COMPLETE APPLICATION FORM : JEE B.Ed.

- 2023

A - Registration Details
Registration Number BED202310325248
Candidate Name SUPREET KAUR
Candidate's Father Name KULTAR SINGH MAINI
Candidate's Mother Name HARMEET KAUR
Candidate's Date of Birth 12/Oct/1989
Email Address ravneetmalhotra@gmail.com
Primary Mobile Number 9559567508

B - Personal Details
Gender Female Marital Status Married
Spouse Name RAVNEET SINGH MALHOTRA Nationality Indian
Category General Category Certificate Number
State Domicile UP Is 10 From Up No
Is 12 From Up No Is UG From Up No
Is Person with Disability No Disability Type
Disability Percentage Is Economically Weaker No
Id Proof Others Id Proof No
Alternate Email ravneetmalhotra@ymail.com Alternate Mobile Number 9452576027
Do you belong to non creamy layer ?

C - Communication Address
109/A Lahar Gird Near Harkishan Degree College Jhansi Jhansi Uttar Pradesh 284003

D - Permanent Address
109/A Lahar Gird Near Harkishan Degree College Jhansi Jhansi Uttar Pradesh 284003

E - Opted Stream Details

Stream opted for B.Ed. Commerce

F - SSC / 10th Std / Equivalent Details

Board Name CBSE
Marks Obtained 355 Maximum Marks 600
Year Of Passing 2005 Percentage 59.17
G - HSC / 12th Std / Equivalent Details
Board Name CBSE
Marks Obtained 336 Maximum Marks 500
Year Of Passing 2007 Percentage 67.2

H - Graduation Details
Is Graduation complete Pass Stream of Graduation Commerce
Specified Stream Have you done BE/BTech
Name of University KOTA UNIVERSITY
Marks Obtained 668 Maximum Marks 1200
Percentage 55.67 Year Of Passing 2010
Roll Number 222373 Expected Year of Passing

I - Post Graduation Details

Is Post Graduation complete
Name of University
Marks Obtained Maximum Marks
Percentage Year Of Passing
Roll Number Expected Year of Passing

J - Weightage Details
TOTAL WEIGHTAGE : 5
A. Have you participated in National or State level or Inter University Sports Competition Yes
A.1. In the individual items by the Candidate

A.2. In the team items by the Candidate Member of Participating Team

A.3. In other college tournaments or sports run by a university

B. Are you Candidates of National Cadet Corps/National Service Scheme/Scout-Ranger Rovers?

C. Do you need reservation of dependents of freedom fighters No

D.
No
Are you in active service / immersed / retired defense personnel or son/daughter of such personnel, or related
to a disabled, missing or dead defensive personnel as their son/daughter/wife

E. Is your father or husband is serving in/retired from police or PAC or BSF or SSB or ITBP or CRPF or service in
home guards or disabled / dead in such services No
F. Female Candidate who is Widowed, Divorced or Abandoned

K - Center Details
Center Choice 1 Jhansi Center Choice 2 Agra Center Choice 3 Lalitpur
Center Choice 4 Jalaun Center Choice 5 Mahoba

L - Payment Details
Payment Status Success Payment Date 03/Mar/2023
Transaction Number YHD41765137711 Receipt Number 20230303
Order Id BED20231032524820230303141141022 Total Amount 1400

M - Declaration
I understand that it is my responsibility to check the eligibility criterion and other conditions of the J.E.E. B.Ed. 2023 – 25. I am also aware that the Bundelkhand University,
Jhansi is not verifying the eligibility at the time of submission of online application form. I, hereby, certify that the particulars given by me in this B.Ed. 2023 – 25 online
application form are true to best of my knowledge and belief and only I will be responsible for any mismatch or incorrect information. I also certify that I fulfil the
eligibility criteria laid down by Bundelkhand University, Jhansi for J.E.E. B.Ed. 2023 – 25 and undertake to produce original documents whenever necessary. I will follow all
instruction given by Bundelkhand University, Jhansi in this regard. I understand all disputes will be subjected to territorial jurisdiction of Jhansi City only.