सं युत वे श परीा (मु य)

Joint Entrance Examination (Main)

JEE(Main)
APPLICATION
240310583074
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)
1-2-1,BALAJI
पता (Premises No/ Name) SADAN,MUNUSWAMI ईमेल पता (Email Address) NAMBURUKARTHIK07@GMAIL.COM
NAIDU STREET
उप-थानीयता (Sub-
थानीयता (Locality) TENALI NAZERPETA
Locality)(Optional)
दे श कोड (Country Code) 91 दे श (Country) INDIA
राय (State) ANDHRA PRADESH िजला (District) Guntur
वै किपक संपक सू (Alternate
मोबाइल नंबर (Mobile Number) 91 - 9347081089 8688089129
Contact No.) (Optional)
िपन कोड (Pin Code) 522201
थायी पता (Permanent Address)
1-2-1,BALAJI
पता (Premises No/ Name) SADAN,MUNUSWAMI थानीयता (Locality) TENALI
NAIDU STREET
उप-थानीयता (Sub-
NAZERPETA दे श (Country) INDIA
Locality)(Optional):
राय (State) ANDHRA PRADESH िजला (District) Guntur
िपन कोड (Pin Code) 522201
यितगत योरा (PERSONAL DETAILS)
अयथी की जम ितिथ
अयथी का नाम (Candidate's Name) NAMBURU KARTHIK 07-09-2007
(Candidate's Date of Birth)
िपता / अिभभावक का नाम (Father / NAMBURU RAJASEKHARA माता / अिभभावक का नाम (Mother
NAMBURU MADHAVI
Guardian Name) RAO / Guardian Name)
िलंग (Gender) MALE राटीयता (Nationality ) INDIAN
ANY OTHER VALID GOVT
पहचान संया (Identification
पहचान के कार (Identity Type) IDENTITY WITH 339674391881
Number)
PHOTOGRAPH
राय / केद शािसत दे श जहाँ से 12वीं
/ समक उीण / उपिथत (State/ UT
ANDHRA PRADESH े णी (Category ) GEN-EWS
from where 12th/ Equivalent
Passed/ Appearing)
या आपको मधुमेह ह  (Are You िनवास की जगह ( Place of
NO URBAN
Diabetic ? ) Residence )
यिद आप एक Pwd उमीदवार ह , तो
या आपके पास ब चमाक िवकलांगता है वािषक पािरवािरक आय ( Annual
NA 100001-200000
(If you are a Pwd Candidate, do Family Income )
you have benchmark disability)?
योयता परीा म कू ली िशा का
तैयारी का तरीका ( Mode of
Self-Study मायम ( Medium of schooling in English
Preparation )
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 /
PRIVATE SERVICE Graduate
Guardian Occupation) Guardian Qualification)
माता / अिभभावक यवसाय (Mother / माता / अिभभावक योयता (Mother
Not Applicable GRADUATE
Guardian Occupation) / Guardian Qualification)
परीा राय-पहला िवकप (Exam परीा शहर-पहला िवकप (Exam
ANDHRA PRADESH GUNTUR
State 1st Choice ) City 1st Choice )
परीा राय-दूसरा िवकप (Exam परीा शहर-दूसरा िवकप (Exam
ANDHRA PRADESH VIJAYAWADA
State 2nd Choice ) City 2nd Choice )
परीा राय-तीसरा िवकप (Exam परीा शहर-तीसरा िवकप (Exam
ANDHRA PRADESH CHIRALA
State 3rd Choice ) City 3rd Choice )
परीा राय-चौथा िवकप (Exam परीा शहर-चौथा िवकप (Exam
ANDHRA PRADESH ONGOLE
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 (Year
उीण की िथित (Pass Status) Passed 2022
of Passing/Appearing)
कू िलंग का थान (Place of
योयता परीा (Qualifying Exam) 10 th or equivalent Urban
Schooling)
कू ल / कॉलेज का कार (Type of योयता परीा राय (Qualifying
Government School ANDHRA PRADESH
School / College) Examination State)
योयता परीा िजला (Qualifying ANDHRA PRADESH BOARD OF
Guntur कू ल बोड (School Board)
Examination District) SECONDARY EDUCATION
का 10वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम
S R S M P L B HIGH कू ल / कॉलेज का पता (School /
(School/College name should be as TENALI
SCHOOL College Address)
per Class 10th Mark
sheet/certificate)
रोल नंबर 10वीं माणप के अनुसार
कू ल / कॉलेज िपनकोड (School /
522201 (Roll number as per 10th 2215126648
College Pincode)
certificate)
पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 600.0
ातांक (Obtain Marks) 553.0 ितशत (Percentage) 92.17
th
12वीं या समक योयता िववरण (12 or equivalent Qualification Details)
उीण / सिमिलत होने का वष (Year
उीण की िथित (Pass Status) Appearing 2024
of Passing/Appearing)
Intermediate or two-year Pre-
University examination कू िलंग का थान (Place of
योयता परीा (Qualifying Exam) Urban
conducted by a recognized Schooling)
Board/ University.
कू ल / कॉलेज का कार (Type of योयता परीा राय (Qualifying
Private Unaided ANDHRA PRADESH
School / College) Examination State)
योयता परीा िजला (Qualifying ANDHRA PRADESH BOARD OF
Guntur 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 /
(School/College name should be as nri junior college TENALI
College Address)
per Class 12th Mark
sheet/certificate)
रोल नंबर 12वीं माणप के अनुसार
कू ल / कॉलेज िपनकोड (School /
522201 (Roll number as per 12th NA
College Pincode)
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) 9032077756 ईमेल आईडी (Email ID) namburulikhitha06@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) 167884358
लेन-दे न की ितिथ (Date of
परीा शु क (Exam Fee) 900.0 19-11-2023 09:55:58 AM
Transaction)
शु क जमा िकया गया (Fee Submitted
19-11-2023 09:53:47 AM
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 : 49.37.156.46 Date of Downloading : 19-11-2023 09:57:48 AM