JANUARY JEE(MAIN) 2020

Confirmation Page

Application No. 2003 1080 1456 -

DO NOT SEND THIS PAGE TO NATIONAL TESTING AGENCY (NTA).
CANDIDATE IS REQUESTED TO RETAIN THE PRINTOUT OF CONFIRMATION PAGE FOR FUTURE REFERENCE.

Personal Details
Candidate's Name PRIYANSHU PRIYADARSHI MEHER Date of Birth 22-03-2002
Mother's Name ANANDINI MEHER Category OBC- NCL (Central List)
Father's Name CHITTARANJAN MEHER Gender Male
If you are a PwD Candidate, do you have No Nationality Indian
benchmark disability (40% or more /
“Severe” where percentage is not defined)
?
Place of Residence Urban State Code of Eligibility ODISHA
Are You Diabetic? NO Mode of Preparation Individual Tuition

Apply For
Apply For B.E./B.Tech. Only Question Paper Medium English
Exam City 1st ODISHA - SAMBALPUR Exam City 2nd ODISHA - BHUBANESWAR
Exam City 3rd ODISHA - DHENKANAL Exam City 4th ODISHA - CUTTACK

Additional Details
Are you a Twin No

Contact Details
Address BUTUPALI,BOUDH Locality
City/Town/Village BOUDH District BOUDH (BAUDA)
State/UT ODISHA Pin Code 762014
Email Address meh************************@gmail.com Mobile Number (+91) 993****898
Land Line No. with 9178352883
STD code or any
other Contact No.

Fee Payment Details

Payment Mode: Pay through SBI(MOPS) Transaction ID: CPV1025881
Exam Fee: 650 /- Date of Transaction: 28/09/2019 22:27:30
Fee Submitted On: 28/09/2019
DECLARATION
I hereby declare that all the particulars given by me in this form are true to the best of my knowledge and belief and any mistake / misinformation, detected at the time
of admission or at any stage in future, will result in the cancellation of admission/candidature. I have read the information bulletin and understood all the procedures. In
case I furnish any false information, my result will not be declared/ my candidature will automatically stand cancelled. I shall abide by terms and conditions therein.

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Photograph Signature

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Photograph,Signature

IP Address : 223.176.45.107 Date of Downloading : 28/09/2019 10:28:45 PM