JEE(Main) AcknowledgementPage

Joint Entrance Examination (Main) - 2014CENTRAL BOARD OF SECONDARY EDUCATION

ACKNOWLEDGEMENT PAGE

Application No. 40647766DO NOT SEND THIS PAGE TO CBSE.

CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.

Personal DetailsName: RAGHAV MANGAL Date of Birth: 09/07/1995

Mother's Name: MEENAKSHI AGARWAL Category GENERAL

Father's Name: AJAY AGARWAL Person with Disability(PwD): NO

State of Eligibility: UTTAR PRADESH Percentage of Disability: --

Gender: MALE Are you the only child?: NO

Nationality: INDIAN Place of Residence: URBAN

Aadhaar Number (UIDAI): -- You need scribe/reader ?: NO

Examination DetailsApplying 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: ROORKEE 2nd Choice of Exam Centre: DELHI/NEW DELHI (NCR)

3rd Choice of Exam Centre: FARIDABAD 4th Choice of Exam Centre: KOTA

Academic DetailsYear of passing class 10th: 2011 Place of 12th class schooling: CITY

Year of Passing or Appearing class 12th/Qualifying Exam: 2013 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 CentralBoard of Secondary Education, New Delhi; Council for the Indian School Certificate Examinations, New Delhi;etc.

Percentage of Marks in Class 12th/Qualifying Exam: 76.00 Roll Number of Class 12th/Qualifying Exam: 5726931

Appearing for Improvement of Class 12th/QualifyingExam:

YES Mode of preperation: SELF STUDY

Name and Address of the School/College from wherepassed / appearing:

Dehradun Public School Jansath Road Muzaffarnagar U.P.

Candidate's Mailing AddressAddress: 505, Civil Lines North Locality: Malviya Marg

City/Town/Village: Muzaffarnagar District: Muzaffarnagar

State: UTTAR PRADESH Pin Code: 251001

Email Address: raghavmangal@gmail.com Mobile Number: 9837055065

Land Line Number: --

Guardian DetailsQualification Occupation Annual Income

Father's/Guardian's: GRADUATE SELF EMPLOYMENT RS. 100001 -200000

Mother's: POST GRADUATE SELF EMPLOYMENT UPTO 100000

Payment DetailsPayment Mode: Credit / Debit Card Transaction ID: MCND3185542019

Exam Fee: 1000 /- Date of Transaction: 05-12-2013 19:22:58

Card Type: VISA/Master Card -- --

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 bothJEE(Main) and JEE(Advanced) - 2014. I shall abide by the terms and conditions thereon.

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