Joint Entrance Examination (Main) April 2019

NATIONAL TESTING AGENCY

CONFIRMATION PAGE

Application No. 190310044837

DO NOT SEND THIS PAGE TO NATIONAL TESTING AGENCY(NTA).
CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF CONFIRMATION PAGE FOR FUTURE REFERENCE.

Personal Details
Name: MOHAMMAD KAIF AHMED Date of Birth: 02/10/2001
Mother's Name: SHABANA ANJUM AHMED Category: GENERAL
Caste Name: NA Father's Name: AIFAZ AHMED
Person with Disability(PwD): NO State of Eligibility: MAHARASHTRA
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
NAGPUR (MAHARASHTRA) 2nd Choice of Exam City: AMRAVATI (MAHARASHTRA)
BHANDARA (MAHARASHTRA) 4th Choice of Exam City: GADCHIROLI (MAHARASHTRA)

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: MAHARASTRA STATE BOARD OF SECONDARY AND HIGHER 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 INDIAN OLYMPIAD SCHOOL Bhilgaon, 61/1, Kamptee Road, Nagpur
passed/appearing:

Candidate's Mailing Address

Country: India State: MAHARASHTRA
District: NAGPUR Address: PLOT NO. A-33, ANANT NAGAR, RATHOD LAYOUT
Locality: JAFAR NAGAR City/Town/Village: NAGPUR
Pin Code: 440013 Email Address: The*******@gmail.com
Mobile Number: 983****527

Guardian Details
Qualification Occupation Annual Income
Father's/Guardian's: GRADUATE BUSINESS RS. 700001-800000
Mother's: GRADUATE -- --

Payment Details
Provider Name: HDFC Bank Payment Mode: Electronic Payment Gateway
Fee Type: Examination Fee for JEE(Main) April 2019 Transaction Amount: 500 /-
Transaction ID: 8103031307 Date of Transaction: 2019-03-02 19:24:38
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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