UTTARAKHAND BOARD OF TECHNICAL EDUCATION, AAMWALA, DEHRADUN

JOINT ENTRANCE EXAMINATION POLYTECHNICS, ENTRANCE EXAMINATION REGISTRATION

( JEEP-2018 )

APPLICATION FORM FOR JEEP ENTRANCE EXAMINATION-2018

Registration Number: 18005326

Candidate Name: PANKAJ KHATI

Father Name: BHAGWAT SINGH KHATI

Mother Name: MANJU KHATI

Date of Birth: 11/02/2001

Gender: MALE
Nationality: Indian
Are you a Bonafide Resident of Uttarakhand ? No
Category: GENERAL(UR)
Sub Category: None
For Claiming Reservation Facility For Cerificate Holder in NCC, NCC CERTIFICATE PASSED: None
Group in Which The Candidate Wishes To Appear In JEEP-2018: A
Mobile Number: 8954891645
Qualifying Examination: 10+2(PCM)/10+2(Professional/Technical)/ITI
Qualifying Examination Appeared/Passed: Appeared
Aadhar Number:
E-Mail Address: PANKAJ.KHATI.45@GMAIL.COM
Transaction Number: 177746636
Transaction Date: 2018-01-30
Fee Submitted: 800/-
Examination center City Name-1: Almora
Examination center City Name-2: Nainital

CORRESPONDENCE ADDRESS DETAILS

Address ARYA INTER COLLEGE DEGHAT (ALMORA) VILL. DEGHAT POST- DEGHAT State UTTARAKHAND
District ALMORA Pin Code 263659
PERMANENT ADDRESS DETAILS
Address ARYA INTER COLLEGE DEGHAT (ALMORA) VILL. DEGHAT POST- DEGHAT State UTTARAKHAND
District ALMORA Pin Code 263659

I hereby declare that the particulars filled are true, correct and complete to the best of my knowledge and belief and nothing has been
concealed, In case any of the information is found to be false, incorrect or misleading at any stage I shall have no claim against
cancellation of my candidature and/or taking other legal action as deemed fit by U.B.T.E.R.
( Signature of the Applicant )