सं युत वे श परीा (मु य)

Joint Entrance Examination (Main)

JEE(Main)
APPLICATION
240310461689
NUMBER
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)
KATTIGENAHALLI,KIBBANAHALLI
पता (Premises No/ Name) ईमेल पता (Email Address) VKVARUN719@GMAIL.COM
HOBLI,TIPTUR TALUK
उप-थानीयता (Sub-
थानीयता (Locality) TUMKUR TIPTUR
Locality)(Optional)
दे श कोड (Country Code) 91 दे श (Country) INDIA
राय (State) KARNATAKA िजला (District) Tumakuru
वै किपक संपक सू (Alternate
मोबाइल नंबर (Mobile Number) 91 - 7760639981 9742192015
Contact No.) (Optional)
िपन कोड (Pin Code) 572114
थायी पता (Permanent Address)
KATTIGENAHALLI,KIBBANAHALLI
पता (Premises No/ Name) थानीयता (Locality) TUMKUR
HOBLI,TIPTUR TALUK
उप-थानीयता (Sub-
TIPTUR दे श (Country) INDIA
Locality)(Optional):
राय (State) KARNATAKA िजला (District) Tumakuru
िपन कोड (Pin Code) 572114
यितगत योरा (PERSONAL DETAILS)
अयथी का नाम (Candidate's अयथी की जम ितिथ
VARUNKUMAR K C 06-02-2006
Name) (Candidate's Date of Birth)
िपता / अिभभावक का नाम (Father माता / अिभभावक का नाम (Mother
CHANDRAIAH K B SHAKUNTHALA
/ Guardian Name) / Guardian Name)
िलंग (Gender) MALE राटीयता (Nationality ) INDIAN
पहचान संया (Identification
पहचान के कार (Identity Type) RATION CARD WITH PHOTOGRAPH 250800154843
Number)
राय / केद शािसत दे श जहाँ से
12वीं / समक उीण / उपिथत OBC-(NCL) AS PER CENTRAL
KARNATAKA े णी (Category )
(State/ UT from where 12th/ LIST
Equivalent Passed/ Appearing)
या आपको मधुमेह ह  (Are You िनवास की जगह ( Place of
NO RURAL
Diabetic ? ) Residence )
यिद आप एक Pwd उमीदवार ह ,
तो या आपके पास ब चमाक
वािषक पािरवािरक आय ( Annual
िवकलांगता है (If you are a Pwd NA 0-100000
Family Income )
Candidate, do you have
benchmark disability)?
योयता परीा म कू ली िशा का
तैयारी का तरीका ( Mode of
Self-Study मायम ( Medium of schooling in English
Preparation )
qualifying exam )
परीा कद िववरण (Exam centre Details)
परीा के स के िलए आवे दन कर
के िलए आवे दन (Apply For) B. Planning, B.Arch., B.E./B.Tech Session 1 & Session 2
(Session Of Exam Apply For)
िपता / अिभभावक यवसाय
िपता / अिभभावक योयता (Father
(Father / Guardian AGRICULTURE Illiterate
/ Guardian Qualification)
Occupation)
माता / अिभभावक यवसाय माता / अिभभावक योयता
(Mother / Guardian Not Applicable (Mother / Guardian ILLITERATE
Occupation) Qualification)
परीा राय-पहला िवकप (Exam परीा शहर-पहला िवकप (Exam
KARNATAKA TUMAKURU
State 1st Choice ) City 1st Choice )
परीा राय-दूसरा िवकप (Exam परीा शहर-दूसरा िवकप (Exam
KARNATAKA BENGALURU
State 2nd Choice ) City 2nd Choice )
परीा राय-तीसरा िवकप परीा शहर-तीसरा िवकप (Exam
KARNATAKA BENGALURU- URBAN
(Exam State 3rd Choice ) City 3rd Choice )
परीा राय-चौथा िवकप (Exam परीा शहर-चौथा िवकप (Exam
KARNATAKA HASSAN
State 4th Choice ) City 4th 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
उीण की िथित (Pass Status) Passed 2022
(Year of Passing/Appearing)
योयता परीा (Qualifying कू िलंग का थान (Place of
10 th or equivalent Rural
Exam) Schooling)
कू ल / कॉलेज का कार (Type of योयता परीा राय (Qualifying
Private Unaided KARNATAKA
School / College) Examination State)
KARNATAKA SECONDARY
योयता परीा िजला (Qualifying
Tumakuru कू ल बोड (School Board) EDUCATION EXAMINATION
Examination District)
BOARD
का 10वीं की माकशीट/माणप
के अनुसार िवालय/कॉलेज का srimad rambhapuri eng.med.high
कू ल / कॉलेज का पता (School /
नाम (School/College name srimad rambapuri eng med high school school, k b cross tiptur taluk tumakuru
College Address)
should be as per Class 10th district
Mark sheet/certificate)
रोल नंबर 10वीं माणप के अनुसार
कू ल / कॉलेज िपनकोड (School /
572114 (Roll number as per 10th 20220709844
College Pincode)
certificate)
पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 625.0
ातांक (Obtain Marks) 623.0 ितशत (Percentage) 99.68
th
12वीं या समक योयता िववरण (12 or equivalent Qualification Details)
उीण / सिमिलत होने का वष
उीण की िथित (Pass Status) Appearing 2024
(Year of Passing/Appearing)
Any Public School/ Board/ University
examination in India or any foreign country
योयता परीा (Qualifying कू िलंग का थान (Place of
is recognized as equivalent to the 10+2 Rural
Exam) Schooling)
system by the Association of Indian
Universities (AIU).
कू ल / कॉलेज का कार (Type of योयता परीा राय (Qualifying
Private Unaided KARNATAKA
School / College) Examination State)
योयता परीा िजला (Qualifying KARNATAKA PRE-UNIVERSITY
Tumakuru कू ल बोड (School Board)
Examination District) EDUCATION EXAMINATION
का 12वीं की माकशीट/माणप
के अनुसार िवालय/कॉलेज का
कू ल / कॉलेज का पता (School / ashoknagar,8th cross
नाम (School/College name mahesh pu college
College Address) rd,tumakuru,karnataka
should be as per Class 12th
Mark sheet/certificate)
रोल नंबर 12वीं माणप के अनुसार
कू ल / कॉलेज िपनकोड (School /
572103 (Roll number as per 12th NA
College Pincode)
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 (Are you
NO
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) 8217280372 ईमेल आईडी (Email ID) chandraiahk.b69@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
Online लेन-दे न आईडी (Transaction ID) ZIC51539045181
Mode)
 लेन-दे न की ितिथ (Date of
परीा शु क (Exam Fee) 4000.0 16-11-2023 17:52:04 PM
Transaction)
शु क जमा िकया गया (Fee
16-11-2023 17:51:32 PM
Submitted 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 : 171.76.219.79 Date of Downloading : 02-12-2023 11:32:41 AM