Joint Entrance Examination (Main) - 2016

CENTRAL BOARD OF SECONDARY EDUCATION

ACKNOWLEDGEMENT PAGE

Application No. 60156096

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Personal Details
Name: SHUBHAM SINGH Date of Birth: 13/01/1997
Mother's Name: NITU SINGH Category GENERAL
Father's Name: RAVI SHANKAR SINGH Person with Disability(PwD): NO
State of Eligibility: DELHI Percentage of Disability: --
Gender: MALE Are you the only child?: NO
Nationality: INDIAN Place of Residence: URBAN
Aadhaar Number (UIDAI): -- You need scribe/reader ?: NO

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

Academic Details
Year of passing class 10th: 2013 Place of 12th class schooling: CITY
Year of Passing or Appearing class 12th/Qualifying Exam: 2015 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: 91.2 Roll No. of Class 12th/Qualifying Exam: 9178401
Appeared/Appearing for Improvement of Class NO Mode of preperation: SELF STUDY
12th/Qualifying Exam:
Name and Address of the School/College from where St Pauls School C-3, Safdarjung Development Area, New Delhi, Delhi 110016
passed/appearing:

Candidate's Mailing Address

Address: B-4/3 Phase-5 Aya Nagar Ext. Near Kali Mandir Locality: Aya Nagar
City/Town/Village: New Delhi District: South Delhi
State: DELHI Pin Code: 110047
Email Address: imshubhamsingh007@gmail.com Mobile Number: 8826470989
Land Line Number: --

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

Payment Details
Payment Mode: Credit / Debit Card Transaction ID: ESMP4163583587
Exam Fee: 1000 /- Date of Transaction: 10-12-2015 13:21:47
Card Type: VISA/Master Card -- --
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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