JANUARY JEE(MAIN) 2020

Confirmation Page

Application No. 2003 1063 1336 -

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 KUNDAR ANUJ ANIL Date of Birth 13-01-2003
Mother's Name SAROJA KUNDAR Category General
Father's Name ANIL KUNDAR 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 Tutorial Classes

Apply For
Apply For B.E./B.Tech. Only Question Paper Medium English
Exam City 1st MAHARASHTRA - THANE Exam City 2nd MAHARASHTRA - MUMBAI/NAVI MUMBAI
Exam City 3rd MAHARASHTRA - PUNE Exam City 4th MAHARASHTRA - NASHIK

Additional Details
Are you a Twin No

Contact Details
Address SAI DARSHAN BLDG ROOM NO.13 2ND FLOOR Locality SAVARKAR NAGAR
City/Town/Village THANE WEST District THANE
State/UT MAHARASTRA Pin Code 400606
Email Address anu**********@gmail.com Mobile Number (+91) 913****686
Land Line No. with 8080064292
STD code or any
other Contact No.

Fee Payment Details

Payment Mode: Pay through PAYTM Transaction ID: 20190922111212800110168024488927
739
Exam Fee: 650 /- Date of Transaction: 22/09/2019 12:00:00
Fee Submitted On: 22/09/2019
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

List of Document Uploaded

Photograph,Signature

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