Embed Size (px)
DESCRIPTION
jee
Citation preview
Joint Entrance Examination (Main) - 2016CENTRAL BOARD OF SECONDARY EDUCATION
ACKNOWLEDGEMENT PAGE
Application No. 60149199DO NOT SEND THIS PAGE TO CBSE.
CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.
Personal DetailsName: SWAMINATHAN R Date of Birth: 18/01/1998
Mother's Name: V.S.POORNA Category GENERAL
Father's Name: A.RAMESH Person with Disability(PwD): NO
State of Eligibility: TAMIL NADU 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: COMPUTER BASED EXAMINATION Question Paper Medium: ENGLISH
Choice of Online Exam Centre: CHENNAI
Academic DetailsYear of passing class 10th: 2013 Place of 12th class schooling: CITY
Year of Passing or Appearing class 12th/Qualifying Exam: 2015 Type of Institution of Class 12th/Qualifying Exam: GOVERNMENT
School Board of class 12th/Qualifying Exam: TAMIL NADU BOARD OF HIGHER SECONDARY EDUCATION
Name of the Qualifying Examination passed / appearing: Any Public School/ Board/ University examination in India or in any foreign country recognized as equivalent tothe 10+2 system by the Association of Indian Universities (AIU).
Percentage of Marks in Class 12th/Qualifying Exam: 73.5 Roll No. of Class 12th/Qualifying Exam: 809909
Appeared/Appearing for Improvement of Class12th/Qualifying Exam:
NO Mode of preperation: SELF STUDY
Name and Address of the School/College from wherepassed/appearing:
GILL ADARSH MATRIC HR SEC SCHOOL 46,V.M.STREET,BALAJI NAGAR,ROYAPETTAH,CHENNAI-14
Candidate's Mailing AddressAddress: 3,KARTHIK FLATS,13/27,NALLAPPAN STREET Locality: MYLAPORE
City/Town/Village: CHENNAI District: CHENNAI
State: TAMIL NADU Pin Code: 600004
Email Address: [email protected] Mobile Number: 9884218631
Land Line Number: --
Guardian DetailsQualification Occupation Annual Income
Father's/Guardian's: GRADUATE ENGINEERING RS. 800001 AND ABOVE
Mother's: GRADUATE OTHERS (INCLUDING HOUSE WIFE) --
Payment DetailsPayment Mode: Credit / Debit Card Transaction ID: ESMP4193906730
Exam Fee: 500 /- Date of Transaction: 25-12-2015 18:35:37
Card Type: VISA/Master Card -- --
Selected Date for Computer Based Examination of Paper-1Your selected date for Computer Based Examination: No date is selected.
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) - 2016. I shall abide by the terms and conditions thereon.
Images Uploaded by Candidate
Photograph Signature Thumb Impression
