Percentage) 96.80
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
योयता परीा (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 / योयता परीा राय (Qualifying
Private Unaided DELHI
College) Examination State)
योयता परीा िजला (Qualifying CENTRAL BOARD OF SECONDARY
North West Delhi कू ल बोड (School Board)
Examination District) EDUCATION
का 12वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम Bharat Mata Saraswati Bal कू ल / कॉलेज का पता (School / College Narela-Bawana Road, Narela, New Delhi,
(School/College name should be as per Mandir Address) Delhi 110040
Class 12th Mark sheet/certificate)
कू ल / कॉलेज िपनकोड (School / College रोल नंबर 12वीं माणप के अनुसार (Roll
110040 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) 7015794597 ईमेल आईडी (Email ID) lalitsananadv@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)
परीा शु क (Exam Fee)
शु क जमा िकया गया (Fee Submitted
On)
Online लेन-दे न आईडी (Transaction ID) ZIC51545347711
2000.0 लेन-दे न की ितिथ (Date of Transaction) 19-11-2023 12:48:22 PM
19-11-2023 12:47:23 PM
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 : 49.36.188.50 Date of Downloading : 19-11-2023 12:49:25 PM