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THE CANDIDATE IS REQUESTED TO RETAIN THE PRINTOUT OF THE CONFIRMATION PAGE FOR FUTURE REFERENCE. यितगत योरा (Contact Details) वतमान पता (Present Address) VILLAGE AND POST पता (Premises No/ Name) ईमेल पता (Email Address) SHALINI.HITENDER@GMAIL.COM OFFICE OACHGHAT उप-थानीयता (Sub- थानीयता (Locality) OACHGHAT NA Locality)(Optional) दे श कोड (Country Code) 91 दे श (Country) INDIA राय (State) HIMACHAL PRADESH िजला (District) Solan वै किपक संपक सू (Alternate मोबाइल नंबर (Mobile Number) 91 - 9418151616 9418459858 Contact No.) (Optional) िपन कोड (Pin Code) 173223 थायी पता (Permanent Address) VILLAGE AND POST पता (Premises No/ Name) थानीयता (Locality) OACHGHAT OFFICE OACHGHAT उप-थानीयता (Sub- NA दे श (Country) INDIA Locality)(Optional): राय (State) HIMACHAL PRADESH िजला (District) Solan िपन कोड (Pin Code) 173223 यितगत योरा (PERSONAL DETAILS) अयथी की जम ितिथ (Candidate's अयथी का नाम (Candidate's Name) EKLAVYA SHARMA 10-09-2006 Date of Birth) िपता / अिभभावक का नाम (Father / माता / अिभभावक का नाम (Mother / HITENDER SHARMA SHALINI SHARMA Guardian Name) Guardian Name) िलंग (Gender) MALE राटीयता (Nationality ) INDIAN ANY OTHER VALID पहचान संया (Identification पहचान के कार (Identity Type) GOVT IDENTITY WITH 774637876935 Number) PHOTOGRAPH राय / केद शािसत दे श जहाँ से 12वीं / समक उीण / उपिथत (State/ UT HIMACHAL PRADESH े णी (Category ) GENERAL from where 12th/ Equivalent Passed/ Appearing) या आपको मधुमेह ह (Are You िनवास की जगह ( Place of Residence NO RURAL Diabetic ? ) ) यिद आप एक Pwd उमीदवार ह , तो या आपके पास ब चमाक िवकलांगता है (If you वािषक पािरवािरक आय ( Annual NA 800000 AND ABOVE are a Pwd Candidate, do you have Family Income ) benchmark disability)? योयता परीा म कू ली िशा का तैयारी का तरीका ( Mode of Preparation Online Coaching मायम ( Medium of schooling in English ) qualifying exam ) परीा कद िववरण (Exam centre Details) परीा के स के िलए आवे दन कर के िलए आवे दन (Apply For) B.E./B.Tech Session 1 & Session 2 (Session Of Exam Apply For) िपता / अिभभावक यवसाय (Father / GOVERNMENT िपता / अिभभावक योयता (Father / Graduate Guardian Occupation) SERVICE Guardian Qualification) माता / अिभभावक यवसाय (Mother / माता / अिभभावक योयता (Mother / Teaching / Research DOCTORATE Guardian Occupation) Guardian Qualification) परीा राय-पहला िवकप (Exam State परीा शहर-पहला िवकप (Exam City HIMACHAL PRADESH SHIMLA 1st Choice ) 1st Choice ) परीा राय-दूसरा िवकप (Exam State परीा शहर-दूसरा िवकप (Exam City HIMACHAL PRADESH SOLAN 2nd Choice ) 2nd Choice ) परीा राय-तीसरा िवकप (Exam State परीा शहर-तीसरा िवकप (Exam HIMACHAL PRADESH UNA 3rd Choice ) City 3rd Choice ) परीा राय-चौथा िवकप (Exam State परीा शहर-चौथा िवकप (Exam City PUNJAB LUDHIANA 4th Choice ) 4th Choice ) न प मायम (Question Paper Medium) English th 10वीं या समक योयता िववरण (10 or equivalent Qualification Details) उीण / सिमिलत होने का वष (Year उीण की िथित (Pass Status) Passed 2022 of Passing/Appearing) कू िलंग का थान (Place of योयता परीा (Qualifying Exam) 10 th or equivalent Urban Schooling) कू ल / कॉलेज का कार (Type of School / योयता परीा राय (Qualifying Private Unaided HIMACHAL PRADESH College) Examination State) योयता परीा िजला (Qualifying CENTRAL BOARD OF SECONDARY Solan कू ल बोड (School Board) Examination District) EDUCATION का 10वीं की माकशीट/माणप के अनुसार िवालय/कॉलेज का नाम St lukes sr sec school solan कू ल / कॉलेज का पता (School / the mall solan hp (School/College name should be as per hp College Address) Class 10th Mark sheet/certificate) रोल नंबर 10वीं माणप के अनुसार कू ल / कॉलेज िपनकोड (School / College 173212 (Roll number as per 10th 17258446 Pincode) certificate) पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 600.0 ातांक (Obtain Marks) 526.0 ितशत (Percentage) 87.67 th 12वीं या समक योयता िववरण (12 or equivalent Qualification Details) उीण / सिमिलत होने का वष (Year उीण की िथित (Pass Status) Appearing 2024 of Passing/Appearing) The final examination of the 10+2 system, conducted by any recognized Central/ State Board, such as the Central Board of Secondary कू िलंग का थान (Place of योयता परीा (Qualifying Exam) Urban Education, New Delhi; Schooling) Council for the Indian School Certificate Examinations, New Delhi etc. कू ल / कॉलेज का कार (Type of School / योयता परीा राय (Qualifying Private Unaided HIMACHAL PRADESH College) Examination State) योयता परीा िजला (Qualifying CENTRAL BOARD OF SECONDARY Solan कू ल बोड (School Board) Examination District) EDUCATION का 12वीं की माकशीट/माणप के अनुसार िवालय/कॉलेज का नाम st lukes sr sec school solan कू ल / कॉलेज का पता (School / the mall solan hp (School/College name should be as per hp College Address) Class 12th Mark sheet/certificate) रोल नंबर 12वीं माणप के अनुसार कू ल / कॉलेज िपनकोड (School / College 173212 (Roll number as per 12th NA Pincode) certificate) अितिरत 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) 7018862449 ईमेल आईडी (Email ID) hitender.shalini@gmail.com उमीदवार ारा अपलोड की गई छिवयां (IMAGES UPLOADED BY THE CANDIDATE)
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भु गतान का कार (Payment Mode) Online लेन-दे न आईडी (Transaction ID) 83907813559 लेन-दे न की ितिथ (Date of परीा शु क (Exam Fee) 2000.0 24-11-2023 22:39:28 PM Transaction) शु क जमा िकया गया (Fee Submitted 24-11-2023 22:37:33 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 : 59.178.49.105 Date of Downloading : 24-11-2023 22:39:33 PM