Click Here to Print This Page Home

You have successfully submitted On-line Application. Please preserve this page alongwith proof of fee payment for future reference.

CONFIRMATION PAGE - NEET (UG) - 2019

Application No. 190411158278  

अ यथ का नाम (Candidate's Name) TULJA * ज म त थ (Date of Birth) 21/04/2002

माता का नाम (Mother's Name) SANGEETA लग (Gender) Female

पता का नाम (Father's Name) VIVEKANAND वग (Category) OBC (NCL)

क ा बारहव / यो यता परी ा उ ीण करने /परी ा का वष

द ांग
(Year of Passing/Appearing Class-XII/Qualifying 2019 * No
(Person with Disability)
Exam)

पा ता का रा य/दे श
Maharashtra रा ीयता (Nationality) Indian *
(State/Country of Eligibility)

ा तांक का तशत ( % of Marks obtained in Class

प का मा यम (Medium of Question Paper))# English -
12thQualifying Examination)

मोबाइल नंबर (Mobile No.) 91xxxxxx9057 ईमेल पता (Email Address) vexxxxxxxxxxxxxxxxx@gmail.com

परी ा शहर के वक प (Choice of Examination City)

(1) NASHIK ( 3113) (2) THANE ( 3118) (3) MUMBAI ( 3110) (4) PUNE ( 3115)

DECLARATION: - I hereby affirm that all the particulars stated by me in the Application Form are true and correct. Even the spelling of names and category are also correct. I have not
concealed any information. However, if any information furnished herein is found fraudulent, incorrect or untrue, I will be liable for criminal prosecution which will result in
cancellation of my candidature. Further that the selection and admission to the course is liable to be cancelled. I agree to abide by the Rules and Regulations governing the
Examination as contained in the Information Bulletin for NEET (UG) - 2019 which I have gone through carefully. I further declare that I have not submitted any other application for
NEET (UG) -2019  and mobile number and email address given in the form are correct and my own or of my parents.

Signature

Photo

Complete mailing address:

Address 262/2, ganesh colony,behind hanuman nagar, near gorakshanath aashram

City PANCHAVATI NASHIK ,NASHIK

State /Country Maharashtra Pin Code 422003

Details of Transaction(SBI Bank).

Transaction ID.: CPL2453105 Total Amount: 1400 Date of Transaction: 11/29/2018 10:35:07 PM

Card Type : VISA/Master Card

Application No: 190411158278                                                       Printed On : 31/03/2019 11:51:38

Note : - Kindly check following details in Confirmation Page :

Candidate’s Name, Mother’s Name, Father’ s Name, Date of Birth, Gender, Category, PwD, Choice of Examination Cities and Medium of Question Paper. In case of any discrepancy, these may please be
corrected during 14th January, 2019 to 31st January, 2019. No corrections shall be allowed under any circumstances after this date.