Joint Entrance Examination (Main) - 2016

CENTRAL BOARD OF SECONDARY EDUCATION

ACKNOWLEDGEMENT PAGE

Application No.

60087508
DO NOT SEND THIS PAGE TO CBSE.

CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.

Personal Details
Name:

NIRMALJOT SINGH

Date of Birth:

12/05/1998

Mother's Name:

BALJINDER KAUR

Category

GENERAL

Father's Name:

GURPREET S BHASIN

Person with Disability(PwD):

NO

State of Eligibility:

PUNJAB

Percentage of Disability:

--

Gender:

MALE

Are you the only child?:

NO

Nationality:

INDIAN

Place of Residence:

URBAN

Aadhaar Number (UIDAI):

994366047966

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:

CHANDIGARH/MOHALI

2nd Choice of Exam Centre:

KURUKSHETRA

3rd Choice of Exam Centre:

BATHINDA

4th Choice of Exam Centre:

KARNAL

Academic Details
Year of passing class 10th:

2014

Year of Passing or Appearing class 12th/Qualifying Exam: 2016

Place of 12th class schooling:

CITY

Type of Institution of Class 12th/Qualifying Exam:

GOVERNMENT

School Board of class 12th/Qualifying Exam:

PUNJAB SCHOOL EDUCATION BOARD

Name of the Qualifying Examination passed / appearing:

Any Public School/ Board/ University examination in India or in any foreign country recognized as equivalent to
the 10+2 system by the Association of Indian Universities (AIU).

Percentage of Marks in Class 12th/Qualifying Exam:

--

Roll No. of Class 12th/Qualifying Exam:

--

Appeared/Appearing for Improvement of Class

12th/Qualifying Exam:

Mode of
preperation:

COACHING

Name and
Address of the
School/College
from where
passed/appearing:

Candidate's Mailing Address

Address:

H.No.127 Street No.2 K.S. Enclave

Locality:

Near 23No. Phatak

City/Town/Village:

Patiala

District:

Patiala

State:

PUNJAB

Pin Code:

147001

Email Address:

nsbhasincool@gmail.com

Mobile Number:

9465393645

Land Line Number:

01752201579

Guardian Details
Qualification

Occupation

Annual Income

Father's/Guardian's:

GRADUATE

PRIVATE SERVICE

RS. 200001 - 300000

Mother's:

POST GRADUATE

GOVERNMENT SERVICE

RS. 500001-600000

Payment Mode:

Credit / Debit Card

Transaction ID:

ESMP4153079257

Exam Fee:

1000 /-

Date of Transaction:

04-12-2015 20:18:16

Card Type:

VISA/Master Card

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Payment Details

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) - 2016. I shall abide by the terms and conditions thereon.

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