jee(main) acknowledgementpage

Joint Entrance Examination (Main) - 2015 CENTRAL BOARD OF SECONDARY EDUCATION ACKNOWLEDGEMENT PAGE Application No. 50390574 DO NOT SEND THIS PAGE TO CBSE. CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE. Personal Details Name: BHUVNESH ARYA Date of Birth: 08/05/1996 Mother's Name: SUSHILA KANSARA Category OBC- NCL (CENTRAL LIST) Father's Name: KAMAL KISHORE ARYA Person with Disability(PwD): NO State of Eligibility: RAJASTHAN 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 and Paper - 2 Both Examination Mode (B.Tech.): PEN AND PAPER BASED EXAMINATION Examination Mode (B.Arch.): PEN AND PAPER BASED EXAMINATION Question Paper Medium: ENGLISH 1st Choice of Exam Centre: JODHPUR 2nd Choice of Exam Centre: JAIPUR 3rd Choice of Exam Centre: BIKANER 4th Choice of Exam Centre: AJMER Academic Details Year of passing class 10th: 2012 Place of 12th class schooling: CITY Year of Passing or Appearing class 12th/Qualifying Exam: 2014 Type of Institution of Class 12th/Qualifying Exam: PRIVATE School Board of class 12th/Qualifying Exam: RAJASTHAN BOARD OF SECONDARY EDUCATION Name of the Qualifying Examination passed / appearing: Any Public School/ Board/ University examination in India or in any foreign country recognized as equivalent to the 10+2 system by the Association of Indian Universities (AIU). Percentage of Marks in Class 12th/Qualifying Exam: 74.20 Roll No. of Class 12th/Qualifying Exam: 1592314 Appeared/Appearing for Improvement of Class 12th/Qualifying Exam: NO Mode of preperation: COACHING Roll Number of Class 12th/Qualifying Examination of Improvement Examination: Name and Address of the School/College from where passed/appearing: SHRI MAHESHWARI SENIOR SECONDARY SCHOOL OPPOSITE UMAID HOSPITAL , GEETA BHAWAN ROAD , SIWANCHI GATE , JODHPUR Candidate's Mailing Address Address: OPPOSITE A-1 KASHIDA CENTRE , FARASON KA BANGLA Locality: MOTI CHOWK City/Town/Village: JODHPUR District: JODHPUR State: RAJASTHAN Pin Code: 342001 Email Address: [email protected] Mobile Number: 9680919046 Land Line Number: 02912631095 Guardian Details Qualification Occupation Annual Income Father's/Guardian's: -- -- -- Mother's: -- -- -- Payment Details Payment Mode: Credit / Debit Card Transaction ID: ASMP3567897488 Exam Fee: 1800 /- Date of Transaction: 25-11-2014 08:08:32 Card Type: VISA/Master Card -- -- 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) - 2015. I shall abide by the terms and conditions thereon. Images Uploaded by Candidate Photograph Signature Thumb Impression

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Joint Entrance Examination (Main) - 2015CENTRAL BOARD OF SECONDARY EDUCATION

ACKNOWLEDGEMENT PAGE

Application No. 50390574DO NOT SEND THIS PAGE TO CBSE.

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

Personal DetailsName: BHUVNESH ARYA Date of Birth: 08/05/1996Mother's Name: SUSHILA KANSARA Category OBC- NCL (CENTRAL LIST)Father's Name: KAMAL KISHORE ARYA Person with Disability(PwD): NOState of Eligibility: RAJASTHAN Percentage of Disability: --Gender: MALE Are you the only child?: NONationality: INDIAN Place of Residence: URBANAadhaar Number (UIDAI): -- You need scribe/reader ?: NOExamination DetailsApplying For: JEE(Main) Paper - 1 and Paper - 2 BothExamination Mode (B.Tech.): PEN AND PAPER BASED EXAMINATION Examination Mode (B.Arch.): PEN AND PAPER BASED EXAMINATIONQuestion Paper Medium: ENGLISH 1st Choice of Exam Centre: JODHPUR2nd Choice of Exam Centre: JAIPUR 3rd Choice of Exam Centre: BIKANER4th Choice of Exam Centre: AJMER

Academic DetailsYear of passing class 10th: 2012 Place of 12th class schooling: CITYYear of Passing or Appearing class 12th/Qualifying Exam: 2014 Type of Institution of Class 12th/Qualifying Exam: PRIVATESchool Board of class 12th/Qualifying Exam: RAJASTHAN BOARD OF SECONDARY EDUCATIONName of the Qualifying Examination passed / appearing: Any Public School/ Board/ University examination in India or in any foreign country recognized as equivalent to

the 10+2 system by the Association of Indian Universities (AIU).Percentage of Marks in Class 12th/Qualifying Exam: 74.20 Roll No. of Class 12th/Qualifying Exam: 1592314Appeared/Appearing for Improvement of Class12th/Qualifying Exam:

NO Mode of preperation: COACHING

Roll Number of Class 12th/Qualifying Examination ofImprovement Examination:Name and Address of the School/College from wherepassed/appearing:

SHRI MAHESHWARI SENIOR SECONDARY SCHOOL OPPOSITE UMAID HOSPITAL , GEETA BHAWANROAD , SIWANCHI GATE , JODHPUR

Candidate's Mailing AddressAddress: OPPOSITE A-1 KASHIDA CENTRE , FARASON KA

BANGLALocality: MOTI CHOWK

City/Town/Village: JODHPUR District: JODHPURState: RAJASTHAN Pin Code: 342001Email Address: [email protected] Mobile Number: 9680919046Land Line Number: 02912631095

Guardian DetailsQualification Occupation Annual Income

Father's/Guardian's: -- -- --Mother's: -- -- --

Payment DetailsPayment Mode: Credit / Debit Card Transaction ID: ASMP3567897488Exam Fee: 1800 /- Date of Transaction: 25-11-2014 08:08:32Card Type: VISA/Master Card -- --

DECLARATIONI 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 bothJEE(Main) and JEE(Advanced) - 2015. I shall abide by the terms and conditions thereon.Images Uploaded by Candidate

Photograph Signature Thumb Impression