Joint Entrance Examination (Main) - 2015

CENTRAL BOARD OF SECONDARY EDUCATION

ACKNOWLEDGEMENT PAGE

Application No.

50674962
DO NOT SEND THIS PAGE TO CBSE.

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

Personal Details
Name:

PALDE AJINKYA DINKAR

Date of Birth:

27/04/1998

Mother's Name:

MANDA

Category

OBC- NCL (CENTRAL LIST)

Father's Name:

DINKAR

Person with Disability(PwD):

NO

State of Eligibility:

MAHARASTRA

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 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:

NASIK

2nd Choice of Exam Centre:

MUMBAI

3rd Choice of Exam Centre:

AURANGABAD

4th Choice of Exam Centre:

PUNE

Academic Details
Year of passing class 10th:

2013

Year of Passing or Appearing class 12th/Qualifying Exam: 2015

Place of 12th class schooling:

CITY

Type of Institution of Class 12th/Qualifying Exam:

GOVERNMENT

School Board of class 12th/Qualifying Exam:

MAHARASTRA STATE BOARD OF SECONDARY AND HIGHER SECONDARY 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 No. of Class 12th/Qualifying Exam:

--

Appeared/Appearing for Improvement of Class

12th/Qualifying Exam:

NO

Mode of preperation:

COACHING

Roll Number of Class 12th/Qualifying Examination of

Improvement Examination:
Name and Address of the School/College from where
passed/appearing:

RNC ARTS JDB COMMERCE AND NSC SCIENCE COLLEGE NASHIK ROAD NASHIK

Candidate's Mailing Address

Address:

VISHAL PRIDE ROW HS NO 2 KHARJUL MALA NASHIK

ROAD

Locality:

URBAN

City/Town/Village:

NASHIK

District:

NASHIK

State:

MAHARASTRA

Pin Code:

422101

Email Address:

ajinkya1144palde35@gmail.com

Mobile Number:

8275922815

Land Line Number:

--

Guardian Details
Qualification

Occupation

Annual Income

Father's/Guardian's:

MATRICULATE

GOVERNMENT SERVICE

RS. 200001 - 300000

Mother's:

OTHERS

OTHERS (INCLUDING HOUSE WIFE)

--

Payment Mode:

ICICI Bank e-Challan

Transaction ID:

M3411241

Exam Fee:

1000 /-

Branch Name/Code:

NA

Deposit Date:

01/12/2014

--

--

Payment Details

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) - 2015. I shall abide by the terms and conditions thereon.

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