JANUARY JEE(MAIN) 2020

Confirmation Page

Application No. 2003 1066 4543 -

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 PARTH NIKHIL ISASARE Date of Birth 19-10-2002
Mother's Name NITA Category OBC- NCL (Central List)
Father's Name NIKHIL 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 MAHARASHTRA
Are You Diabetic? NO Mode of Preparation Self Study

Apply For
Apply For B.E./B.Tech. Only Question Paper Medium English
Exam City 1st MAHARASHTRA - NAGPUR Exam City 2nd MAHARASHTRA - AMRAVATI
Exam City 3rd MAHARASHTRA - WARDHA Exam City 4th MAHARASHTRA - AKOLA

Additional Details
Are you a Twin No

Contact Details
Address HOUSE NO 8 NEAR GANPATI MANDIR SAHAKAR Locality YAVATMAL
NAGAR WADGAON YAVATMAL
City/Town/Village YAVATMAL District YAVATMAL
State/UT MAHARASTRA Pin Code 445001
Email Address isa****************@gmail.com Mobile Number (+91) 708****888
Land Line No. with --
STD code or any
other Contact No.

Fee Payment Details

Payment Mode: Pay through HDFC Bank Transaction ID: 9110684613
Exam Fee: 650 /- Date of Transaction: 26/09/2019 09:53:20
Fee Submitted On: 26/09/2019
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.

Images Uploaded by Candidate

Photograph Signature

List of Document Uploaded

Photograph,Signature

IP Address : 49.35.9.171 Date of Downloading : 09/10/2019 09:44:50 AM