सं युत वे श परीा (मु य)

Joint Entrance Examination (Main)

JEE(Main)

APPLICATION NUMBER 240310895795

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)
पता (Premises No/ Name) PLOT NO 24 A ईमेल पता (Email Address) KISUISOFFBEAT@GMAIL.COM
उप-थानीयता (Sub-
थानीयता (Locality) TONK SHASTRI NAGAR
Locality)(Optional)
दे श कोड (Country Code) 91 दे श (Country) INDIA
राय (State) RAJASTHAN िजला (District) Tonk
वै किपक संपक सू (Alternate Contact
मोबाइल नंबर (Mobile Number) 91 - 9460762287 NA
No.) (Optional)
िपन कोड (Pin Code) 304001
थायी पता (Permanent Address)
पता (Premises No/ Name) PLOT NO 24 A थानीयता (Locality) TONK
उप-थानीयता (Sub-
SHASTRI NAGAR दे श (Country) INDIA
Locality)(Optional):
राय (State) RAJASTHAN िजला (District) Tonk
िपन कोड (Pin Code) 304001
यितगत योरा (PERSONAL DETAILS)
KRISHNA अयथी की जम ितिथ (Candidate's
अयथी का नाम (Candidate's Name) 20-08-2006
VIJAYVARGIA Date of Birth)
िपता / अिभभावक का नाम (Father / माता / अिभभावक का नाम (Mother /
PUSHKAR RAJ VIJAY KOMAL VIJAY
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) 818360795895
PHOTOGRAPH
राय / केद शािसत दे श जहाँ से 12वीं /
समक उीण / उपिथत (State/ UT
RAJASTHAN े णी (Category ) GEN-EWS
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 400001-500000
are a Pwd Candidate, do you have Income )
benchmark disability)?
योयता परीा म कू ली िशा का
तैयारी का तरीका ( Mode of Preparation
Self-Study मायम ( Medium of schooling in English
)
qualifying exam )
परीा कद िववरण (Exam centre Details)
परीा 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 / िपता / अिभभावक योयता (Father /
BUSINESS Graduate
Guardian Occupation) Guardian Qualification)
माता / अिभभावक यवसाय (Mother / माता / अिभभावक योयता (Mother /
Others GRADUATE
Guardian Occupation) Guardian Qualification)
परीा राय-पहला िवकप (Exam State परीा शहर-पहला िवकप (Exam City
RAJASTHAN JAIPUR
1st Choice ) 1st Choice )
परीा राय-दूसरा िवकप (Exam State परीा शहर-दूसरा िवकप (Exam City
RAJASTHAN KOTA
2nd Choice ) 2nd Choice )
परीा राय-तीसरा िवकप (Exam State परीा शहर-तीसरा िवकप (Exam City
RAJASTHAN AJMER
3rd Choice ) 3rd Choice )
परीा राय-चौथा िवकप (Exam State परीा शहर-चौथा िवकप (Exam City
RAJASTHAN DAUSA
4th Choice ) 4th 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 RAJASTHAN
College) Examination State)
योयता परीा िजला (Qualifying RAJASTHAN BOARD OF SECONDARY
Tonk कू ल बोड (School Board)
Examination District) EDUCATION
का 10वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम SUN SHINE GLOBAL कू ल / कॉलेज का पता (School / College
AMBIKA NAGAR TONK
(School/College name should be as per SEC SCHOOL TONK Address)
Class 10th Mark sheet/certificate)
कू ल / कॉलेज िपनकोड (School / College रोल नंबर 10वीं माणप के अनुसार (Roll
304001 1931533
Pincode) number as per 10th certificate)
पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 600.0
ातांक (Obtain Marks) 469.0 ितशत (Percentage) 78.17
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
योयता परीा (Qualifying Exam) कू िलंग का थान (Place of Schooling) Urban
Secondary 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 RAJASTHAN
College) Examination State)
योयता परीा िजला (Qualifying CENTRAL BOARD OF SECONDARY
Tonk कू ल बोड (School Board)
Examination District) EDUCATION
का 12वीं की माकशीट/माणप के
SANT SUDHA SAGAR
अनुसार िवालय/कॉलेज का नाम कू ल / कॉलेज का पता (School / College NEAR TOLL PLAZA KOTA ROAD
PUBLIC SR SEC
(School/College name should be as per Address) TONK
SCHOOL
Class 12th Mark sheet/certificate)
कू ल / कॉलेज िपनकोड (School / College रोल नंबर 12वीं माणप के अनुसार (Roll
304001 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) 9462869520 ईमेल आईडी (Email ID) sweetyvj9462@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) 171118981
परीा शु क (Exam Fee) 1800.0 लेन-दे न की ितिथ (Date of Transaction) 23-11-2023 16:44:40 PM
शु क जमा िकया गया (Fee Submitted
23-11-2023 16:40:27 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 : 152.58.71.223 Date of Downloading : 08-12-2023 21:47:00 PM