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APPENDIX –11

Guidelines for filling up the online application form


S.N. Description of Field Input Remarks

• Max length 46 characters


• Only characters are allowed
1 Candidate’s Name • As registered in class 12 or
equivalent Examination

• Maximum 46 characters
• Only characters are allowed
• As registered in class 12 or
2. Father’s Name equivalent Examination.
• Salutations like Late, Mr., Ms., Mrs.,
Dr., Prof. should not used

• Maximum 46 characters
• Only characters are allowed
• As registered in class 12 or
3. Mother’s Name equivalent Examination.
• Salutations like Late, Mr., Ms., Mrs.,
Dr., Prof. should not used

• DD/MM/YYYY
4. Date of Birth ---Select--- • (See section 3.1 of Information
Bulletin)

• Male
5. Gender ---Select--- • Female
• Transgender

6. Domicile ---Select---  Dropdown list.

 For domiciles of W.B.


o General
o SC
---Select--- o ST
7. Category o OBC-A
o OBC –B
 For domicile in other states/UTs
o General
 Yes
---Select---  No
8. Person with Disability (PwD) (Formerly known as Physically
Handicapped)
 Locomotor disability
 Visual Impairment
9. Type of Disability ---Select---  Hearing impairment
 Speech and language disability

10. Percentage of Disability  Percentage of Disability

 Dropdown list if domicile of WB.


11. Home District ---Select--- Otherwise write name of home
district

1. Above 10 lakhs
---Select--- 2. From 6.0 lakhs to below 10 lakhs
12. Income Category 3. From 2.5 lakhs to below 6.0 lakhs
4. Below 2.5 lakhs

 Auto filled
---Select---  ‘Yes’ , If income category given
13. Do you belong to TFW above is 4 and domicile of WB then
TFW=’YES’ else TFW=’NO’
 Hindu
 Muslim
 Christian
14. Religion ---Select---  Buddhist
 Sikh
 Other

15. Nationality Auto Filled  Indian

16. Aadhaar No. Aadhar No. (Optional)

Have you Applied in JEE ---Select---  Yes


17.
(Main) 2017?  No

Enter Application No of  Mandatory, if answer of the


18. previous question is ‘Yes’.
JEE(Main) 2017
---Select---  Engineering/Architecture/Pharmacy
19. Apply For

20. 1st Choice of Exam City: ---Select--- Mandatory. Select from dropdown list

21. 2nd Choice of Exam City: ---Select--- Mandatory. Select from dropdown list

22. 3rd Choice of Exam City: ---Select--- Mandatory. Select from dropdown list

th
Class 12 equivalent examination details

23. Educational Qualification ---Select---  Class 12 or equivalent


th

---Select---  Passed
24. Pass Status  Appearing

25. Course/Stream Name ---Select---  Class 12 or equivalent


th

Select from drop down list


26. Board/University Name ---Select---

Select from drop down list


27. Year of Passing ---Select---

28. Maximum Marks

29. Marks Obtained

30. Marks (%) Auto Calculate

31. Roll No/Enroll No

32. Institute Name and address Mandatory

33. Pin code Mandatory

Communication Details
34. Complete Address Max 50 char
35 Locality Max 50 char (optional)

36 City / Town / Village Mandatory

37. State ---Select--- Mandatory. Select from dropdown list

38. District ---Select--- Mandatory. Select from dropdown list

39. Pin Code Mandatory

40. Email Id Mandatory

41. Mobile no. Mandatory


Choose Password

42. Choose Password Mandatory

43. Confirm Password Mandatory

44. Security Question ---Select--- Mandatory. Select from dropdown list

45. Security Answer Mandatory

Image Uploading

At this stage the candidate is required to upload scanned images of his/her recent colour photograph
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and signature all in one go. For detail instruction, see section 8.3 of the Information Bulletin.
Fee Payment

At this stage, the candidate is required to pay the requisite fees. For detail instruction, see section 8.4
47
of the Information Bulletin.
Confirmation Page
Once the fee payment is made, the candidate will be directed to download the confirmation page.
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Download the confirmation page and preserve the same.