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    JEEMAINJAN ConfirmationPage

    Uploaded by

    Ritesh Kumar Ranjan
    This document is a confirmation page for Manish Kumar's January 2020 JEE(Main) application, providing his personal details like name, date of birth, category, gender, address, contact information, and the exam cities selected. It also shows that he paid the 325 rupee exam fee on September 20, 2019 and uploaded images of his photograph and signature.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    JEEMAINJAN ConfirmationPage

    Uploaded by

    Ritesh Kumar Ranjan
    13 views1 page
    This document is a confirmation page for Manish Kumar's January 2020 JEE(Main) application, providing his personal details like name, date of birth, category, gender, address, contact information, and the exam cities selected. It also shows that he paid the 325 rupee exam fee on September 20, 2019 and uploaded images of his photograph and signature.

    Original Description:

    Sample form for JEE Mains

    Original Title

    JEEMAINJAN_ConfirmationPage

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    This document is a confirmation page for Manish Kumar's January 2020 JEE(Main) application, providing his personal details like name, date of birth, category, gender, address, contact information, and the exam cities selected. It also shows that he paid the 325 rupee exam fee on September 20, 2019 and uploaded images of his photograph and signature.

    Copyright:

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

    JEEMAINJAN ConfirmationPage

    Uploaded by

    Ritesh Kumar Ranjan
    This document is a confirmation page for Manish Kumar's January 2020 JEE(Main) application, providing his personal details like name, date of birth, category, gender, address, contact information, and the exam cities selected. It also shows that he paid the 325 rupee exam fee on September 20, 2019 and uploaded images of his photograph and signature.

    Copyright:

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

    JANUARY JEE(MAIN) 2020

    Confirmation Page

    Application No. 2003 1042 1426 -


    DO NOT SEND THIS PAGE TO NATIONAL TESTING AGENCY (NTA).
    CANDIDATE IS REQUESTED TO RETAIN THE PRINTOUT OF CONFIRMATION PAGE FOR FUTURE REFERENCE.

    Personal Details
    Candidate's Name MANISH KUMAR Date of Birth 21-06-2002
    Mother's Name ASHA DEVI Category SC
    Father's Name RAVINDRA MANJHI Gender Male
    If you are a PwD Candidate, do you have No Nationality Indian
    benchmark disability (40% or more /
    “Severe” where percentage is not defined)
    ?
    Place of Residence Urban State Code of Eligibility BIHAR
    Are You Diabetic? NO Mode of Preparation Tutorial Classes

    Apply For
    Apply For B.E./B.Tech. Only Question Paper Medium English
    Exam City 1st MAHARASHTRA - MUMBAI/NAVI MUMBAI Exam City 2nd MAHARASHTRA - THANE
    Exam City 3rd GUJARAT - VALSAD/VAPI Exam City 4th GUJARAT - SURAT

    Additional Details
    Are you a Twin No

    Contact Details
    Address TYPE- D SPECIAL 36/08 Locality BARC STAFF COLONY
    City/Town/Village BOISAR District PALGHAR
    State/UT MAHARASTRA Pin Code 401504
    Email Address man**************@gmail.com Mobile Number (+91) 970****986
    Land Line No. with 02525-268364
    STD code or any
    other Contact No.

    Fee Payment Details


    Payment Mode: Pay through SBI(MOPS) Transaction ID: IGAHBDRZH8
    Exam Fee: 325 /- Date of Transaction: 20/09/2019 20:36:32
    Fee Submitted On: 20/09/2019
    DECLARATION
    I hereby declare that all the particulars given by me in this form are true to the best of my knowledge and belief and any mistake / misinformation, detected at the time
    of admission or at any stage in future, will result in the cancellation of admission/candidature. I have read the information bulletin and understood all the procedures. In
    case I furnish any false information, my result will not be declared/ my candidature will automatically stand cancelled. I shall abide by terms and conditions therein.

    Images Uploaded by Candidate


    Photograph Signature

    List of Document Uploaded


    Photograph,Signature

    IP Address : 117.204.168.31 Date of Downloading : 20/09/2019 08:37:04 PM

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