Jee(main)_confirmationpage.pdf
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Joint Entrance Examination (Main) April 2019 NATIONAL TESTING AGENCY CONFIRMATION PAGE
Application No.
190320274416 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:
LAVANYA PATHAK
Date of Birth:
27/03/2001
Mother's Name:
MANJU PATHAK
Category:
GENERAL
Caste Name:
NA
Father's Name:
KRISHNA KUMAR PATHAK
Person with Disability(PwD):
NO
State of Eligibility:
UTTAR PRADESH
Percentage of Disability:
--
Gender:
FEMALE
Are you Diabetic:
NO
Nationality:
INDIAN
Place of Residence:
URBAN
Do you need scribe:
NO
Examination Details Applying For:
JEE(Main) Paper - 1 (B.E./B.Tech.) Only
Mode of Examination:
COMPUTER BASED EXAMINATION
Question Paper Medium:
ENGLISH
1st Choice of Exam City:
ALLAHABAD (UTTAR PRADESH)
2nd Choice of Exam City:
VARANASI (UTTAR PRADESH)
3rd Choice of Exam City:
KANPUR (UTTAR PRADESH)
4th Choice of Exam City:
LUCKNOW (UTTAR PRADESH)
Academic Details Year of passing class 10th:
2017
Year of Passing or Appearing class 12th/Qualifying Exam: 2019
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 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:
5620533
Appeared/Appearing for Improvement of Class 12th/Qualifying Exam:
NO
Mode of preperation:
SELF STUDY
Roll Number of Class 12th/Qualifying Exam of Improvement Exam:
--
Name and Address of the School/College from where passed/appearing:
TAGORE PUBLIC SCHOOL 32 ATTARSUIYA ALLAHABAD
Candidate's Mailing Address Country:
India
State:
UTTAR PRADESH
District:
ALLAHABAD
Address:
1178
Locality:
KALYANI DEVI MANDIR
City/Town/Village:
ALLAHABAD
Pin Code:
211003
Email Address:
lav*******@gmail.com
Mobile Number:
708****626
Guardian Details Qualification
Occupation
Annual Income
Father's/Guardian's:
--
--
--
Mother's:
--
--
--
Provider Name:
HDFC Bank
Payment Mode:
Electronic Payment Gateway
Fee Type:
Examination Fee for JEE(Main) April 2019
Transaction Amount:
250 /-
Transaction ID:
8120652821
Date of Transaction:
2019-03-06 20:42:08
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.
Images Uploaded by Candidate Candidate Photograph
Candidate Signature
Application No.
190320274416 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:
LAVANYA PATHAK
Date of Birth:
27/03/2001
Mother's Name:
MANJU PATHAK
Category:
GENERAL
Caste Name:
NA
Father's Name:
KRISHNA KUMAR PATHAK
Person with Disability(PwD):
NO
State of Eligibility:
UTTAR PRADESH
Percentage of Disability:
--
Gender:
FEMALE
Are you Diabetic:
NO
Nationality:
INDIAN
Place of Residence:
URBAN
Do you need scribe:
NO
Examination Details Applying For:
JEE(Main) Paper - 1 (B.E./B.Tech.) Only
Mode of Examination:
COMPUTER BASED EXAMINATION
Question Paper Medium:
ENGLISH
1st Choice of Exam City:
ALLAHABAD (UTTAR PRADESH)
2nd Choice of Exam City:
VARANASI (UTTAR PRADESH)
3rd Choice of Exam City:
KANPUR (UTTAR PRADESH)
4th Choice of Exam City:
LUCKNOW (UTTAR PRADESH)
Academic Details Year of passing class 10th:
2017
Year of Passing or Appearing class 12th/Qualifying Exam: 2019
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 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:
5620533
Appeared/Appearing for Improvement of Class 12th/Qualifying Exam:
NO
Mode of preperation:
SELF STUDY
Roll Number of Class 12th/Qualifying Exam of Improvement Exam:
--
Name and Address of the School/College from where passed/appearing:
TAGORE PUBLIC SCHOOL 32 ATTARSUIYA ALLAHABAD
Candidate's Mailing Address Country:
India
State:
UTTAR PRADESH
District:
ALLAHABAD
Address:
1178
Locality:
KALYANI DEVI MANDIR
City/Town/Village:
ALLAHABAD
Pin Code:
211003
Email Address:
lav*******@gmail.com
Mobile Number:
708****626
Guardian Details Qualification
Occupation
Annual Income
Father's/Guardian's:
--
--
--
Mother's:
--
--
--
Provider Name:
HDFC Bank
Payment Mode:
Electronic Payment Gateway
Fee Type:
Examination Fee for JEE(Main) April 2019
Transaction Amount:
250 /-
Transaction ID:
8120652821
Date of Transaction:
2019-03-06 20:42:08
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.
Images Uploaded by Candidate Candidate Photograph
Candidate Signature
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