सं युत वे श परीा (मु य)

Joint Entrance Examination (Main)

JEE(Main)

APPLICATION NUMBER 240310738674

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यितगत योरा (Contact Details) वतमान पता (Present Address)
SHRUSHTI VIHAR
पता (Premises No/ Name) ,B/3,CHINTAMANI ईमेल पता (Email Address) STEVEMINI03@GMAIL.COM
NAGAR
थानीयता (Locality) SANGLI उप-थानीयता (Sub-Locality)(Optional) MADHAV NAGAR ROAD
दे श कोड (Country Code) 91 दे श (Country) INDIA
राय (State) MAHARASHTRA िजला (District) Sangli
वै किपक संपक सू (Alternate Contact
मोबाइल नंबर (Mobile Number) 91 - 9356055143 NA
No.) (Optional)
िपन कोड (Pin Code) 416416
थायी पता (Permanent Address)
SHRUSHTI VIHAR
पता (Premises No/ Name) ,B/3,CHINTAMANI थानीयता (Locality) SANGLI
NAGAR
उप-थानीयता (Sub-
MADHAV NAGAR ROAD दे श (Country) INDIA
Locality)(Optional):
राय (State) MAHARASHTRA िजला (District) Sangli
िपन कोड (Pin Code) 416416
यितगत योरा (PERSONAL DETAILS)
अयथी की जम ितिथ (Candidate's
अयथी का नाम (Candidate's Name) SABALE PRANAV 30-05-2006
Date of Birth)
िपता / अिभभावक का नाम (Father / माता / अिभभावक का नाम (Mother /
PRAKASH MEENAKSHI
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) 326584899330
PHOTOGRAPH
राय / केद शािसत दे श जहाँ से 12वीं /
समक उीण / उपिथत (State/ UT
MAHARASHTRA े 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 0-100000
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
Of Exam Apply For)
िपता / अिभभावक यवसाय (Father / DEFENCE SERVICES िपता / अिभभावक योयता (Father /
Graduate
Guardian Occupation) (ARMY , NAVY, IAF) Guardian Qualification)
माता / अिभभावक यवसाय (Mother / माता / अिभभावक योयता (Mother /
Not Applicable MATRICULATE
Guardian Occupation) Guardian Qualification)
परीा राय-पहला िवकप (Exam State परीा शहर-पहला िवकप (Exam City 1st
MAHARASHTRA SANGLI
1st Choice ) Choice )
परीा राय-दूसरा िवकप (Exam State परीा शहर-दूसरा िवकप (Exam City 2nd
MAHARASHTRA KOLHAPUR
2nd Choice ) Choice )
परीा राय-तीसरा िवकप (Exam State परीा शहर-तीसरा िवकप (Exam City
MAHARASHTRA SATARA
3rd Choice ) 3rd Choice )
परीा राय-चौथा िवकप (Exam State परीा शहर-चौथा िवकप (Exam City 4th
MAHARASHTRA PUNE
4th Choice ) Choice )
न प मायम (Question Paper Medium) English
th
10वीं या समक योयता िववरण (10 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 MAHARASHTRA
/ College) Examination State)
योयता परीा िजला (Qualifying CENTRAL BOARD OF SECONDARY
Sangli कू ल बोड (School Board)
Examination District) EDUCATION
का 10वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम Appasaheb birnale public कू ल / कॉलेज का पता (School / College
Shinde mala near lovely circle
(School/College name should be as per school sangli Address)
Class 10th Mark sheet/certificate)
कू ल / कॉलेज िपनकोड (School / College रोल नंबर 10वीं माणप के अनुसार (Roll
416416 15176365
Pincode) number as per 10th certificate)
पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 500.0
ातांक (Obtain Marks) 324.0 ितशत (Percentage) 64.80
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 MAHARASHTRA
/ College) Examination State)
योयता परीा िजला (Qualifying CENTRAL BOARD OF SECONDARY
Sangli कू ल बोड (School Board)
Examination District) EDUCATION
का 12वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम Appasaheb birnale public कू ल / कॉलेज का पता (School / College
Shinde mala near lovely circle
(School/College name should be as per school sangli Address)
Class 12th Mark sheet/certificate)
कू ल / कॉलेज िपनकोड (School / College रोल नंबर 12वीं माणप के अनुसार (Roll
416416 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) 9096441062 ईमेल आईडी (Email ID) sabaleminakshi32@gmail.com
उमीदवार ारा अपलोड की गई छिवयां (IMAGES UPLOADED BY THE CANDIDATE)

PHOTO

SIGNATURE

शु क भु गतान िववरण (Fee Payment Details)

भु गतान का कार (Payment Mode) Online लेन-दे न आईडी (Transaction ID) CPADHDAVK9
परीा शु क (Exam Fee) 1000.0 लेन-दे न की ितिथ (Date of Transaction) 26-11-2023 11:55:11 AM
शु क जमा िकया गया (Fee Submitted
26-11-2023 11:54:59 AM
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 : 106.213.86.42 Date of Downloading : 27-11-2023 17:01:32 PM