JEE(Main)-2013: Confirmation Page for Application Number :30572652

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CENTRAL BOARD OF SECONDARY EDUCATION, DELHI

CONFIRMATION PAGE - JEE(Main) 2013

Application No.

30572652

You have successfully submitted Application On-line. Kindly take the printout of this page. Paste your two recent photographs, put left hand thumb impression and sign in the specified box. Send the CONFIRMATION PAGE through Registered/ Speed Post only along with original Demand Draft (if fee paid by Demand Draft) so as to reach positively by 26/12/2012 in the CBSE office to Executive Director, JEE (Main) Secretariat, Central Board of Secondary Education, PS-1-2, Institutional Area, I.P.Extn. Patparganj, Delhi-110 092. Apply for Mode of Exam Paper-1 Exam Cities - JEE(Main) Candidate's Name Mother's Name Father's Name State of Eligibility Mobile No. Email Id Board/University of Q.E. Name of Q.E. passed/appearing Interested in JEE(Advanced)
JEE (Main) Paper - 1 Only ( 1) PEN AND PAPER BASED EXAMINATION

Question Paper Medium Mode of Exam Paper-2

ENGLISH --

1st : MUZZAFARPUR ( 810), 2nd : PATNA ( 811), 3rd : GAYA ( 809), 4th : DURGAPUR ( 876) RAUSHAN RANA REENA SINGH RAMESH KUMAR SINGH BIHAR ( 05) 9931268649 ranvir.rana@hotmail.com BIHAR INTERMEDIATE EDUCATION COUNCIL 01 No

Date of Birth Gender Category Person with Disability Is Blind Candidate Nationality Q.E. Marks(%) Q.E. passing/appearing in

24/05/1996 MALE GENERAL No No INDIAN

2013

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) 2013. I shall abide by the terms and conditions thereon.

Complete Mailing Address in Capital Letters:

Name

Address

Left Hand Thumb Impression

Pin Code:

Signature of the Candidate(Not in capital letters)

Paste (do not staple) a recent Photograph duly attested by the Principal/Head of the Institutions / Gazetted Officer Photograph must not be larger than this box ATTESTED

Countersigned by Parent /Guardian Paste (do not staple) a recent unattested Photograph Photograph must not be larger than this box UNATTESTED

ATTESTATION BY HEAD OF THE INSTITUTION/GAZETTED OFFICER This is to certify that the particulars given in this CONFIRMATION PAGE including Name, Photograph, Address, Category, Date of Birth and Signature are correct to the best of my knowledge and belief.

Signature of Principal/Head of the Instt./Gazetted Officer with date and Seal

Details of Transaction(Syndicate Bank). Transaction ID.: MHCC2861294034 Card Type: VISA/Master Card Amount(Service Tax Extra): 800 Date of Transaction: 29/11/2012 Application No.:

30572652

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http://jeemain.nic.in/jeemain2013/Online/ConfirmationPage.aspx 29-Nov-12