JANUARY JEE(MAIN) 2020

Confirmation Page

Application No. 2003 1063 6194 -

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 BANKHELE ATHARVA KAILAS Date of Birth 17-07-2002
Mother's Name VANDANA Category Gen-EWS
Father's Name KAILAS 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 Rural State Code of Eligibility MAHARASHTRA
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 MAHARASHTRA - PUNE Exam City 2nd MAHARASHTRA - MUMBAI/NAVI MUMBAI
Exam City 3rd MAHARASHTRA - THANE Exam City 4th MAHARASHTRA - NASHIK

Additional Details
Are you a Twin No

Contact Details
Address SULTANPUR ROAD JUNA Locality BAJAR MANCHAR
City/Town/Village MANCHAR District PUNE
State/UT MAHARASTRA Pin Code 410503
Email Address ban*************@gmail.com Mobile Number (+91) 749****037
Land Line No. with --
STD code or any
other Contact No.

Fee Payment Details

Payment Mode: Pay through SBI(MOPS) Transaction ID: CPV0696625
Exam Fee: 650 /- Date of Transaction: 27/09/2019 19:28:47
Fee Submitted On: 27/09/2019
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.

Images Uploaded by Candidate

Photograph Signature

List of Document Uploaded

Photograph,Signature

IP Address : 106.220.142.141 Date of Downloading : 27/09/2019 07:29:26 PM