Joint Entrance Examination (Main) - 2014

CENTRAL BOARD OF SECONDARY EDUCATION

ACKNOWLEDGEMENT PAGE
Application No. 40922418
DO NOT SEND THIS PAGE TO CBSE.
CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.
Personal Details
Name: MEKALA VISHNU RAJU Date of Birth: 11/04/1997
Mother's Name: MEKALA MADHAVI Category OBC- NCL (CENTRAL LIST)
Father's Name: MEKALA SREENIVASULU Person with Disability(PwD): NO
State of Eligibility: ANDHRA PRADESH Percentage of Disability: --
Gender: MALE Are you the only child?: NO
Nationality: INDIAN Place of Residence: URBAN
Aadhaar Number (UIDAI): 265182345557 You need scribe/reader ?: NO
Examination Details
Applying 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: HYDERABAD
Academic Details
Year of passing class 10th: 2012 Place of 12th class schooling: CITY
Year of Passing or Appearing class 12th/Qualifying Exam: 2014 Type of Institution of Class 12th/Qualifying Exam: PRIVATE
School Board of class 12th/Qualifying Exam: ANDHRA PRADESH BOARD OF INTERMEDIATE EDUCATION
Name of the Qualifying Examination passed / appearing: Intermediate or two-year Pre-University examination conducted by a recognized Board/ University.
Percentage of Marks in Class 12th/Qualifying Exam: -- Roll Number of Class 12th/Qualifying Exam: 1423216445
Appearing for Improvement of Class 12th/Qualifying
Exam:
NO Mode of preperation: SELF STUDY
Name and Address of the School/College from where
passed / appearing:
N.R.I JR. COLLEGE 10-1-49, Sy.No.63, ALLADI PENTAIAH NAGAR, WEST MARREDPALLY,
SECUNDERABAD
Candidate's Mailing Address
Address: S/O M.SREENIVASULU ,11-3-384/2, OPP.MOSQUE Locality: SRINIVAS NAGAR, PADMARAO NAGAR
City/Town/Village: SECUNDERABAD District: HYDERABAD
State: ANDHRA PRADESH Pin Code: 500061
Email Address: sreem9@yahoo.com Mobile Number: 9848323320
Land Line Number: --
Guardian Details
Qualification Occupation Annual Income
Father's/Guardian's: POST GRADUATE BUSINESS RS. 100001 -200000
Mother's: GRADUATE OTHERS (INCLUDING HOUSE WIFE) UPTO 100000
Payment Details
Payment Mode: Credit / Debit Card Transaction ID: MSPD3191754311
Exam Fee: 600 /- Date of Transaction: 11-12-2013 21:14:53
Card Type: VISA/Master Card -- --
Selected Date for Computer Based Examination of Paper-1
Your selected date for Computer Based Examination: 09/04/2014
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) - 2014. I shall abide by the terms and conditions thereon.
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