सं युत वे श परीा (मु य)

Joint Entrance Examination (Main)

JEE(Main)

APPLICATION NUMBER 240311208475

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)
11/2 NABIN SENAPATI
पता (Premises No/ Name) ईमेल पता (Email Address) DIPARYASANTY4@GMAIL.COM
LANE
NEAR NARKELTALA उप-थानीयता (Sub-
थानीयता (Locality) PO-KHURUT, PS-SHIBPUR
SPORTING CLUB Locality)(Optional)
दे श कोड (Country Code) 91 दे श (Country) INDIA
राय (State) WEST BENGAL िजला (District) Howrah
वै किपक संपक सू (Alternate
मोबाइल नंबर (Mobile Number) 91 - 8910110281 7980535354
Contact No.) (Optional)
िपन कोड (Pin Code) 711101
थायी पता (Permanent Address)
S/O DEEPAK KUMAR
पता (Premises No/ Name) GUPTA , HOUSE NO 240 थानीयता (Locality) NEAR PRIMARY SCHOOL
VILLAGE- TILTHI
उप-थानीयता (Sub-
PO-TILTHI, PS- CHILH दे श (Country) INDIA
Locality)(Optional):
राय (State) UTTAR PRADESH िजला (District) Mirzapur
िपन कोड (Pin Code) 231312
यितगत योरा (PERSONAL DETAILS)
अयथी की जम ितिथ (Candidate's
अयथी का नाम (Candidate's Name) ARYAN GUPTA 24-12-2005
Date of Birth)
िपता / अिभभावक का नाम (Father / DEEPAK KUMAR माता / अिभभावक का नाम (Mother /
PINKI GUPTA
Guardian Name) GUPTA Guardian Name)
िलंग (Gender) MALE राटीयता (Nationality ) INDIAN
BANK PASSBOOK WITH पहचान संया (Identification
पहचान के कार (Identity Type) 35203607379
PHOTOGRAPH Number)
राय / केद शािसत दे श जहाँ से 12वीं /
समक उीण / उपिथत (State/ UT
WEST BENGAL े णी (Category ) OBC-(NCL) AS PER CENTRAL LIST
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
NA 500001-600000
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)
B. Planning, B.Arch., परीा के स के िलए आवे दन कर
के िलए आवे दन (Apply For) Session 1 & Session 2
B.E./B.Tech (Session Of Exam Apply For)
िपता / अिभभावक यवसाय (Father / PUBLIC SECTOR िपता / अिभभावक योयता (Father /
Graduate
Guardian Occupation) SERVICE Guardian Qualification)
माता / अिभभावक यवसाय (Mother / माता / अिभभावक योयता (Mother /
Not Applicable OTHERS
Guardian Occupation) Guardian Qualification)
परीा राय-पहला िवकप (Exam State परीा शहर-पहला िवकप (Exam City
WEST BENGAL HOWRAH
1st Choice ) 1st Choice )
परीा राय-दूसरा िवकप (Exam State परीा शहर-दूसरा िवकप (Exam City
WEST BENGAL KOLKATA
2nd Choice ) 2nd Choice )
परीा राय-तीसरा िवकप (Exam State परीा शहर-तीसरा िवकप (Exam City
WEST BENGAL HOOGHLY
3rd Choice ) 3rd Choice )
परीा राय-चौथा िवकप (Exam State परीा शहर-चौथा िवकप (Exam City
WEST BENGAL KALYANI
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 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 WEST BENGAL
/ College) Examination State)
योयता परीा िजला (Qualifying COUNCIL FOR THE INDIAN SCHOOL
Howrah कू ल बोड (School Board)
Examination District) CERTIFICATE EXAMINATIONS
का 10वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम st thomas church school कू ल / कॉलेज का पता (School / st. thomas church school 3, church road
(School/College name should be as per howrah College Address) howrah-711101
Class 10th Mark sheet/certificate)
कू ल / कॉलेज िपनकोड (School / College रोल नंबर 10वीं माणप के अनुसार
711101 7560457
Pincode) (Roll number as per 10th certificate)
पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 1000.0
ातांक (Obtain Marks) 790.0 ितशत (Percentage) 79.00
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) 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 WEST BENGAL
/ College) Examination State)
योयता परीा िजला (Qualifying COUNCIL FOR THE INDIAN SCHOOL
Howrah कू ल बोड (School Board)
Examination District) CERTIFICATE EXAMINATIONS
का 12वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम st thomas church school कू ल / कॉलेज का पता (School / ST. THOMAS CHURCH SCHOOL 3,
(School/College name should be as per howrah College Address) CHURCH ROAD HOWRAH-711101
Class 12th Mark sheet/certificate)
कू ल / कॉलेज िपनकोड (School / College रोल नंबर 12वीं माणप के अनुसार
711101 NA
Pincode) (Roll 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) 9674442277 ईमेल आईडी (Email ID) diparyasanty@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 Mode) Online लेन-दे न आईडी (Transaction ID) 091026
लेन-दे न की ितिथ (Date of
परीा शु क (Exam Fee) 4000.0 30-11-2023 00:22:08 AM
Transaction)
शु क जमा िकया गया (Fee Submitted
30-11-2023 00:19:25 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 : 49.37.47.245 Date of Downloading : 09-02-2024 19:38:52 PM