सं युत वे श परीा (मु य)

Joint Entrance Examination (Main)

JEE(Main)

APPLICATION NUMBER 240310864282

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)
KUKATPALLY
पता (Premises No/ Name) HOUSING BOARD ईमेल पता (Email Address) SAIRAMDEV486@GMAIL.COM
COLONY
उप-थानीयता (Sub-
थानीयता (Locality) KUKATPALLY NA
Locality)(Optional)
दे श कोड (Country Code) 91 दे श (Country) INDIA
राय (State) TELANGANA िजला (District) Hyderabad
वै किपक संपक सू (Alternate Contact
मोबाइल नंबर (Mobile Number) 91 - 7981647249 NA
No.) (Optional)
िपन कोड (Pin Code) 500072
थायी पता (Permanent Address)
पता (Premises No/ Name) H.NO:-2-176 थानीयता (Locality) NARAYANAGIRI
उप-थानीयता (Sub-
NA दे श (Country) INDIA
Locality)(Optional):
राय (State) TELANGANA िजला (District) Hanumakonda
िपन कोड (Pin Code) 506142
यितगत योरा (PERSONAL DETAILS)
DEVARUPPULA अयथी की जम ितिथ (Candidate's
अयथी का नाम (Candidate's Name) 22-01-2004
SHIVARAM Date of Birth)
िपता / अिभभावक का नाम (Father / DEVARUPPULA माता / अिभभावक का नाम (Mother /
DEVARUPPULA LATHA
Guardian Name) YADAGIRI 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) 718993925496
PHOTOGRAPH
राय / केद शािसत दे श जहाँ से 12वीं /
समक उीण / उपिथत (State/ UT
TELANGANA े णी (Category ) OBC-(NCL) AS PER CENTRAL LIST
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
NA 100001-200000
are a Pwd Candidate, do you have Family Income )
benchmark disability)?
योयता परीा म कू ली िशा का
तैयारी का तरीका ( Mode of Preparation
Tutorial Classes in School मायम ( Medium of schooling in English
)
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 Of Exam Apply For)
िपता / अिभभावक यवसाय (Father / िपता / अिभभावक योयता (Father /
OTHERS Illiterate
Guardian Occupation) Guardian Qualification)
माता / अिभभावक यवसाय (Mother / माता / अिभभावक योयता (Mother /
Others ILLITERATE
Guardian Occupation) Guardian Qualification)
परीा राय-पहला िवकप (Exam State परीा शहर-पहला िवकप (Exam City
TELANGANA HYDERABAD/SECUNDERABAD
1st Choice ) 1st Choice )
परीा राय-दूसरा िवकप (Exam State परीा शहर-दूसरा िवकप (Exam City
TELANGANA WARANGAL
2nd Choice ) 2nd Choice )
परीा राय-तीसरा िवकप (Exam State परीा शहर-तीसरा िवकप (Exam City
TELANGANA KARIMNAGAR
3rd Choice ) 3rd Choice )
परीा राय-चौथा िवकप (Exam State परीा शहर-चौथा िवकप (Exam City
TELANGANA SURYAPET
4th Choice ) 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 (Year of
उीण की िथित (Pass Status) Passed 2021
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
Government School TELANGANA
College) Examination State)
योयता परीा िजला (Qualifying TELANGANA BOARD OF SECONDARY
Hanumakonda कू ल बोड (School Board)
Examination District) EDUCATION
का 10वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम z p p secondary school कू ल / कॉलेज का पता (School / College zpp secondary school, narayagiri village,
(School/College name should be as per narayanagiri Address) dharmasagar mandal, hanumakonda district
Class 10th Mark sheet/certificate)
कू ल / कॉलेज िपनकोड (School / College रोल नंबर 10वीं माणप के अनुसार (Roll
506142 2112100027
Pincode) number as per 10th certificate)
अिधकतम ग े ड वाइंट (Max Grade
पिरणाम मोड (Result Mode) CGPA 10.0
Point)
संचयी ितशत (Cumulative
सीजीपीए ात िकया (Obtained CGPA) 10.0 100
Percentage)
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) Passed 2023
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
Government Aided Private TELANGANA
College) Examination State)
योयता परीा िजला (Qualifying TELANGANA STATE BOARD OF
Hanumakonda 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 r d junior college, pembarthy(vill),
r d junior college
(School/College name should be as per Address) hasanparthy(mdl), hanumakonda(dist)
Class 12th Mark sheet/certificate)
कू ल / कॉलेज िपनकोड (School / College रोल नंबर 12वीं माणप के अनुसार (Roll
506371 2338215323
Pincode) number as per 12th certificate)
पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 1000.0
ातांक (Obtain Marks) 983.0 ितशत (Percentage) 98.30
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) 6303914284 ईमेल आईडी (Email ID) devaruppulasairam@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) 170890755
परीा शु क (Exam Fee) 900.0 लेन-दे न की ितिथ (Date of Transaction) 23-11-2023 12:40:42 PM
शु क जमा िकया गया (Fee Submitted
23-11-2023 12:36:40 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 : 103.102.87.132 Date of Downloading : 23-11-2023 12:57:06 PM