सं युत वे श परीा (मु य)

Joint Entrance Examination (Main)

JEE(Main)
APPLICATION
240310502362
NUMBER
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) WARD NO 8 ईमेल पता (Email Address) MAHENDRASHARMANKT1981@GMAIL.COM
उप-थानीयता (Sub-
थानीयता (Locality) TEH-NEEM KA THANA VILL-GORDHANPURA KOTRA
Locality)(Optional)
दे श कोड (Country Code) 91 दे श (Country) INDIA
राय (State) RAJASTHAN िजला (District) Sikar
वै किपक संपक सू (Alternate
मोबाइल नंबर (Mobile Number) 91 - 9928422405 NA
Contact No.) (Optional)
िपन कोड (Pin Code) 332713
थायी पता (Permanent Address)
पता (Premises No/ Name) WARD NO 8 थानीयता (Locality) TEH-NEEM KA THANA
उप-थानीयता (Sub- VILL-GORDHANPURA
दे श (Country) INDIA
Locality)(Optional): KOTRA
राय (State) RAJASTHAN िजला (District) Sikar
िपन कोड (Pin Code) 332713
यितगत योरा (PERSONAL DETAILS)
अयथी का नाम (Candidate's अयथी की जम ितिथ
CHINTU SHARMA 28-01-2006
Name) (Candidate's Date of Birth)
िपता / अिभभावक का नाम (Father / माता / अिभभावक का नाम
RAMESH SHARMA SUMAN DEVI
Guardian Name) (Mother / Guardian Name)
िलंग (Gender) MALE राटीयता (Nationality ) INDIAN
ANY OTHER VALID
पहचान संया (Identification
पहचान के कार (Identity Type) GOVT IDENTITY WITH 427148648748
Number)
PHOTOGRAPH
राय / केद शािसत दे श जहाँ से
12वीं / समक उीण / उपिथत
RAJASTHAN े णी (Category ) GEN-EWS
(State/ UT from where 12th/
Equivalent Passed/ Appearing)
या आपको मधुमेह ह  (Are You िनवास की जगह ( Place of
NO RURAL
Diabetic ? ) Residence )
यिद आप एक Pwd उमीदवार ह , तो
या आपके पास ब चमाक िवकलांगता
वािषक पािरवािरक आय ( Annual
है (If you are a Pwd Candidate, NA 100001-200000
Family Income )
do you have benchmark
disability)?
योयता परीा म कू ली िशा का
तैयारी का तरीका ( Mode of
Self-Study मायम ( Medium of schooling English
Preparation )
in qualifying exam )
परीा कद िववरण (Exam centre Details)
परीा के स के िलए आवे दन कर
के िलए आवे दन (Apply For) B.E./B.Tech Session 1 & Session 2
(Session Of Exam Apply For)
िपता / अिभभावक योयता
िपता / अिभभावक यवसाय (Father
PRIVATE SERVICE (Father / Guardian Graduate
/ Guardian Occupation)
Qualification)
माता / अिभभावक योयता
माता / अिभभावक यवसाय
Others (Mother / Guardian OTHERS
(Mother / Guardian Occupation)
Qualification)
परीा राय-पहला िवकप (Exam परीा शहर-पहला िवकप (Exam
RAJASTHAN JAIPUR
State 1st Choice ) City 1st Choice )
परीा राय-दूसरा िवकप (Exam परीा शहर-दूसरा िवकप (Exam
RAJASTHAN SIKAR
State 2nd Choice ) City 2nd Choice )
परीा राय-तीसरा िवकप (Exam परीा शहर-तीसरा िवकप
RAJASTHAN AJMER
State 3rd Choice ) (Exam City 3rd Choice )
परीा राय-चौथा िवकप (Exam परीा शहर-चौथा िवकप (Exam
RAJASTHAN ALWAR
State 4th Choice ) City 4th 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
उीण की िथित (Pass Status) Passed 2021
(Year of Passing/Appearing)
योयता परीा (Qualifying कू िलंग का थान (Place of
10 th or equivalent Urban
Exam) Schooling)
योयता परीा राय
कू ल / कॉलेज का कार (Type of
Private Unaided (Qualifying Examination RAJASTHAN
School / College)
State)
योयता परीा िजला (Qualifying RAJASTHAN BOARD OF SECONDARY
Sikar कू ल बोड (School Board)
Examination District) EDUCATION
का 10वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम
कू ल / कॉलेज का पता (School /
(School/College name should be saraswati pub sr sec sch neem ka thana
College Address)
as per Class 10th Mark
sheet/certificate)
रोल नंबर 10वीं माणप के
कू ल / कॉलेज िपनकोड (School /
332713 अनुसार (Roll number as per 1012615
College Pincode)
10th certificate)
पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 600.0
ातांक (Obtain Marks) 594.0 ितशत (Percentage) 99.00
th
12वीं या समक योयता िववरण (12 or equivalent Qualification Details)
उीण / सिमिलत होने का वष
उीण की िथित (Pass Status) Passed 2023
(Year of Passing/Appearing)
The final examination of the
10+2 system, conducted by
any recognized Central/ State
Board, such as the Central
योयता परीा (Qualifying कू िलंग का थान (Place of
Board of Secondary Urban
Exam) Schooling)
Education, New
Delhi;Council for the Indian
School Certificate
Examinations, New Delhi etc.
योयता परीा राय
कू ल / कॉलेज का कार (Type of
Private Unaided (Qualifying Examination RAJASTHAN
School / College)
State)
योयता परीा िजला (Qualifying RAJASTHAN BOARD OF SECONDARY
Sikar कू ल बोड (School Board)
Examination District) EDUCATION
का 12वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम
कू ल / कॉलेज का पता (School /
(School/College name should be saraswati pub sr sec sch neem ka thana
College Address)
as per Class 12th Mark
sheet/certificate)
रोल नंबर 12वीं माणप के
कू ल / कॉलेज िपनकोड (School /
332713 अनुसार (Roll number as per 2718643
College Pincode)
12th certificate)
पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 500.0
ातांक (Obtain Marks) 450.0 ितशत (Percentage) 90.00
अितिरत जानकािरयां (Additional Details)
या आप जु ड़वा ह और दोनों जे ईई (मे न) - 2024 के िलए आवे दन कर
रहे ह (Are you a Twin and both applying for JEE (MAIN) – NO
2024)?
आपातकालीन संपक िववरण प (Emergency Contact Details)
दे श (Country) INDIA दे श कोड (Country Code) +91
मोबाइल नंबर (Mobile Number) 9929891824 ईमेल आईडी (Email ID) KHANDALKIRANA1981@GMAIL.COM
उमीदवार ारा अपलोड की गई छिवयां (IMAGES UPLOADED BY THE CANDIDATE)

PHOTO
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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) CPADMVUFU2
लेन-दे न की ितिथ (Date of
परीा शु क (Exam Fee) 900.0 08-02-2024 21:56:37 PM
Transaction)
शु क जमा िकया गया (Fee
08-02-2024 21:56:08 PM
Submitted 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 : 223.188.66.208 Date of Downloading : 02-03-2024 16:42:48 PM