JANUARY JEE(MAIN) 2020

Confirmation Page

Application No. 2003 1092 3746 -

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 DHEERAJ SINGH Date of Birth 22-04-2003
Mother's Name LALITA DEVI Category Gen-EWS
Father's Name SHYAM SUNDER RAJPUT 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 RAJASTHAN
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 RAJASTHAN - JAIPUR Exam City 2nd RAJASTHAN - AJMER
Exam City 3rd RAJASTHAN - ALWAR Exam City 4th RAJASTHAN - SIKAR

Additional Details
Are you a Twin No

Contact Details
Address 55 SAWAI PAW KI BAGICHI Locality
City/Town/Village JANTA COLONY District JAIPUR
State/UT RAJASTHAN Pin Code 302004
Email Address dhe******************@gmail.com Mobile Number (+91) 911****250
Land Line No. with --
STD code or any
other Contact No.

Fee Payment Details

Payment Mode: Pay through SBI(MOPS) Transaction ID: IGAHEPTXO4
Exam Fee: 650 /- Date of Transaction: 09/10/2019 18:59:52
Fee Submitted On: 09/10/2019
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

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