सं युत वे श परीा (मु य)

Joint Entrance Examination (Main)

JEE(Main)

APPLICATION NUMBER 240320212278

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)
पता (Premises No/ Name) NORTH SHIMULPUR ईमेल पता (Email Address) MANIKABISWAS0378@GMAIL.COM
उप-थानीयता (Sub-
थानीयता (Locality) GANDHARI PARA NA
Locality)(Optional)
दे श कोड (Country Code) +91 दे श (Country) INDIA
राय (State) WEST BENGAL िजला (District) 24 Paraganas North
वै किपक संपक सू (Alternate
मोबाइल नंबर (Mobile Number) +91 - 8327669215 NA
Contact No.) (Optional)
िपन कोड (Pin Code) 743287
थायी पता (Permanent Address)
पता (Premises No/ Name) NORTH SHIMULPUR थानीयता (Locality) GANDHARI PARA
उप-थानीयता (Sub-
NA दे श (Country) INDIA
Locality)(Optional):
राय (State) WEST BENGAL िजला (District) 24 Paraganas North
िपन कोड (Pin Code) 743287
यितगत योरा (PERSONAL DETAILS)
SHUVRATANAY अयथी की जम ितिथ (Candidate's
अयथी का नाम (Candidate's Name) 13-05-2006
BISWAS Date of Birth)
िपता / अिभभावक का नाम (Father / SWAPAN KUMAR माता / अिभभावक का नाम (Mother /
SWAPAN KUMAR BISWAS
Guardian Name) BISWAS 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 800160884755
Number)
PHOTOGRAPH
राय / केद शािसत दे श जहाँ से 12वीं /
समक उीण / उपिथत (State/ UT
WEST BENGAL े णी (Category ) SC
from where 12th/ Equivalent Passed/
Appearing)
या आपको मधुमेह ह  (Are You िनवास की जगह ( Place of Residence
NO RURAL
Diabetic ? ) )
यिद आप एक Pwd उमीदवार ह , तो या
आपके पास ब चमाक िवकलांगता है (If you वािषक पािरवािरक आय ( Annual
NA 100001-200000
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 Bengali
)
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 / िपता / अिभभावक योयता (Father /
OTHERS Others
Guardian Occupation) Guardian Qualification)
माता / अिभभावक यवसाय (Mother / माता / अिभभावक योयता (Mother /
Others OTHERS
Guardian Occupation) Guardian Qualification)
परीा राय-पहला िवकप (Exam State परीा शहर-पहला िवकप (Exam
WEST BENGAL KOLKATA
1st Choice ) City 1st Choice )
परीा राय-दूसरा िवकप (Exam State परीा शहर-दूसरा िवकप (Exam City
WEST BENGAL HOWRAH
2nd Choice ) 2nd Choice )
परीा राय-तीसरा िवकप (Exam State परीा शहर-तीसरा िवकप (Exam
WEST BENGAL KALYANI
3rd Choice ) City 3rd Choice )
परीा राय-चौथा िवकप (Exam State परीा शहर-चौथा िवकप (Exam City
WEST BENGAL BURDWAN(BARDHAMAN)
4th Choice ) 4th Choice )
न प मायम (Question Paper Medium) English
10वीं या समक योयता िववरण (10th or equivalent Qualification Details)
उीण / सिमिलत होने का वष (Year
उीण की िथित (Pass Status) Passed 2022
of Passing/Appearing)
कू िलंग का थान (Place of
योयता परीा (Qualifying Exam) 10 th or equivalent Rural
Schooling)
कू ल / कॉलेज का कार (Type of School योयता परीा राय (Qualifying
Government School WEST BENGAL
/ College) Examination State)
योयता परीा िजला (Qualifying WEST BENGAL BOARD OF SECONDARY
24 Paraganas North कू ल बोड (School Board)
Examination District) EDUCATION
का 10वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम कू ल / कॉलेज का पता (School /
thakurnagar high school chikanpara,north24 pgs
(School/College name should be as per College Address)
Class 10th Mark sheet/certificate)
रोल नंबर 10वीं माणप के अनुसार
कू ल / कॉलेज िपनकोड (School / College
743287 (Roll number as per 10th 707401n0004
Pincode)
certificate)
पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 700.0
ातांक (Obtain Marks) 578.0 ितशत (Percentage) 82.57
th
12वीं या समक योयता िववरण (12 or equivalent Qualification Details)
उीण / सिमिलत होने का वष (Year
उीण की िथित (Pass Status) Appearing 2024
of Passing/Appearing)
Any Public School/ Board/
University examination in
India or any foreign
country is recognized as कू िलंग का थान (Place of
योयता परीा (Qualifying Exam) Rural
equivalent to the 10+2 Schooling)
system by the Association
of Indian Universities
(AIU).
कू ल / कॉलेज का कार (Type of School योयता परीा राय (Qualifying
Government School WEST BENGAL
/ College) Examination State)
योयता परीा िजला (Qualifying WEST BENGAL COUNCIL OF HIGHER
24 Paraganas North कू ल बोड (School Board)
Examination District) SECONDARY EDUCATION
का 12वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम कू ल / कॉलेज का पता (School /
thakurnagar high school chikanpara, north 24 pgs
(School/College name should be as per College Address)
Class 12th Mark sheet/certificate)
रोल नंबर 12वीं माणप के अनुसार
कू ल / कॉलेज िपनकोड (School / College
743287 (Roll number as per 12th NA
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
NO
ह (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) 8900727320 ईमेल आईडी (Email ID) shuvratanaybiswas0378@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) 91165905905
लेन-दे न की ितिथ (Date of
परीा शु क (Exam Fee) 500.0 02-03-2024 00:30:49 AM
Transaction)
शु क जमा िकया गया (Fee Submitted
02-03-2024 00:30:44 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 : 103.83.186.74 Date of Downloading : 02-03-2024 00:32:08 AM