सं युत वे श परीा (मु य)

Joint Entrance Examination (Main)

JEE(Main)
APPLICATION
240320253290
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)
पता (Premises No/ Name) 635 ईमेल पता (Email Address) PRIYANSHUKUMAR36556@GMAIL.COM
उप-थानीयता (Sub-
थानीयता (Locality) DEVLI VILLAGE NA
Locality)(Optional)
दे श कोड (Country Code) +91 दे श (Country) INDIA
राय (State) DELHI िजला (District) South Delhi
वै किपक संपक सू (Alternate
मोबाइल नंबर (Mobile Number) +91 - 9205277916 9958716823
Contact No.) (Optional)
िपन कोड (Pin Code) 110080
थायी पता (Permanent Address)
पता (Premises No/ Name) 635 थानीयता (Locality) DEVLI VILLAGE
उप-थानीयता (Sub-
NA दे श (Country) INDIA
Locality)(Optional):
राय (State) DELHI िजला (District) South Delhi
िपन कोड (Pin Code) 110080
यितगत योरा (PERSONAL DETAILS)
अयथी की जम ितिथ
अयथी का नाम (Candidate's Name) PRIYANSHU KUMAR 25-12-2005
(Candidate's Date of Birth)
िपता / अिभभावक का नाम (Father / RAKESH KUMAR माता / अिभभावक का नाम (Mother
NITU DEVI
Guardian Name) THAKUR / 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 977551787943
Number)
PHOTOGRAPH
राय / केद शािसत दे श जहाँ से 12वीं
/ समक उीण / उपिथत (State/ UT
DELHI े णी (Category ) GENERAL
from where 12th/ Equivalent
Passed/ Appearing)
या आपको मधुमेह ह  (Are You िनवास की जगह ( Place of
NO URBAN
Diabetic ? ) Residence )
यिद आप एक Pwd उमीदवार ह , तो
या आपके पास ब चमाक िवकलांगता है वािषक पािरवािरक आय ( Annual
NA 500001-600000
(If you are a Pwd Candidate, do Family Income )
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.E./B.Tech Session 2
(Session Of Exam Apply For)
िपता / अिभभावक यवसाय (Father / िपता / अिभभावक योयता (Father
SELF-EMPLOYMENT Illiterate
Guardian Occupation) / Guardian Qualification)
माता / अिभभावक यवसाय (Mother / माता / अिभभावक योयता (Mother
Not Applicable MATRICULATE
Guardian Occupation) / Guardian Qualification)
परीा राय-पहला िवकप (Exam परीा शहर-पहला िवकप (Exam
UTTAR PRADESH NOIDA/GREATER NOIDA
State 1st Choice ) City 1st Choice )
परीा राय-दूसरा िवकप (Exam परीा शहर-दूसरा िवकप (Exam
DELHI DELHI/NEW DELHI
State 2nd Choice ) City 2nd Choice )
परीा राय-तीसरा िवकप (Exam परीा शहर-तीसरा िवकप (Exam
HARYANA FARIDABAD
State 3rd Choice ) City 3rd Choice )
परीा राय-चौथा िवकप (Exam परीा शहर-चौथा िवकप (Exam
UTTAR PRADESH GHAZIABAD
State 4th Choice ) City 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
उीण की िथित (Pass Status) Passed 2021
(Year of Passing/Appearing)
कू िलंग का थान (Place of
योयता परीा (Qualifying Exam) 10 th or equivalent Urban
Schooling)
कू ल / कॉलेज का कार (Type of योयता परीा राय (Qualifying
Government School DELHI
School / College) Examination State)
योयता परीा िजला (Qualifying CENTRAL BOARD OF SECONDARY
South Delhi कू ल बोड (School Board)
Examination District) EDUCATION
का 10वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम GOVERNMENT BOYS
कू ल / कॉलेज का पता (School /
(School/College name should be as SENIOR SECONDARY C Block, sangam vihar
College Address)
per Class 10th Mark SCHOOL
sheet/certificate)
रोल नंबर 10वीं माणप के अनुसार
कू ल / कॉलेज िपनकोड (School /
110080 (Roll number as per 10th 14252202
College Pincode)
certificate)
पिरणाम मोड (Result Mode) Percentage पूणा क (Total Marks) 500.0
ातांक (Obtain Marks) 264.0 ितशत (Percentage) 52.80
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)
Senior Secondary School
Examination conducted by
कू िलंग का थान (Place of
योयता परीा (Qualifying Exam) the National Institute of Urban
Schooling)
Open Schooling with a
minimum of five subjects.
कू ल / कॉलेज का कार (Type of योयता परीा राय (Qualifying
Government School DELHI
School / College) Examination State)
योयता परीा िजला (Qualifying NATIONAL INSTITUTE OF OPEN
South Delhi कू ल बोड (School Board)
Examination District) SCHOOLING
का 12वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम
कू ल / कॉलेज का पता (School /
(School/College name should be as Sarvodaya bal vidhalaya J block, saket
College Address)
per Class 12th Mark
sheet/certificate)
रोल नंबर 12वीं माणप के अनुसार
कू ल / कॉलेज िपनकोड (School /
110017 (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
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) 9910256292 ईमेल आईडी (Email ID) Sgfactcenter@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) ZIC51791402972
लेन-दे न की ितिथ (Date of
परीा शु क (Exam Fee) 1000.0 02-03-2024 08:33:45 AM
Transaction)
शु क जमा िकया गया (Fee Submitted
02-03-2024 08:32:50 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 : 117.98.10.134 Date of Downloading : 02-04-2024 23:12:39 PM