National Eliglbility Cum Entrance Test (UG) 2023

Ministry
Ministry
of Fducatio
of Health and Family Welfare KTT9TT E Tr TteT(77)- 2023 National Testing Agency
G o v e r n m e n t of ndfa
Confirmation Page
National Medical Commission

Application No. 230410335984

DO NOT SEND THIS PAGE TO NATIONAL TES TING AGENCY (NTA).
CANDIDATE IS REQUESTED TO RETAIN THE PRINTOUT OF CONFIRMATION PAGE FOR FUTURE
REFERENCE
a farPersonal Details)
amUTT (Aadhaar) Verifed ATTT 7T (Aadhaar Number) ** 9322
araaref T (Candidate's Name) ROHAN RATHORE a76t f a (Candidate's Date of Birth) 11-05-2005
TTT 3NTO TA (Mother IGuardian Name) CHANDRA DEVI fT (Gender) Male
T3HTATT (Father/ Guardian Name) OM PRAKASH RATHORE T (Nationality) Indian
Apt (Category) General
TC T Pwd 3FaiGAR E, a T ATYS ITTyAT TTATE (If you are a Pwd Candidate, do you have NO
benchmark disability})?
TR R a TTU TT & 12 at/aA 3TuT | 3fNfs (8tate/ UT from where 12th/ Equivalent Passed/ RAJASTHAN
Appearing
feT TE (Place of Residence) Rural
a n t s STT (Annual Family Income) RS. 800001 AND ABOVE
E T s 5 (Belongs to Minority) NO
aT (Country of Residence)
India
TY TT?Are You Diabetic
FT3TT NEET (UG) -2023 $ a yuTTa aHeTs 987A RTCT TEd E (Do you intend to wear Customary No
Dress contrary to the Dress Code while appearing in NEET(UG)-2023):
TtST (Mode of Preparation): Others
in case of Other:
ALLEN OFFLINE COACHING

f T 3TA RA APply For)

Ar 3da TApphy For)
National Eligibility Cum Entrance Test(UG)
AaT/ a 3 5 47H7 (Father/ Guardian Occupation)
GOVERNMENT SERVICE
faTi T T S TTAi (Father / Guardian Qualificatlon)
Doctorate
T / 317TE T (Mother Guardian Occupation)
OTHERS (NCLUDING HOUSE WIFE)
TET 3TTTO5 4 (Mother / Guardian Qualification)
GRADUATE
7 EA (Question Paper Medium) English
oT Ttoa/ aT-TT e6T (Exam Statel City-1st choice)
RAJASTHAN KOTA
T T7/ WGRTE T (Exam Statel City-2nd choice)
RAJASTHAN-JODHPUR

9a1 HT/T67 faeruT (Twin Brother/ Sister Details)

T T 5aT T Ti At ()- 2023 f T 4 T (Are you a Twin and both applying for NEET (UG)-No
2023) ?

3fatea aaBRAI (Additional Details)

T E (a) Taen 7
ATg &? (Did you ever appear in NEET (UG) examination ?) No
F (Place of Birth) /TA (State) / fareT (District)
india i RAJASTHANI JODHPUR

adH dT (Present Address)

Tar (Premises No/ Name), 3- A (Sub-Locality), FuraaT (Locality) VILLAGE KHARIYA MEETHAPUR. BERA GANESH SAGAR.
r (Distric). u a (8tate), TEHSIL BILARA
(Country), 194 SE (Pin Code) JODHPUR. RAJASTHAN. india, 342802
SAa Tar (Email Addres
( M o b i l e Number) roh*******@gmai.com
91-B00473
der rT Aternate Contact No.) (Optional)
9461117425
Fu T ITT (Permanent Address State)
F a rA (Permanem Address State)
RAJASTHAN
3FHEaR qaRT 3TATS f T (Images Uploaded by Candidate)
7CT(Photo) TE AR AT gI 61 311t A
s7o RIT (Left and Right hands Fingers and R (Signature)
Thumb impressions)

Fee Payment Details

Activity Application No Reference No Transaction Date
Appiication fee Amount Customer iD Paymet Mode
230410335984
IGAPGRFOF 11/03/2023 1846.45
1700 23041033598401401 EPG