Beruflich Dokumente
Kultur Dokumente
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:
Date of Birth:
28/09/1997
Mother's Name:
BIJAMANI TUDU
Category
ST
Father's Name:
NO
State of Eligibility:
ODISHA
Percentage of Disability:
--
Gender:
MALE
NO
Nationality:
INDIAN
Place of Residence:
URBAN
--
NO
Examination Details
Applying For:
Mode of Examination:
ENGLISH
BHUBANESWAR
CUTTACK
BALASORE
BERHAMPUR
Academic Details
Year of passing class 10th:
2013
CITY
GOVERNMENT
61.66
303MA356
NO
Mode of preperation:
SELF STUDY
BJB JUNIOR COLLEGE, BHUBANESWAR Kalpana Road, Infront Of Court, Bhubaneswar, Odisha 751014
Locality:
Acharya Vihar
City/Town/Village:
Bhubaneswar
District:
Khurda
State:
ODISHA
Pin Code:
751013
Email Address:
event2do@gmail.com
Mobile Number:
9776973476
06742379274
Guardian Details
Qualification
Occupation
Annual Income
Father's/Guardian's:
GRADUATE
GOVERNMENT SERVICE
RS. 500001-600000
Mother's:
GRADUATE
UPTO 100000
Payment Mode:
Transaction ID:
60441924
Exam Fee:
500 /-
Branch Name/Code:
1252
Deposit Date:
22/12/2015
--
--
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.
Signature
Thumb Impression