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    JEE (Main) AcknowledgementPage

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    rajeswar roy
    1) The document is an acknowledgement page for Agniswar Roy's application to the 2017 Joint Entrance Examination (Main) administered by the Central Board of Secondary Education. 2) It provides personal details for Agniswar such as name, date of birth, gender, address, as well as examination details like choice of exam center and medium. 3) Academic details are also listed, including information on Agniswar's secondary education, qualifying exam, percentage marks, and details of his coaching institution.

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    JEE (Main) AcknowledgementPage

    Uploaded by

    rajeswar roy
    69 views1 page
    1) The document is an acknowledgement page for Agniswar Roy's application to the 2017 Joint Entrance Examination (Main) administered by the Central Board of Secondary Education. 2) It provides personal details for Agniswar such as name, date of birth, gender, address, as well as examination details like choice of exam center and medium. 3) Academic details are also listed, including information on Agniswar's secondary education, qualifying exam, percentage marks, and details of his coaching institution.

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    jee main

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    JEE(Main) AcknowledgementPage

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    1) The document is an acknowledgement page for Agniswar Roy's application to the 2017 Joint Entrance Examination (Main) administered by the Central Board of Secondary Education. 2) It provides personal details for Agniswar such as name, date of birth, gender, address, as well as examination details like choice of exam center and medium. 3) Academic details are also listed, including information on Agniswar's secondary education, qualifying exam, percentage marks, and details of his coaching institution.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    69 views1 page

    JEE (Main) AcknowledgementPage

    Uploaded by

    rajeswar roy
    1) The document is an acknowledgement page for Agniswar Roy's application to the 2017 Joint Entrance Examination (Main) administered by the Central Board of Secondary Education. 2) It provides personal details for Agniswar such as name, date of birth, gender, address, as well as examination details like choice of exam center and medium. 3) Academic details are also listed, including information on Agniswar's secondary education, qualifying exam, percentage marks, and details of his coaching institution.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Joint Entrance Examination (Main) - 2017

    CENTRAL BOARD OF SECONDARY EDUCATION


    ACKNOWLEDGEMENT PAGE

    Application No. 70182726


    DO NOT SEND THIS PAGE TO CBSE.
    CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.

    Personal Details
    Name: AGNISWAR ROY Date of Birth: 07/04/1999
    Mother's Name: NIBEDITA ROY Category GENERAL
    Father's Name: SANJIB ROY Person with Disability(PwD): NO
    State of Eligibility: WEST BENGAL Percentage of Disability: --
    Gender: MALE Are you the only child?: NO
    Nationality: INDIAN Place of Residence: URBAN
    Aadhaar Number 948912759996 You need scribe/reader ?: NO

    Examination Details
    Applying For: JEE(Main) Paper - 1 (B.E./B.Tech.) Only
    Mode of Examination: PEN AND PAPER BASED EXAMINATION Question Paper Medium: ENGLISH
    1st Choice of Exam Centre: KOLKATA 2nd Choice of Exam Centre: DURGAPUR
    3rd Choice of Exam Centre: SILIGURI 4th Choice of Exam Centre: BHUBANESWAR

    Academic Details
    Year of passing class 10th: 2015 Place of 12th class schooling: CITY
    Year of Passing or Appearing class 12th/Qualifying Exam: 2017 Type of Institution of Class 12th/Qualifying Exam: PRIVATE
    School Board of class 12th/Qualifying Exam: CENTRAL BOARD OF SECONDARY EDUCATION
    Name of the Qualifying Examination passed / appearing: The final examination of the 10+2 system, conducted by any recognized central/ state Board, such as Central
    Board of Secondary Education, New Delhi; Council for the Indian School Certificate Examinations, New Delhi;
    etc.
    Percentage of Marks in Class 12th/Qualifying Exam: -- Roll No. of Class 12th/Qualifying Exam: --
    Appeared/Appearing for Improvement of Class NO Mode of preperation: COACHING
    12th/Qualifying Exam:
    Roll Number of Class 12th/Qualifying Examination of
    Improvement Examination:
    Name and Address of the School/College from where HARIYANA VIDYA MANDIR BA-193, Sector-1, Salt Lake, Kolkata, West Bengal 700064
    passed/appearing:

    Candidate's Mailing Address


    Country: India State: WEST BENGAL
    District: SOUTH 24 PARGANAS Address: EE 182/12 sourav abasan salt lake kolkata 700091
    Locality: EE block City/Town/Village: kolkata
    Pin Code: 700091 Email Address: [email protected]
    Mobile Number: 9433565483 Land Line Number: 03323216101

    Guardian Details
    Qualification Occupation Annual Income
    Father's/Guardian's: GRADUATE PRIVATE SERVICE RS. 800001 AND ABOVE
    Mother's: GRADUATE OTHERS (INCLUDING HOUSE WIFE) --

    Payment Details
    Provider Name: HDFC Bank Payment Gateway Payment Mode: Electronic Payment Gateway
    Fee Type: Examination Fee Transaction Amount: 1000 /-
    Transaction ID: HHMP4959587298 Date of Transaction: 10-12-2016 13:22:24
    DECLARATION
    I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. I have read and understood the JEE procedures for both
    JEE(Main) and JEE(Advanced) - 2017. I shall abide by the terms and conditions thereon.

    Images Uploaded by Candidate


    Photograph Signature

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