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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: [email protected] 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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