Joint Entrance Examination (Main) - 2018

CENTRAL BOARD OF SECONDARY EDUCATION

ACKNOWLEDGEMENT PAGE

Application No. 80575486

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CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.

Personal Details
Name: VIDIT JAIN Date of Birth: 25/05/2000
Mother's Name: YOGITA JAIN Category GENERAL
Caste Name NA Father's Name: RAJENDRA PRASAD JAIN
Person with Disability(PwD): NO State of Eligibility: RAJASTHAN
Percentage of Disability: -- Gender: MALE
Are you Diabetic :: NO Nationality: INDIAN
Place of Residence: URBAN You need scribe/reader ?: NO

Examination Details
Applying For: JEE(Main) Paper - 1 (B.E./B.Tech.) Only
Mode of Examination: COMPUTER BASED EXAMINATION Question Paper Medium: ENGLISH
Choice of Online Exam Centre: JAIPUR

Academic Details
Year of passing class 10th: 2016 Place of 12th class schooling: CITY
Year of Passing or Appearing class 12th/Qualifying Exam: 2018 Type of Institution of Class 12th/Qualifying Exam: PRIVATE
School Board of class 12th/Qualifying Exam: CENTRAL BOARD OF SECONDARY EDUCATION
Name of the Qualifying Examination passed / appearing: The final examination of the 10+2 system, conducted by any recognized central/ state Board, such as Central
Board of Secondary Education, New Delhi; Council for the Indian School Certificate Examinations, New Delhi;
etc.
Percentage of Marks in Class 12th/Qualifying Exam: -- Roll No. of Class 12th/Qualifying Exam: --
Appeared/Appearing for Improvement of Class NO Mode of preperation: COACHING
12th/Qualifying Exam:
Roll Number of Class 12th/Qualifying Examination of
Improvement Examination:
Name and Address of the School/College from where ST ANSLEM SR. SEC. SCHOOL SECTOR 6 HEERA PATH MANSAROVAR JAIPUR
passed/appearing:

Candidate's Mailing Address

Country: India State: RAJASTHAN
District: JAIPUR Address: 38/164 KIRAN PATH MANSAROVAR JAIPUR
Locality: KIRAN PATH City/Town/Village: JAIPUR
Pin Code: 302020 Email Address: raj****com
Mobile Number: 941****613

Guardian Details
Qualification Occupation Annual Income
Father's/Guardian's: OTHERS PRIVATE SERVICE RS. 300001 -400000
Mother's: GRADUATE OTHERS UPTO 100000

Payment Details
Provider Name: Syndicate Bank Payment Gateway Payment Mode: Electronic Payment Gateway
Fee Type: Examination Fee Transaction Amount: 500 /-
Transaction ID: LSM35895732728 Date of Transaction: 18-12-2017 21:36:53

Selected Date for Computer Based Examination of Paper-1

Your selected date for Computer Based Examination: No date is selected.
DECLARATION
I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. I have read and understood the JEE procedures for both
JEE(Main) and JEE(Advanced) - 2018. I shall abide by the terms and conditions thereon.

Images Uploaded by Candidate

Candidate Photograph Candidate Signature Parent/Guardian Signature