Joint Entrance Examination (Main) 2019

NATIONAL TESTING AGENCY

CONFIRMATION PAGE

Application No. 190310850294

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Personal Details
Name: AKARSH MITTAL Date of Birth: 01/08/2000
Mother's Name: SEEMA AGARWAL Category: GENERAL
Caste Name: NA Father's Name: AVINESH MITTAL
Person with Disability(PwD): NO State of Eligibility: UTTAR PRADESH
Percentage of Disability: -- Gender: MALE
Are you Diabetic: NO Nationality: INDIAN
Place of Residence: URBAN Do you need scribe: NO

Examination Details
Applying For:
Mode of Examination:
1st Choice of Exam City:
3rd Choice of Exam City:
JEE(Main) Paper - 1 (B.E./B.Tech.) Only
COMPUTER BASED EXAMINATION Question Paper Medium: ENGLISH
BAREILLY 2nd Choice of Exam City: MORADABAD
GREATER NOIDA/NOIDA 4th Choice of Exam City: LUCKNOW

Academic Details
Year of passing class 10th: 2017 Place of 12th class schooling: CITY
Year of Passing or Appearing class 12th/Qualifying Exam: 2019 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 Exam 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: -- Roll No. of Class 12th/Qualifying Exam: --
Appeared/Appearing for Improvement of Class NO Mode of preperation: SELF STUDY
12th/Qualifying Exam:
Roll Number of Class 12th/Qualifying Exam of --
Improvement Exam:
Name and Address of the School/College from where SHRI GULAB RAI MONTESSORI SENIOR SECONDARY SCHOOL NAINITAL ROAD BAREILLY
passed/appearing:

Candidate's Mailing Address

Country: India State: UTTAR PRADESH
District: BAREILLY Address: DT 38 SHASTRI NAGR
Locality: NEAR TELEPHONE COLONY City/Town/Village: BAREILLY
Pin Code: 243122 Email Address: mit*******@gmail.com
Mobile Number: 875****210

Guardian Details
Qualification Occupation Annual Income
Father's/Guardian's: GRADUATE BUSINESS RS. 100001 -200000
Mother's: GRADUATE OTHERS UPTO 100000

Payment Details
Provider Name: State Bank of India (MOPS) Payment Mode: Electronic Payment Gateway
Fee Type: Examination Fee Transaction Amount: 500 /-
Transaction ID: CPK2219726 Date of Transaction: 30/09/2018 10:40:04
DECLARATION
I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief.
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