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. यितगत योरा (Contact Details) वतमान पता (Present Address) HOUSE NO FCA -67 GALI NO 2 FRIENDS पता (Premises No/ Name) ईमेल पता (Email Address) INFOSONATECH16@GMAIL.COM COLONY NEAR RAWAL CONVENT SCHOOL उप-थानीयता (Sub- थानीयता (Locality) BALLABGARH BALLABGARH Locality)(Optional) दे श कोड (Country Code) +91 दे श (Country) INDIA राय (State) HARYANA िजला (District) Faridabad वै किपक संपक सू (Alternate मोबाइल नंबर (Mobile Number) +91 - 9654865181 7827755492 Contact No.) (Optional) िपन कोड (Pin Code) 121004 थायी पता (Permanent Address) HOUSE NO -13 SHYAM पता (Premises No/ Name) थानीयता (Locality) BALLABGARH COLONY BALLABGARH उप-थानीयता (Sub- BALLABGARH दे श (Country) INDIA Locality)(Optional): राय (State) HARYANA िजला (District) Faridabad िपन कोड (Pin Code) 121004 यितगत योरा (PERSONAL DETAILS) अयथी की जम ितिथ (Candidate's अयथी का नाम (Candidate's Name) ABHISHEK KUMAR 23-12-2005 Date of Birth) िपता / अिभभावक का नाम (Father / माता / अिभभावक का नाम (Mother / TIKKU CHAND GEETA RANI Guardian Name) Guardian Name) िलंग (Gender) MALE राटीयता (Nationality ) INDIAN ANY OTHER VALID पहचान संया (Identification पहचान के कार (Identity Type) GOVT IDENTITY WITH 470979971666 Number) PHOTOGRAPH राय / केद शािसत दे श जहाँ से 12वीं / समक उीण / उपिथत (State/ UT HARYANA े 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 उमीदवार ह , तो या आपके पास ब चमाक िवकलांगता है (If you वािषक पािरवािरक आय ( Annual NA 100001-200000 are a Pwd Candidate, do you have Family Income ) benchmark disability)? योयता परीा म कू ली िशा का तैयारी का तरीका ( Mode of Preparation Self-Study मायम ( Medium of schooling in English ) qualifying exam ) परीा कद िववरण (Exam centre Details) परीा के स के िलए आवे दन कर के िलए आवे दन (Apply For) B.E./B.Tech Session 1 (Session Of Exam Apply For) िपता / अिभभावक यवसाय (Father / िपता / अिभभावक योयता (Father / PRIVATE SERVICE Others Guardian Occupation) Guardian Qualification) माता / अिभभावक यवसाय (Mother / माता / अिभभावक योयता (Mother / Others OTHERS Guardian Occupation) Guardian Qualification) परीा राय-पहला िवकप (Exam State परीा शहर-पहला िवकप (Exam City HARYANA FARIDABAD 1st Choice ) 1st Choice ) परीा राय-दूसरा िवकप (Exam State परीा शहर-दूसरा िवकप (Exam City nd DELHI nd DELHI/NEW DELHI 2 Choice ) 2 Choice ) परीा राय-तीसरा िवकप (Exam State परीा शहर-तीसरा िवकप (Exam City UTTAR PRADESH GHAZIABAD 3rd Choice ) 3rd Choice ) परीा राय-चौथा िवकप (Exam State परीा शहर-चौथा िवकप (Exam City HARYANA AMBALA 4th Choice ) 4th Choice ) न प मायम (Question Paper Medium) English th 10वीं या समक योयता िववरण (10 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 HARYANA College) Examination State) योयता परीा िजला (Qualifying CENTRAL BOARD OF SECONDARY Faridabad 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 / rawal convent school friends colony rawal convent school (School/College name should be as per College Address) ballabgarh Class 10th Mark sheet/certificate) कू ल / कॉलेज िपनकोड (School / College रोल नंबर 10वीं माणप के अनुसार 40248 17124006 Pincode) (Roll number as per 10th certificate) पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 500.0 ातांक (Obtain Marks) 460.0 ितशत (Percentage) 92.00 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 HARYANA College) Examination State) योयता परीा िजला (Qualifying CENTRAL BOARD OF SECONDARY Faridabad कू ल बोड (School Board) Examination District) EDUCATION का 12वीं की माकशीट/माणप के अनुसार िवालय/कॉलेज का नाम rawal convent school कू ल / कॉलेज का पता (School / rawal convent school friends colony (School/College name should be as per ballabgarh College Address) ballabgarh Class 12th Mark sheet/certificate) कू ल / कॉलेज िपनकोड (School / College रोल नंबर 12वीं माणप के अनुसार 40248 NA Pincode) (Roll 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) 8178650575 ईमेल आईडी (Email ID) sonatechsale@gmail.com उमीदवार ा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) 52767864 लेन-दे न की ितिथ (Date of परीा शु क (Exam Fee) 1000.0 15-11-2023 12:51:07 PM Transaction) शु क जमा िकया गया (Fee Submitted 15-11-2023 12:48:37 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 : 47.31.246.83 Date of Downloading : 11-02-2024 21:27:25 PM