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Joint Entrance Examination (Main) - 2016

CENTRAL BOARD OF SECONDARY EDUCATION


ACKNOWLEDGEMENT PAGE

Application No.

60441924
DO NOT SEND THIS PAGE TO CBSE.

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

Personal Details
Name:

EVEN TARASH TUDU

Date of Birth:

28/09/1997

Mother's Name:

BIJAMANI TUDU

Category

ST

Father's Name:

DEEPAK KUMAR TUDU

Person with Disability(PwD):

NO

State of Eligibility:

ODISHA

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 (B.E./B.Tech.) Only

Mode of Examination:

PEN AND PAPER BASED EXAMINATION

Question Paper Medium:

ENGLISH

1st Choice of Exam Centre:

BHUBANESWAR

2nd Choice of Exam Centre:

CUTTACK

3rd Choice of Exam Centre:

BALASORE

4th Choice of Exam Centre:

BERHAMPUR

Academic Details
Year of passing class 10th:

2013

Year of Passing or Appearing class 12th/Qualifying Exam: 2015

Place of 12th class schooling:

CITY

Type of Institution of Class 12th/Qualifying Exam:

GOVERNMENT

School Board of class 12th/Qualifying Exam:

ODISHA COUNCIL OF HIGHER SECONDARY EDUCATION

Name of the Qualifying Examination passed / appearing:

Intermediate or two-year Pre-University examination conducted by a recognized Board/ University.

Percentage of Marks in Class 12th/Qualifying Exam:

61.66

Roll No. of Class 12th/Qualifying Exam:

303MA356

Appeared/Appearing for Improvement of Class


12th/Qualifying Exam:

NO

Mode of preperation:

SELF STUDY

Name and Address of the School/College from where


passed/appearing:

BJB JUNIOR COLLEGE, BHUBANESWAR Kalpana Road, Infront Of Court, Bhubaneswar, Odisha 751014

Candidate's Mailing Address


Address:

QRT NO. 346, IMMT COLONY

Locality:

Acharya Vihar

City/Town/Village:

Bhubaneswar

District:

Khurda

State:

ODISHA

Pin Code:

751013

Email Address:

event2do@gmail.com

Mobile Number:

9776973476

Land Line Number:

06742379274

Guardian Details
Qualification

Occupation

Annual Income

Father's/Guardian's:

GRADUATE

GOVERNMENT SERVICE

RS. 500001-600000

Mother's:

GRADUATE

OTHERS (INCLUDING HOUSE WIFE)

UPTO 100000

Payment Mode:

HDFC Bank e-Challan

Transaction ID:

60441924

Exam Fee:

500 /-

Branch Name/Code:

1252

Deposit Date:

22/12/2015

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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. I have read and understood the JEE procedures for both
JEE(Main) and JEE(Advanced) - 2016. I shall abide by the terms and conditions thereon.

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