COMPLETE APPLICATION FORM : JEE B.Ed.

- 2020

A - Registration Details
Registration Number BED202010128487
Candidate Name AMIT KUMAR
Candidate's Father Name MANGE RAM
Candidate's Mother Name SUMITRA DEVI
Candidate's Date of Birth 14/Mar/1995
Email Address prveenkaranwal@gmail.com
Primary Mobile Number 9758417752

B - Personal Details
Gender Male Marital Status Unmarried
Spouse Name Nationality Indian
Category SC Category Certificate Number 012184003770
State Domicile UP Is 10 From Up Yes
Is 12 From Up Yes Is UG From Up No
Is Person with Disability No Disability Type
Disability Percentage Is Economically Weaker
Id Proof Aadhar Card Id Proof No 249461628090
Is Zero Fees Required No Alternate Mobile Number 9027719863
Is Annual Family Income less than 2 Lac pa

C - Communication Address
VILL KOLKI RANGHAD POST NAGRAJPUR SAHARANPUR Saharanpur Uttar Pradesh 247001

D - Permanent Address
VILL KOLKI RANGHAD POST NAGRAJPUR SAHARANPUR Saharanpur Uttar Pradesh 247001

E - Opted Stream Details

Stream opted for B.Ed. Science

F - SSC / 10th Std / Equivalent Details

Board Name UP BOARD
Marks Obtained 313 Maximum Marks 600
Year Of Passing 2010 Percentage 52.17
G - Graduation Details
Is Graduation complete Pass Stream of Graduation Science/Engineering
Specified Stream Have you done BE/BTech No
Name of University H.N.B.G. UNIVERSITY
Marks Obtained 819 Maximum Marks 1800
Percentage 45.5 Year Of Passing 2017
Roll Number 60350108 Expected Year of Passing

H - Post Graduation Details

Is Post Graduation complete Pass
Name of University H N B G UNIVERSITY
Marks Obtained 459 Maximum Marks 720
Percentage 63.75 Year Of Passing 2019
Roll Number 17314339019 Expected Year of Passing

I - Weightage Details
TOTAL WEIGHTAGE : 0
A. Have you participated in National or State level or Inter
No
University Sports Competition
A.1. In the individual items by the Candidate
A.2. In the team items by the Candidate
A.3. In other college tournaments or sports run by a university
B. Candidates of National Cadet Corps and National Service Scheme

C. Do you need reservation of dependents of freedom fighters No

D. Are you in active service / immersed / retired defense personnel
or son/daughter of such personnel, or related to a disabled, No
missing or dead defensive personnel as their son/daughter/wife
E. Is your father or husband is serving in/retired from police or PAC
or BSF or SSB or ITBP or CRPF or service in home guards or No
disabled / dead in such services
F. Female Candidate who is Widowed, Divorced or Abandoned

J - Center Details
Center Choice 1 Meerut Center Choice 2 Ghaziabad Center Choice 3 Moradabad

K - Payment Details
Payment Status Success Payment Date 24/Feb/2020
Transaction Number RHD48553987558 Receipt Number 20200224
Order Id BED20201012848720200224130120563 Total Amount 750

L - Declaration
I understand that it is my responsibility to check the eligibility criterion and other conditions of the J.E.E. B.Ed. 2020 – 22. I also am aware
that the University of Lucknow, Lucknow is not verifying the eligibility at the time of submission of online application form. I, hereby, certify
that the particulars given by me in this B.Ed. 2020 – 22 online application form are true to best of my knowledge and belief and only I will be
responsible for any mismatch or incorrect information. I also certify that I fulfil the eligibility criteria laid down by University of Lucknow,
Lucknow for J.E.E. B.Ed. 2020 – 22 and undertake to produce original documents whenever necessary. I will follow all instruction given by
University of Lucknow, Lucknow in this regard. I understand all disputes will be subjected to territorial jurisdiction of LUCKNOW City only.