Joint Entrance Examination (Main) - 2024

CENTRAL BOARD OF SECONDARY EDUCATION

ACKNOWLEDGEMENT PAGE

Application No. 71036624

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Personal Details
Name: BIDYUT KONWAR Date of Birth: 21/03/2002
Mother's Name: BHARATI KONWAR Category OBC
Father's Name: DILIP KONWAR Person with Disability(PwD): NO
State of Eligibility: ASSAM Percentage of Disability: --
Gender: MALE In case of girl candidate, Are NO
you the only child of your
parents?:
Nationality: INDIAN Place of Residence: RURAL
Aadhar Number 836786053567 You need scribe/reader ?: NO
Examination Details
Applying For: JEE(Main) Paper - 1 (B.E./B.Tech.) Only
Mode of Examination: PEN AND PAPER BASED EXAMINATION Question Paper Medium: ENGLISH
1st Choice of Exam Centre: LAKHIMPUR 2nd Choice of Exam Centre: DIBUGRAH
3rd Choice of Exam Centre: JORHAT 4th Choice of Exam Centre: GUWAHATI
Academic Details
Year of passing class 10th: 2019 Place of 12th class schooling: CITY
Year of Passing or Appearing class 12th/Qualifying Exam: 2022 Type of Institution of Class 12th/Qualifying Exam: GOVERNMENT
School Board of class 12th/Qualifying Exam: AICTE
Name of the Qualifying Examination passed / appearing: The final examination of the 10+2 system, conducted by any recognized central/ state Board, such as Central
Board of Secondary Education, New Delhi; Council for the Indian School Certificate Examinations, New Delhi;
etc.
Percentage of Marks in Class 12th/Qualifying Exam: 8.7 Roll No. of Class 12th/Qualifying Exam: B/19/EC/028
Appeared/Appearing for Improvement of Class NO Mode of preperation: SELF STUDY
12th/Qualifying Exam:
Roll Number of Class 12th/Qualifying Examination of
Improvement Examination:
Name and Address of the School/College from where NERIST Arunachal Pradesh
passed/appearing:
Candidate's Mailing Address
Country: India State: ASSAM
District: Lakhimpur Address: Kadam Gohain Gaon
Locality: Kadam City/Town/Village: Gohain Gaon
Pin Code: 787032 Email Address: kobidyut@gmail.com
Mobile Number: 7086181154 Land Line Number:
Guardian Details
Qualification Occupation Annual Income
Father's/Guardian's: H S PASS BUSINESS RS. 100001 -200000
Mother's: H S PASS OTHERS (INCLUDING HOUSE WIFE) --
Payment Details
Provider Name: HDFC Bank Payment Gateway Payment Mode: Electronic Payment Gateway
Fee Type: Examination Fee Transaction Amount: 1000 /-
Transaction ID: HHMP5015097321 Date of Transaction: 06-12-2023 13:59:28
DECLARATION
I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. I have read and understood the JEE procedures for both
JEE(Main) and JEE(Advanced) - 2024. I shall abide by the terms and conditions thereon.
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