You are on page 1of 2

APPLICATION NUMBER 2314010609526

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 (PERSONAL DETAILS)
उमीदवार का नाम (CANDIDATE DIVESH AJAY उमीदवार की जम ितिथ
09-06-2007
NAME) BADGUJAR (CANDIDATE DATE OF BIRTH)
िलंग (GENDER) MALE िपता का नाम (FATHER'S NAME) AJAY MADHUKAR BADGUJAR
KAVITA AJAY
माता का नाम (MOTHER'S NAME) राटीयता (NATIONALITY) INDIA
BADGUJAR
वग (CATEGORY) OTHER BACKWARD CLASS(OBC)
यिद आप पीडयूडी उमीदवार ह , तो या आपके पास ब चमाक िवकलांगता है  (IF YOU ARE A PWD
No
CANDIDATE, DO YOU HAVE A BENCHMARK DISABILITY?)
AADHAAR / पहचान संया (IDENTIFICATION
पहचान का कार (IDENTITY TYPE) XXXX XXXX 7632
ENROLLMENT ID NUMBER)
वािषक पािरवािरक आय (ANNUAL
अिधवास राय (DOMICILE STATE) MAHARASHTRA NOT MORE THAN 2.5 LAKHS
FAMILY INCOME)
संपक योरा और वतमान पता (CONTACT DETAILS and PRESENT ADDRESS)
वतमान पता (PRESENT ADDRESS) BHUSAWAL IDBI BANK दे श (COUNTRY) INDIA
राय/संघ (STATE/UT)) MAHARASHTRA िज़ला (DISTRICT) JALGAON
िपन कोड (PINCODE) 425311 मेल पता (EMAIL ADDRESS) Badgujardivesh350@gmail.com
मोबाइल नंबर (MOBILE NUMBER) 7385630561
थायी पता (PERMENENT ADDRESS)
थायी पता (PERMENENT
BHUSAWAL IDBI BANK दे श (COUNTRY) INDIA
ADDRESS)
राय/संघ (STATE/UT)) MAHARASHTRA िज़ला (DISTRICT) JALGAON
िपन कोड (PINCODE) 425311
योयता योरा (QUALIFICATION DETAILS)
2022-23 म परीा उीण (EXAM PASSED IN 2022-23) CLASS 10TH
परीा के िलए आवे दन िकया (EXAM APPLIED FOR) CLASS 11TH
कू ल का राय (STATE OF SCHOOL) MAHARASHTRA
कू ल का शहर/िजला (CITY/DISTRICT पाठशाला का नाम (NAME OF INDIRA LALWANI SEC SCH. JAMNER
JALGAON
OF SCHOOL) SCHOOL) PURA
अंितम परीा म ात अंकों का% ितशत
अययन का मायम (MEDIUM OF
(% PERCENTAGE OF MARKS 77.4 MARATHI
STUDY)
OBTAINED IN FINAL EXAM)
अय िववरण (OTHER DETAILS)
माता-िपता की िशा पृ ठभूिम
माता-िपता का यवसाय
(EDUCATIONAL BACKGROUND SCHOOL FINAL OTHERS
(OCCUPATION OF PARENTS)
OF PARENTS)
आपके िकतने भाई है (HOW MANY आपकी िकतनी बहन ह (HOW MANY
0 1
BROTHERS DO YOU HAVE) SISTERS DO YOU HAVE)
या आप राय / सरकार की िकसी अय
या आपके भाई/बहनों म से कोई इस
योजना के तहत िकसी अय छावृ ि या
योजना के तहत छावृ ि पाने वाला है
अय लाभों के ातकता ह (ARE YOU A
(IS/ARE ANY OF YOUR
RECIPIENT OF ANY OTHER
No BROTHER/SISTERS No
SCHOLARSHIP OR OTHER
RECIPIENTS OF A
BENEFITS UNDER ANY OTHER
SCHOLARSHIP UNDER THIS
SCHEME OF
SCHEME)
STATE/GOVERNMENT)
उमीदवार ारा अपलोड की गई छिवयां (IMAGES UPLOADED BY THE CANDIDATE)
PHOTO Uploaded
SIGNATURE Uploaded
INCOME CERTIFICATE View
CATEGORY CERTIFICATE View
AADHAAR / ENROLLMENT ID
View
DOCUMENT
परीा कद और िववरण (EXAM CENTER AND DETAILS)
मायम परीा के िलए चुना गया (MEDIUM OPTED FOR THE
HINDI
EXAM)
1st CHOICE FOR STATE/CITY/DISTRICT JALGAON (MAHARASHTRA)
2nd CHOICE FOR STATE/CITY/DISTRICT DHULE (MAHARASHTRA)
3rd CHOICE FOR STATE/CITY/DISTRICT NASHIK (MAHARASHTRA)
4th CHOICE FOR STATE/CITY/DISTRICT PUNE (MAHARASHTRA)

You might also like