सं युत वे श परीा (मु य)

Joint Entrance Examination (Main)

JEE(Main)

APPLICATION NUMBER 240310637582

DO NOT SEND THIS PAGE TO NATIONAL TESTING AGENCY (NTA).
THE CANDIDATE IS REQUESTED TO RETAIN THE PRINTOUT OF THE CONFIRMATION PAGE FOR FUTURE REFERENCE.
यितगत योरा (Contact Details) वतमान पता (Present Address)
PURBACHAL HOUSING
पता (Premises No/ Name) ईमेल पता (Email Address) JUNISN03@GMAIL.COM
ESTATE
थानीयता (Locality) SALT LAKE उप-थानीयता (Sub-Locality)(Optional) CLUSTER 14 FLAT B-4
दे श कोड (Country Code) +91 दे श (Country) INDIA
राय (State) WEST BENGAL िजला (District) 24 Paraganas North
वै किपक संपक सू (Alternate Contact
मोबाइल नंबर (Mobile Number) +91 - 9836235210 6291638817
No.) (Optional)
िपन कोड (Pin Code) 700097
थायी पता (Permanent Address)
PURBACHAL HOUSING
पता (Premises No/ Name) थानीयता (Locality) SALT LAKE
ESTATE
उप-थानीयता (Sub-
CLUSTER 14 FLAT B-4 दे श (Country) INDIA
Locality)(Optional):
राय (State) WEST BENGAL िजला (District) 24 Paraganas North
िपन कोड (Pin Code) 700097
यितगत योरा (PERSONAL DETAILS)
अयथी की जम ितिथ (Candidate's Date
अयथी का नाम (Candidate's Name) SHARMIK SEN 28-06-2006
of Birth)
िपता / अिभभावक का नाम (Father / माता / अिभभावक का नाम (Mother /
DIPANKAR SEN JUNI SEN
Guardian Name) Guardian Name)
िलंग (Gender) MALE राटीयता (Nationality ) INDIAN
ANY OTHER VALID
पहचान के कार (Identity Type) GOVT IDENTITY WITH पहचान संया (Identification Number) 572914686955
PHOTOGRAPH
राय / केद शािसत दे श जहाँ से 12वीं /
समक उीण / उपिथत (State/ UT
WEST BENGAL े णी (Category ) GENERAL
from where 12th/ Equivalent Passed/
Appearing)
या आपको मधुमेह ह  (Are You
NO िनवास की जगह ( Place of Residence ) URBAN
Diabetic ? )
यिद आप एक Pwd उमीदवार ह , तो या
आपके पास ब चमाक िवकलांगता है (If you वािषक पािरवािरक आय ( Annual Family
NA 500001-600000
are a Pwd Candidate, do you have Income )
benchmark disability)?
योयता परीा म कू ली िशा का मायम (
तैयारी का तरीका ( Mode of Preparation
Self-Study Medium of schooling in qualifying English
)
exam )
परीा कद िववरण (Exam centre Details)
परीा के स के िलए आवे दन कर (Session
के िलए आवे दन (Apply For) B.E./B.Tech Session 1 & Session 2
Of Exam Apply For)
िपता / अिभभावक यवसाय (Father / िपता / अिभभावक योयता (Father /
PRIVATE SERVICE Post Graduate
Guardian Occupation) Guardian Qualification)
माता / अिभभावक यवसाय (Mother / माता / अिभभावक योयता (Mother /
Teaching / Research POST GRADUATE
Guardian Occupation) Guardian Qualification)
परीा राय-पहला िवकप (Exam State परीा शहर-पहला िवकप (Exam City 1st
WEST BENGAL KOLKATA
1st Choice ) Choice )
परीा राय-दूसरा िवकप (Exam State परीा शहर-दूसरा िवकप (Exam City 2nd
WEST BENGAL HOWRAH
2nd Choice ) Choice )
परीा राय-तीसरा िवकप (Exam State परीा शहर-तीसरा िवकप (Exam City 3rd
WEST BENGAL HOOGHLY
3rd Choice ) Choice )
परीा राय-चौथा िवकप (Exam State परीा शहर-चौथा िवकप (Exam City 4th
WEST BENGAL KALYANI
4th Choice ) Choice )
न प मायम (Question Paper Medium) English
10वीं या समक योयता िववरण (10th or equivalent Qualification Details)
उीण / सिमिलत होने का वष (Year of
उीण की िथित (Pass Status) Passed 2022
Passing/Appearing)
योयता परीा (Qualifying Exam) 10 th or equivalent कू िलंग का थान (Place of Schooling) Urban
कू ल / कॉलेज का कार (Type of School / योयता परीा राय (Qualifying
Private Unaided WEST BENGAL
College) Examination State)
