Joint Entrance Examination (Main) April 2019

NATIONAL TESTING AGENCY

CONFIRMATION PAGE

Application No. 190310457923

DO NOT SEND THIS PAGE TO NATIONAL TESTING AGENCY(NTA).
CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF CONFIRMATION PAGE FOR FUTURE REFERENCE.

Personal Details
Name: ADITI ANIL ANGADI Date of Birth: 29/08/2001
Mother's Name: SUJATA A ANGADI Category: GENERAL
Caste Name: NA Father's Name: ANIL S ANGADI
Person with Disability(PwD): NO State of Eligibility: KARNATAKA
Percentage of Disability: -- Gender: FEMALE
Are you Diabetic: NO Nationality: INDIAN
Place of Residence: URBAN Do you need scribe: NO

Examination Details
Applying For:
Mode of Examination:
1st Choice of Exam City:
3rd Choice of Exam City:
JEE(Main) Paper - 1 (B.E./B.Tech.) Only
COMPUTER BASED EXAMINATION Question Paper Medium: ENGLISH
DHARWAD (KARNATAKA) 2nd Choice of Exam City: HUBLI (KARNATAKA)
BELAGAVI(BELGAUM) (KARNATAKA) 4th Choice of Exam City: BENGALURU (KARNATAKA)

Academic Details
Year of passing class 10th: 2017 Place of 12th class schooling: CITY
Year of Passing or Appearing class 12th/Qualifying Exam: 2019 Type of Institution of Class 12th/Qualifying Exam: PRIVATE
School Board of class 12th/Qualifying Exam: KARNATAKA BOARD OF PRE UNIVERSITY EDUCATION
Name of the Qualifying Exam passed / appearing: Intermediate or two-year Pre-University examination conducted by a recognized Board/ University.
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 Exam of --
Improvement Exam:
Name and Address of the School/College from where SHRI MANJUNATHESHWARA PRE UNIVERSITY SCIENCE COLLEGE VIDYAGIRI,DHARWAD,KARNATAKA-
passed/appearing: 580004

Candidate's Mailing Address

Country: India State: KARNATAKA
District: DHARWAD Address: GURU KRUPA, SAMPIGE NAGAR,1st A ROAD ,
Locality: OPPOSITE TO LITTLE BUTTERFLY SCHOOL City/Town/Village: DHARWAD
Pin Code: 580008 Email Address: ang*******@gmail.com
Mobile Number: 948****614

Guardian Details
Qualification Occupation Annual Income
Father's/Guardian's: GRADUATE BUSINESS UPTO 100000
Mother's: GRADUATE OTHERS UPTO 100000

Payment Details
Provider Name: Syndicate Bank Payment Mode: e-Challan
Fee Type: Examination Fee for JEE(Main) April 2019 Transaction Amount: 250 /-
Transaction ID: 101332 Date of Transaction: 2019-02-15
DECLARATION
I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief.

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