सं युत वे श परीा (मु य)

Joint Entrance Examination (Main)

JEE(Main)

APPLICATION NUMBER 240310273362

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) 04-68/1A ईमेल पता (Email Address) ASHOKVIBES@GMAIL.COM
थानीयता (Locality) LINGAMPARTHI उप-थानीयता (Sub-Locality)(Optional) BAVI VEEDHI
दे श कोड (Country Code) 91 दे श (Country) INDIA
राय (State) ANDHRA PRADESH िजला (District) East Godavari
वै किपक संपक सू (Alternate Contact
मोबाइल नंबर (Mobile Number) 91 - 7378850608 NA
No.) (Optional)
िपन कोड (Pin Code) 533429
थायी पता (Permanent Address)
पता (Premises No/ Name) 04-68/1A थानीयता (Locality) LINGAMPARTHI
उप-थानीयता (Sub-
BAVI VEEDHI दे श (Country) INDIA
Locality)(Optional):
राय (State) ANDHRA PRADESH िजला (District) East Godavari
िपन कोड (Pin Code) 533429
यितगत योरा (PERSONAL DETAILS)
GURRAM ASHOK अयथी की जम ितिथ (Candidate's Date
अयथी का नाम (Candidate's Name) 27-06-2007
MANIKANTA of Birth)
िपता / अिभभावक का नाम (Father / GURRAM ESWARUDU माता / अिभभावक का नाम (Mother /
GURRAM MANGARANI
Guardian Name) ANE SIVA 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) 732159990335
PHOTOGRAPH
राय / केद शािसत दे श जहाँ से 12वीं /
समक उीण / उपिथत (State/ UT
ANDHRA PRADESH े णी (Category ) GENERAL
from where 12th/ Equivalent Passed/
Appearing)
या आपको मधुमेह ह  (Are You
NO िनवास की जगह ( Place of Residence ) RURAL
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 ) Tutorial Classes in School 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 /
BUSINESS Matriculate
Guardian Occupation) Guardian Qualification)
माता / अिभभावक यवसाय (Mother / माता / अिभभावक योयता (Mother /
Others MATRICULATE
Guardian Occupation) Guardian Qualification)
परीा राय-पहला िवकप (Exam State परीा शहर-पहला िवकप (Exam City 1st
ANDHRA PRADESH RAJAHMUNDRY
1st Choice ) Choice )
परीा राय-दूसरा िवकप (Exam State परीा शहर-दूसरा िवकप (Exam City 2nd
ANDHRA PRADESH KAKINADA
2nd Choice ) Choice )
परीा राय-तीसरा िवकप (Exam State परीा शहर-तीसरा िवकप (Exam City 3rd
ANDHRA PRADESH AMALAPURAM
3rd Choice ) Choice )
परीा राय-चौथा िवकप (Exam State परीा शहर-चौथा िवकप (Exam City 4th
ANDHRA PRADESH ELURU
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) Rural
कू ल / कॉलेज का कार (Type of School / योयता परीा राय (Qualifying
Private Unaided ANDHRA PRADESH
College) Examination State)
योयता परीा िजला (Qualifying ANDHRA PRADESH BOARD OF
East Godavari कू ल बोड (School Board)
Examination District) SECONDARY EDUCATION
का 10वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम कू ल / कॉलेज का पता (School / College
bhashyam em school yeleswaram
(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
533429 2208131923
Pincode) number as per 10th certificate)
पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 600.0
ातांक (Obtain Marks) 542.0 ितशत (Percentage) 90.33
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)
Intermediate or two-year
Pre-University
योयता परीा (Qualifying Exam) examination conducted by कू िलंग का थान (Place of Schooling) Rural
a recognized Board/
University.
कू ल / कॉलेज का कार (Type of School / योयता परीा राय (Qualifying
Private Unaided ANDHRA PRADESH
College) Examination State)
योयता परीा िजला (Qualifying ANDHRA PRADESH BOARD OF
East Godavari कू ल बोड (School Board)
Examination District) INTERMEDIATE EDUCATION
का 12वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम कू ल / कॉलेज का पता (School / College
tirumala junior college katheru
(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
533105 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) 9959936595 ईमेल आईडी (Email ID) ashokvibes0@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) 5266892967
परीा शु क (Exam Fee) 2000.0 लेन-दे न की ितिथ (Date of Transaction) 21-11-2023 14:50:56 PM
शु क जमा िकया गया (Fee Submitted
21-11-2023 14:50:47 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 : 103.22.175.144 Date of Downloading : 07-12-2023 10:07:20 AM