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JEE (Main) AcknowledgementPage PDF

The document is an acknowledgement page for Mayank Suresh Bundele's application to the Joint Entrance Examination (Main) - 2018. It provides his personal details like name, date of birth, category, academic details from class 10th and 12th, contact information, guardian details, and payment details for the application fee. It acknowledges receipt of his online application and reminds him to retain the printout for future reference.

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1K views1 page

JEE (Main) AcknowledgementPage PDF

The document is an acknowledgement page for Mayank Suresh Bundele's application to the Joint Entrance Examination (Main) - 2018. It provides his personal details like name, date of birth, category, academic details from class 10th and 12th, contact information, guardian details, and payment details for the application fee. It acknowledges receipt of his online application and reminds him to retain the printout for future reference.

Uploaded by

Anonymous eStXSx
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Joint Entrance Examination (Main) - 2018

CENTRAL BOARD OF SECONDARY EDUCATION


ACKNOWLEDGEMENT PAGE

Application No. 80224085


DO NOT SEND THIS PAGE TO CBSE.
CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.

Personal Details
Name: MAYANK SURESH BUNDELE Date of Birth: 01/02/2000
Mother's Name: MANDA SURESH BUNDELE Category SC
Caste Name MAHAR Father's Name: SURESH BUNDELE
Person with Disability(PwD): NO State of Eligibility: MAHARASTRA
Percentage of Disability: -- Gender: MALE
Are you Diabetic :: NO Nationality: INDIAN
Place of Residence: URBAN You need scribe/reader ?: NO

Examination Details
Applying For: JEE(Main) Paper - 1 (B.E./B.Tech.) Only
Mode of Examination: PEN AND PAPER BASED EXAMINATION Question Paper Medium: ENGLISH
1st Choice of Exam Centre: NAGPUR 2nd Choice of Exam Centre: PUNE
3rd Choice of Exam Centre: AMRAVATI 4th Choice of Exam Centre: MUMBAI

Academic Details
Year of passing class 10th: 2016 Place of 12th class schooling: CITY
Year of Passing or Appearing class 12th/Qualifying Exam: 2018 Type of Institution of Class 12th/Qualifying Exam: PRIVATE
School Board of class 12th/Qualifying Exam: CENTRAL BOARD OF SECONDARY EDUCATION
Name of the Qualifying Examination passed / appearing: The final examination of the 10+2 system, conducted by any recognized central/ state Board, such as Central
Board of Secondary Education, New Delhi; Council for the Indian School Certificate Examinations, New Delhi;
etc.
Percentage of Marks in Class 12th/Qualifying Exam: -- Roll No. of Class 12th/Qualifying Exam: --
Appeared/Appearing for Improvement of Class NO Mode of preperation: SELF STUDY
12th/Qualifying Exam:
Roll Number of Class 12th/Qualifying Examination of
Improvement Examination:
Name and Address of the School/College from where USA VIDYA NIKETAN RAMKRUSNA NAGAR TUMSAR
passed/appearing:

Candidate's Mailing Address


Country: India State: MAHARASTRA
District: BHANDARA Address: SHRIRAM NAGAR TUMSAR
Locality: TUMSAR City/Town/Village: TUMSAR
Pin Code: 441912 Email Address: may****com
Mobile Number: 913****716

Guardian Details
Qualification Occupation Annual Income
Father's/Guardian's: GRADUATE PRIVATE SERVICE RS. 100001 -200000
Mother's: GRADUATE TEACHING / RESEARCH RS. 300001 -400000

Payment Details
Provider Name: HDFC Bank Payment Gateway Payment Mode: Electronic Payment Gateway
Fee Type: Examination Fee Transaction Amount: 500 /-
Transaction ID: LHMP5873672231 Date of Transaction: 09-12-2017 18:18:39
DECLARATION
I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. I have read and understood the JEE procedures for both
JEE(Main) and JEE(Advanced) - 2018. I shall abide by the terms and conditions thereon.

Images Uploaded by Candidate


Candidate Photograph Candidate Signature Parent/Guardian Signature

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