Joint Entrance Examination (Main) - 2014

CENTRAL BOARD OF SECONDARY EDUCATION

ACKNOWLEDGEMENT PAGE

Application No.

40647766
DO NOT SEND THIS PAGE TO CBSE.

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

Personal Details
Name:

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 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:

ROORKEE

2nd Choice of Exam Centre:

DELHI/NEW DELHI (NCR)

3rd Choice of Exam Centre:

FARIDABAD

4th Choice of Exam Centre:

KOTA

Academic Details
Year of passing class 10th:

2011

Year of Passing or Appearing class 12th/Qualifying Exam: 2013

Place of 12th class schooling:

CITY

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 Central
Board 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/Qualifying

Exam:

YES

Mode of preperation:

SELF STUDY

Name and Address of the School/College from where

passed / appearing:

Dehradun Public School Jansath Road Muzaffarnagar U.P.

Candidate's Mailing Address

Address:

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 Details
Qualification

Occupation

Annual Income

Father's/Guardian's:

GRADUATE

SELF EMPLOYMENT

RS. 100001 -200000

Mother's:

POST GRADUATE

SELF EMPLOYMENT

UPTO 100000

Payment Mode:

Credit / Debit Card

Transaction ID:

MCND3185542019

Exam Fee:

1000 /-

Date of Transaction:

05-12-2013 19:22:58

Card Type:

VISA/Master Card

--

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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) - 2014. I shall abide by the terms and conditions thereon.

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