JOINT ENTRANCE EXAMINATION (Main) - APRIL 2020

Confirmation Page

Application No. 200310229617 -

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 JYOTI SINGH Candidate's Date of Birth 03-03-2003
Mother's Name PHULAN SINGH Category OBC- NCL (Central List)
Father's Name JAYDEEP SINGH Gender Female
In case of Girl candidate, Are you only girl NO If you are a PwD Candidate, No
child of your parents? do you have benchmark
disability (40% or more /
“Severe” where percentage is
not defined) ?
Nationality Indian Place of Residence Rural
State Code of Eligibility MADHYA PRADESH Are You Diabetic? NO
Medium of Instructions/Study - Physics, Hindi Mode of Preparation Self Study
Chemistry and Mathematics in Class
11th/12th/equivalent

Apply For
Apply For B.E./B.Tech. Only Question Paper Medium Hindi
Exam City 1st MADHYA PRADESH - REWA Exam City 2nd MADHYA PRADESH - SATNA
Exam City 3rd MADHYA PRADESH - SAGAR Exam City 4th MADHYA PRADESH - JABALPUR

Additional Details
Are you a Twin No

Contact Details
Address VILL POST DEVMAU DALDAL Locality RAMPUR BAGHELAN
City/Town/Village DEVMAU DALDAL District SATNA
State MADHYA PRADESH Pin Code 485111
Email Address jat***********@gmail.com Mobile Number 881****632
Land Line No. with --
STD code or any
other Contact No.

Fee Payment Details

Payment Mode: Pay through HDFC Bank Transaction ID: 9855257767
Exam Fee: 325 /- Date of Transaction: 14/02/2020 08:10:34
Fee Submitted On: 14/02/2020
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. No
Candidate should adopt any unfair means, or indulge in any unfair examination practices. If at any stage, it is found that the candidate has submitted multiple
Applications and/or appeared in more than one date/shift, then the candidature will be cancelled and legal action will be taken including debarring in all future
examinations conducted by NTA

Images Uploaded by Candidate

Photograph Signature

List of Document Uploaded

Photograph,Signature,12th Admit Card/Marksheet/Certificate

IP Address : 106.66.19.180 Date of Downloading : 14/02/2020 08:15:10 PM