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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) FLAT NO-1503, पता (Premises No/ Name) NIHARIKA RESIDENCY, ईमेल पता (Email Address) JATINY114@GMAIL.COM PLOT NO-15 TO 20 थानीयता (Locality) NAVI MUMBAI उप-थानीयता (Sub-Locality)(Optional) SEC-34B, KHARGHAR दे श कोड (Country Code) 91 दे श (Country) INDIA राय (State) MAHARASHTRA िजला (District) Raigad वै किपक संपक सू (Alternate Contact मोबाइल नंबर (Mobile Number) 91 - 9326191271 9167157464 No.) (Optional) िपन कोड (Pin Code) 410210 थायी पता (Permanent Address) पता (Premises No/ Name) H NO 19 थानीयता (Locality) TEHSIL MANETHI उप-थानीयता (Sub- VILL-MAJRA MUTSAL दे श (Country) INDIA Locality)(Optional): BHALAKI राय (State) HARYANA िजला (District) Rewari िपन कोड (Pin Code) 123102 यितगत योरा (PERSONAL DETAILS) अयथी की जम ितिथ (Candidate's Date अयथी का नाम (Candidate's Name) JATIN YADAV 25-11-2006 of Birth) िपता / अिभभावक का नाम (Father / YUDHVEER SINGH माता / अिभभावक का नाम (Mother / MAMTA YADAV Guardian Name) YADAV Guardian Name) िलंग (Gender) MALE राटीयता (Nationality ) INDIAN ANY OTHER VALID पहचान के कार (Identity Type) GOVT IDENTITY WITH पहचान संया (Identification Number) 600786535383 PHOTOGRAPH राय / केद शािसत दे श जहाँ से 12वीं / समक उीण / उपिथत (State/ UT MAHARASHTRA े णी (Category ) OBC-(NCL) AS PER CENTRAL LIST 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 Family NA 700001-800000 are a Pwd Candidate, do you have Income ) benchmark disability)? योयता परीा म कू ली िशा का मायम ( तैयारी का तरीका ( Mode of Preparation Self-Study Medium of schooling in qualifying English ) exam ) परीा कद िववरण (Exam centre Details) परीा 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 / GOVERNMENT िपता / अिभभावक योयता (Father / Graduate Guardian Occupation) SERVICE Guardian Qualification) माता / अिभभावक यवसाय (Mother / माता / अिभभावक योयता (Mother / Others GRADUATE Guardian Occupation) Guardian Qualification) परीा राय-पहला िवकप (Exam State परीा शहर-पहला िवकप (Exam City 1st MAHARASHTRA MUMBAI/NAVI MUMBAI 1st Choice ) Choice ) परीा राय-दूसरा िवकप (Exam State परीा शहर-दूसरा िवकप (Exam City 2nd MAHARASHTRA THANE 2nd Choice ) Choice ) परीा राय-तीसरा िवकप (Exam State परीा शहर-तीसरा िवकप (Exam City 3rd MAHARASHTRA PUNE 3rd Choice ) Choice ) परीा राय-चौथा िवकप (Exam State परीा शहर-चौथा िवकप (Exam City 4th MAHARASHTRA NASHIK 4th Choice ) Choice ) न प मायम (Question Paper Medium) English 10वीं या समक योयता िववरण (10th 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 MAHARASHTRA College) Examination State) योयता परीा िजला (Qualifying CENTRAL BOARD OF SECONDARY Thane 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 / College delhi public school navi mumbai maharashtra (School/College name should be as per Address) Class 10th Mark sheet/certificate) कू ल / कॉलेज िपनकोड (School / College रोल नंबर 10वीं माणप के अनुसार (Roll 30047 15130521 Pincode) number as per 10th certificate) पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 600.0 ातांक (Obtain Marks) 548.0 ितशत (Percentage) 91.33 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 Board of Secondary योयता परीा (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 / योयता परीा राय (Qualifying Private Unaided MAHARASHTRA College) Examination State) योयता परीा िजला (Qualifying CENTRAL BOARD OF SECONDARY Thane कू ल बोड (School Board) Examination District) EDUCATION का 12वीं की माकशीट/माणप के अनुसार िवालय/कॉलेज का नाम कू ल / कॉलेज का पता (School / College delhi public school navi mumbai maharashtra (School/College name should be as per Address) Class 12th Mark sheet/certificate) कू ल / कॉलेज िपनकोड (School / College रोल नंबर 12वीं माणप के अनुसार (Roll 30047 NA Pincode) 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) 9004294050 ईमेल आईडी (Email ID) veer_ydv@rediffmail.com उमीदवार ारा अपलोड की गई छिवयां (IMAGES UPLOADED BY THE CANDIDATE)
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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) 003899 परीा शु क (Exam Fee) 1800.0 लेन-दे न की ितिथ (Date of Transaction) 25-11-2023 12:18:34 PM शु क जमा िकया गया (Fee Submitted 25-11-2023 12:17:29 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 : 49.36.110.38 Date of Downloading : 30-01-2024 20:46:32 PM