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6/9/2015

REAP2015

BOARDOFTECHNICALEDUCATION,RAJASTHAN
RajasthanEngineeringAdmissionProcess(REAP)2015
OnlineApplicationForm
:2014463
FormFilled
:1515120010046505 Amount,date

FormNo
TokenNo

1.JEE(MAIN2015)Detail
2.NameofCandidate:
3.Father'sName:
4.Mother'sName:
5.Gender:
6.Category:
7.Category2:
8.ExServiceMan
9.DateofBirth:
10.CompleteAddress:

:09Jun20158:52AM
:400/,04/06/2015

JEE(MAIN2015)RollNo 31139178

PRASHANTKACHHAWAHA
MANSINGHKACHHAWAHA
MANJULATAKACHHAWAHA
MALE
OBC
NONE

05Nov1998
NEARCHAINPURASCHOOL,HANSLAVKIPAL,MANDOR,JODHPUR,JODHPUR,JODHPUR,
RAJASTHAN342304
prashantkachhawaha@gmail.com

12.MobileNo:

11.PhoneNo:

9461600106

Exam.Details

Passed/ROLLNO

Board/University

StateOfStudy

Year Max.Marks

MarksObt.

PASSED

CBSE

RAJASTHAN

2012

500

447

89.40

XI

PASSED

CBSE

RAJASTHAN

2013

1000

813

81.30

XII

1633789

CBSE

RAJASTHAN

2014

500

438

87.60

13.DetailsofmarksinXII
Subject
MaxMarks ObtMarks
Mathematics
100
95
Physics
100
92
Chemistry
100
95
Total
300
282
Percentage(%)
94.00

14.DetailofmarksinJEE(MAIN2015)
Subject
ObtMarks
Mathematics
23
Physics
30
Chemistry
74
Total
127

15.Stateof
BonafideResidence:
16.Nationality:
18.AreaofResidence
19.Tehsil

RAJASTHAN

INDIAN
URBAN
999

17.Religion:
19.DomicileDistt.
20.Bonafidearea

HINDU
999
999

I hereby solemnly and sincerely affirm that all the information furnished by me in this application form are true and correct. I have not
concealedanyinformation.However,ifanyinformationfurnishedhereinisfoundtobefraudulent,incorrectoruntrueatanystage.Iamliable
tocriminalprosecutionandIalsoagreetoforgomyseat.Furtherthattheselectionandadmissiontothecourseisliabletobecancelled.Iagree
toabidebytheRulesandRegulationsgoverningtheExaminationascontainedintheInformationBooklet,whichIhavedulygonethrough.
SignatureofCandidate
DOCUMENTSUPLOADED
Certificate/MarksheetofHighSchool/SecondarybearingDateofBirthofthecandidate.

YES

Marksheetof10+2Examination,asaproofofhavingpassedthequalifyingexamination.

YES

Domicilecertificate

YES

Castecertificate

YES

Note:Fortheconvenienceofcandidates,formatsofcertificatesareavailableonthewebsite.Thecandidatescanreproducetheformatofthe
certificate(s)bytyping/photocopyingetc.forthepurposeofcertificationfromappropriateauthority.
http://www.reapadm.com/ReAPfoRm2015/RpeTaPpForm.php

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