Rs.
10/-
JOINT ENTRANCE EXAMINATION (JEE MAIN) 2024
REPORT FORM
1. Name (Capital Letter) : __________________________________________________________
2. Father’s Name (Capital Letter) : __________________________________________________________
3. Mother’s Name (Capital Letter) : __________________________________________________________
4. Date of Birth : __________________________________________________________
5. Address : __________________________________________________________
___________________________________________________________
6. Parents appointment letter No.(For Cat-III & IV) : ___________________________________________________
7. Ph No/Mobile No (At least 2 whatsapp No.) : ________________________________________________________
8. Email ID : __________________________________________________________
9. Name of Institution with Address : __________________________________________________________
(Cl – VIII) ___________________________________________________________
10. Name of Institution with Address : __________________________________________________________
(HSLC) ___________________________________________________________
a. Total Mark : _____________ Mark Obtain : _____________
b. Percentage (HSLC) : _____________ Name of Board : _____________ Year of Passing ______
11. Name of Institution with Address : __________________________________________________________
(HSSLC) ___________________________________________________________
a. Total Mark : ___________ f. Mark Obtain : ___________ Year of Passing ______
b. Mark in Physics : ___________ g. Mark in Chemistry : ___________
c. Mark in Mathematics : ___________ h. Mark in English : ___________
d. Percentage (HSSLC) : ___________ i. Percentage (PCM) : ___________
e. Name of Board : __________________________________________________________________
12. Original document Shown at the time of Choice Filling:
a. Birth Certificate __________ g. Residential Certificate _________
b. Tribal Certificate/OBC/SC __________ h. Class X Certificate _________
c. Class X Marksheet __________ i. Class XII Certificate _________
d. Class XII Marksheet __________ j. Parents appointment letter (For Cat-III & IV) ________
e. JEE (Main) Admit Card __________ k. Father’s Voter ID _________
f. JEE (Main) Score Card __________ l. Mother’s Voter ID _________
g. Migration Certificate __________ m. Transfer Certificate _________
13. ST/OBC/SC/General Rank in JEE (Main) 2024 : _______________________________________________
14. Percentile mark in JEE (Main) – 2024 : _______________________________________________
For Office use only
15. Course allotted in the Choice Filling : _______________________________________________
16. Name of Institution with Address : _______________________________________________
________________________________________________
Signature of Student Signature of parent
