सं युत वे श परीा (मु य)

Joint Entrance Examination (Main)

JEE(Main)

APPLICATION NUMBER 240320032123

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)
MUDDEPALLI
पता (Premises No/ Name) ईमेल पता (Email Address) DATTHATHREYAMP@GMAIL.COM
VILLAGE
उप-थानीयता (Sub-
थानीयता (Locality) SRINIVASPUR TALUK PULGURKOTE POST
Locality)(Optional)
दे श कोड (Country Code) +91 दे श (Country) INDIA
राय (State) KARNATAKA िजला (District) Kolar
वै किपक संपक सू (Alternate
मोबाइल नंबर (Mobile Number) +91 - 9449568701 8088158184
Contact No.) (Optional)
िपन कोड (Pin Code) 563135
थायी पता (Permanent Address)
MUDDEPALLI
पता (Premises No/ Name) थानीयता (Locality) SRINIVASPUR TALUK
VILLAGE
उप-थानीयता (Sub-
PULGURKOTE POST दे श (Country) INDIA
Locality)(Optional):
राय (State) KARNATAKA िजला (District) Kolar
िपन कोड (Pin Code) 563135
यितगत योरा (PERSONAL DETAILS)
अयथी की जम ितिथ (Candidate's
अयथी का नाम (Candidate's Name) DATTHATHREYA MP 09-11-2006
Date of Birth)
िपता / अिभभावक का नाम (Father / माता / अिभभावक का नाम (Mother /
PRABHAKAR REDDY RAMATHULASI
Guardian Name) 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 621257875467
Number)
PHOTOGRAPH
राय / केद शािसत दे श जहाँ से 12वीं /
समक उीण / उपिथत (State/ UT
KARNATAKA े णी (Category ) OBC-(NCL) AS PER CENTRAL LIST
from where 12th/ Equivalent Passed/
Appearing)
या आपको मधुमेह ह  (Are You िनवास की जगह ( Place of Residence
NO 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 0-100000
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 2
(Session Of Exam Apply For)
िपता / अिभभावक यवसाय (Father / िपता / अिभभावक योयता (Father /
AGRICULTURE Others
Guardian Occupation) Guardian Qualification)
माता / अिभभावक यवसाय (Mother / माता / अिभभावक योयता (Mother /
Others OTHERS
Guardian Occupation) Guardian Qualification)
परीा राय-पहला िवकप (Exam State परीा शहर-पहला िवकप (Exam
KARNATAKA KOLAR
1st Choice ) City 1st Choice )
परीा राय-दूसरा िवकप (Exam State परीा शहर-दूसरा िवकप (Exam City
KARNATAKA CHIKABALLAPUR
2nd Choice ) 2nd Choice )
परीा राय-तीसरा िवकप (Exam State परीा शहर-तीसरा िवकप (Exam
KARNATAKA BENGALURU
3rd Choice ) City 3rd Choice )
परीा राय-चौथा िवकप (Exam State परीा शहर-चौथा िवकप (Exam City
KARNATAKA BENGALURU- URBAN
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
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 Rural
Schooling)
कू ल / कॉलेज का कार (Type of School योयता परीा राय (Qualifying
Private Unaided KARNATAKA
/ College) Examination State)
योयता परीा िजला (Qualifying KARNATAKA SECONDARY EDUCATION
Kolar कू ल बोड (School Board)
Examination District) EXAMINATION BOARD
का 10वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम कू ल / कॉलेज का पता (School / lakshmipura cross,nelevanki hobli,srinivaspura
v s r school
(School/College name should be as per College Address) tq,kolar dist
Class 10th Mark sheet/certificate)
रोल नंबर 10वीं माणप के अनुसार
कू ल / कॉलेज िपनकोड (School / College
563135 (Roll number as per 10th 20220495474
Pincode)
certificate)
पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 625.0
ातांक (Obtain Marks) 506.0 ितशत (Percentage) 80.96
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
कू िलंग का थान (Place of
योयता परीा (Qualifying Exam) examination conducted by Rural
Schooling)
a recognized Board/
University.
कू ल / कॉलेज का कार (Type of School योयता परीा राय (Qualifying
Private Unaided KARNATAKA
/ College) Examination State)
योयता परीा िजला (Qualifying KARNATAKA PRE-UNIVERSITY
Chikkaballapura कू ल बोड (School Board)
Examination District) EDUCATION EXAMINATION
का 12वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम कू ल / कॉलेज का पता (School / nallimaradahalli ,shidlagatta,chikkaballapura
dolphins indp pu college
(School/College name should be as per College Address) dist
Class 12th Mark sheet/certificate)
रोल नंबर 12वीं माणप के अनुसार
कू ल / कॉलेज िपनकोड (School / College
562105 (Roll number as per 12th NA
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
NO
ह (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) 8123830088 ईमेल आईडी (Email ID) dattathreyamp@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) ZUR31739274822
लेन-दे न की ितिथ (Date of
परीा शु क (Exam Fee) 900.0 09-02-2024 21:58:00 PM
Transaction)
शु क जमा िकया गया (Fee Submitted
09-02-2024 21:55:47 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 : 223.231.139.81 Date of Downloading : 09-02-2024 21:59:35 PM