योयता परीा िजला (Qualifying CENTRAL BOARD OF SECONDARY
24 Paraganas North कू ल बोड (School Board)
Examination District) EDUCATION
का 10वीं की माकशीट/माणप के BHAVAN S G B
अनुसार िवालय/कॉलेज का नाम KANORIA VIDYA कू ल / कॉलेज का पता (School / College block fa, sector-iii,salt lake kolkata
(School/College name should be as per MANDIR S LAKE Address) 700097
Class 10th Mark sheet/certificate) KOLKATA
कू ल / कॉलेज िपनकोड (School / College रोल नंबर 10वीं माणप के अनुसार (Roll
700097 12199064
Pincode) number as per 10th certificate)
पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 500.0
ातांक (Obtain Marks) 429.0 ितशत (Percentage) 85.80
th
12वीं या समक योयता िववरण (12 or equivalent Qualification Details)
उीण / सिमिलत होने का वष (Year of
उीण की िथित (Pass Status) Appearing 2024
Passing/Appearing)
The final examination of the
10+2 system, conducted by
any recognized Central/
State Board, such as the
Central Board of Secondary
योयता परीा (Qualifying Exam) कू िलंग का थान (Place of Schooling) Urban
Education, New Delhi;
Council for the Indian
School Certificate
Examinations, New Delhi
etc.
कू ल / कॉलेज का कार (Type of School / योयता परीा राय (Qualifying
Private Unaided WEST BENGAL
College) Examination State)
योयता परीा िजला (Qualifying CENTRAL BOARD OF SECONDARY
Kolkata कू ल बोड (School Board)
Examination District) EDUCATION
का 12वीं की माकशीट/माणप के BHAVAN S G B
अनुसार िवालय/कॉलेज का नाम KANORIA VIDYA कू ल / कॉलेज का पता (School / College BLOCK FA, SECTOR-III,SALT LAKE
(School/College name should be as per MANDIR S LAKE Address) KOLKATA 700097
Class 12th Mark sheet/certificate) KOLKATA
कू ल / कॉलेज िपनकोड (School / College रोल नंबर 12वीं माणप के अनुसार (Roll
700097 NA
Pincode) number as per 12th certificate)
अितिरत जानकािरयां (Additional Details)
या आप जु ड़वा ह और दोनों जे ईई (मे न) - 2024 के िलए आवे दन कर रहे ह
NO
(Are you a Twin and both applying for JEE (MAIN) – 2024)?
आपातकालीन संपक िववरण प (Emergency Contact Details)
दे श (Country) INDIA दे श कोड (Country Code) +91
मोबाइल नंबर (Mobile Number) 9874669586 ईमेल आईडी (Email ID) senguptamaya26@gmail.com
उमीदवार ारा अपलोड की गई छिवयां (IMAGES UPLOADED BY THE CANDIDATE)

PHOTO

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शु क भु गतान िववरण (Fee Payment Details)

भु गतान का कार (Payment Mode) Online लेन-दे न आईडी (Transaction ID) 168345801
परीा शु क (Exam Fee) 2000.0 लेन-दे न की ितिथ (Date of Transaction) 19-11-2023 23:09:16 PM
शु क जमा िकया गया (Fee Submitted
19-11-2023 23:08:12 PM
On)
घोषणा (Declaration)
I declare that information furnished by me in the application form is true in all respect and nothing is concealed. In case any entry or information is found to
be false, this shall entail automatic cancellation of my admission besides rendering me liable to such actions as deemed fit by the University. I hereby
undertake that I have carefully gone through the eligibility conditions prescribed in the prospectus for the programme. I am applying after satisfying that I
meet the eligibility conditions. If at any stage it is found that I do not fullfill the minimum prescribed criteria, my admission, if granted, shall stand cancelled
and I shall have no right to admission whatsoever.
IP Address : 115.187.62.203 Date of Downloading : 19-11-2023 23:10:30 PM