सं युत वे श परीा (मु य)

Joint Entrance Examination (Main)

JEE(Main)

APPLICATION NUMBER 240320176681

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)
SANGAM VIHAR PHASE
2 CHARAYAL NAYAK
पता (Premises No/ Name) ईमेल पता (Email Address) 7.HIMANSHUJOSHI@GMAIL.COM
HALDWANI NAINITAL
263139
उप-थानीयता (Sub-
थानीयता (Locality) CHARAYAL NA
Locality)(Optional)
दे श कोड (Country Code) +91 दे श (Country) INDIA
राय (State) UTTARAKHAND िजला (District) Nainital
वै किपक संपक सू (Alternate
मोबाइल नंबर (Mobile Number) +91 - 7535051333 8126236657
Contact No.) (Optional)
िपन कोड (Pin Code) 263139
थायी पता (Permanent Address)
SANGAM VIHAR PHASE
2 CHARAYAL NAYAK
पता (Premises No/ Name) थानीयता (Locality) CHARAYAL
HALDWANI NAINITAL
263139
उप-थानीयता (Sub-
NA दे श (Country) INDIA
Locality)(Optional):
राय (State) UTTARAKHAND िजला (District) Nainital
िपन कोड (Pin Code) 263139
यितगत योरा (PERSONAL DETAILS)
अयथी की जम ितिथ (Candidate's
अयथी का नाम (Candidate's Name) SANJAY JOSHI 10-02-2005
Date of Birth)
िपता / अिभभावक का नाम (Father / KAILASH CHANDRA माता / अिभभावक का नाम (Mother /
VIDYA JOSHI
Guardian Name) JOSHI Guardian Name)
िलंग (Gender) MALE राटीयता (Nationality ) INDIAN
ANY OTHER VALID
पहचान संया (Identification
पहचान के कार (Identity Type) GOVT IDENTITY WITH 828019294983
Number)
PHOTOGRAPH
राय / केद शािसत दे श जहाँ से 12वीं /
समक उीण / उपिथत (State/ UT
UTTARAKHAND े णी (Category ) GENERAL
from where 12th/ Equivalent Passed/
Appearing)
या आपको मधुमेह ह  (Are You िनवास की जगह ( Place of Residence
NO URBAN
Diabetic ? ) )
यिद आप एक Pwd उमीदवार ह , तो या
आपके पास ब चमाक िवकलांगता है (If you वािषक पािरवािरक आय ( Annual
NA 700001-800000
are a Pwd Candidate, do you have Family Income )
benchmark disability)?
योयता परीा म कू ली िशा का
तैयारी का तरीका ( Mode of Preparation
Self-Study मायम ( Medium of schooling in English
)
qualifying exam )
परीा कद िववरण (Exam centre Details)
परीा के स के िलए आवे दन कर
के िलए आवे दन (Apply For) B.E./B.Tech Session 2
(Session Of Exam Apply For)
िपता / अिभभावक यवसाय (Father / DEFENCE SERVICES िपता / अिभभावक योयता (Father /
Matriculate
Guardian Occupation) (ARMY , NAVY, IAF) Guardian Qualification)
माता / अिभभावक यवसाय (Mother / माता / अिभभावक योयता (Mother /
Others MATRICULATE
Guardian Occupation) Guardian Qualification)
परीा राय-पहला िवकप (Exam State परीा शहर-पहला िवकप (Exam City
UTTARAKHAND HALDWANI
1st Choice ) 1st Choice )
परीा राय-दूसरा िवकप (Exam State परीा शहर-दूसरा िवकप (Exam City
UTTARAKHAND ALMORA
2nd Choice ) 2nd Choice )
परीा राय-तीसरा िवकप (Exam State परीा शहर-तीसरा िवकप (Exam City
UTTARAKHAND ROORKEE
3rd Choice ) 3rd Choice )
परीा राय-चौथा िवकप (Exam State परीा शहर-चौथा िवकप (Exam City
UTTARAKHAND DEHRADUN
4th Choice ) 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 (Year of
उीण की िथित (Pass Status) Passed 2021
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 UTTARAKHAND
College) Examination State)
योयता परीा िजला (Qualifying CENTRAL BOARD OF SECONDARY
Nainital कू ल बोड (School Board)
Examination District) EDUCATION
का 10वीं की माकशीट/माणप के
ST LAWRENCE SCH
अनुसार िवालय/कॉलेज का नाम कू ल / कॉलेज का पता (School / DEHARIYA HALDWANI UK
DEHARIYA HALDWANI
(School/College name should be as per College Address) UTTARAKHAND
UK
Class 10th Mark sheet/certificate)
रोल नंबर 10वीं माणप के अनुसार
कू ल / कॉलेज िपनकोड (School / College
263139 (Roll number as per 10th 25132133
Pincode)
certificate)
पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 500.0
ातांक (Obtain Marks) 450.0 ितशत (Percentage) 90.00
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) Passed 2023
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 UTTARAKHAND
College) Examination State)
योयता परीा िजला (Qualifying CENTRAL BOARD OF SECONDARY
Nainital कू ल बोड (School Board)
Examination District) EDUCATION
का 12वीं की माकशीट/माणप के
ST LAWRENCE SCH
अनुसार िवालय/कॉलेज का नाम कू ल / कॉलेज का पता (School /
DEHARIYA HALDWANI dehariya uk
(School/College name should be as per College Address)
UK
Class 12th Mark sheet/certificate)
रोल नंबर 12वीं माणप के अनुसार
कू ल / कॉलेज िपनकोड (School / College
263139 (Roll number as per 12th 25636325
Pincode)
certificate)
पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 500.0
ातांक (Obtain Marks) 447.0 ितशत (Percentage) 89.40
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) 7310915267 ईमेल आईडी (Email ID) hhop4443@gmail.com
उमीदवार ारा अपलोड की गई छिवयां (IMAGES UPLOADED BY THE CANDIDATE)

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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) CPADOHJLX2
लेन-दे न की ितिथ (Date of
परीा शु क (Exam Fee) 1000.0 26-02-2024 19:57:39 PM
Transaction)
शु क जमा िकया गया (Fee Submitted
26-02-2024 19:55:58 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 : 106.205.175.29 Date of Downloading : 26-02-2024 19:58:20 PM