1/18/2019 NEET- 2019: Confirmation Page for Application Number :190410564913

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CONFIRMATION PAGE - NEET (UG) - 2019

Application No. 190410564913

अ थ का नाम (Candidate's Name) DAYANIDI S K * ज ितिथ (Date of Birth) 26/06/2002

माता का नाम (Mother's Name) DEEPA K िलंग (Gender) Male

िपता का नाम (Father's Name) KANNAIYAN P वग (Category) OBC (NCL)

क ा बारहवीं / यो ता परी ा उ ीण करने /परी ा का वष

िद ां ग
(Year of Passing/Appearing Class-XII/Qualifying 2019 * No
(Person with Disability)
Exam)

पा ता का रा /दे श
Tamil Nadu रा ीयता (Nationality) Indian *
(State/Country of Eligibility)

ा ां क का ितशत ( % of Marks obtained in Class

प का मा म (Medium of Question Paper))# English -
12thQualifying Examination)

मोबाइल नंबर (Mobile No.) 91xxxxxx4619 ईमेल पता (Email Address) daxxxxxxxx@gmail.com

परी ा शहर के िवक (Choice of Examination City)

(1) COIMBATORE ( 4102) (2) SALEM ( 4109) (3) KARUR ( 4105) (4) NAMAKKAL ( 4108)

DECLARATION: - I hereby affirm that all the particulars stated by me in the Application Form are true and correct. Even the spelling of names and category
are also correct. I have not concealed any information. However, if any information furnished herein is found fraudulent, incorrect or untrue, I will be liable for
criminal prosecution which will result in cancellation of my candidature. Further that the selection and admission to the course is liable to be cancelled. I agree
to abide by the Rules and Regulations governing the Examination as contained in the Information Bulletin for NEET (UG) - 2019 which I have gone through
carefully. I further declare that I have not submitted any other application for NEET (UG) -2019 and mobile number and email address given in the form are
correct and my own or of my parents.

Signature

Photo

Complete mailing address:

Address 5/1030, INDIRA NAGAR, OPP.JAMES SCHOOL

City M.KOMARAPALAYAM, SATHYAMANGALAM ,ERODE

State /Country Tamil Nadu Pin Code 638401

Details of Transaction(SBI Bank).

Total Amount: 1400 Date of Transaction: 11/14/2018 12:43:19

Transaction ID.: CPK8577841
AM

Card Type : VISA/Master Card

Application No: 190410564913 Printed On : 18/01/2019 03:37:51

Note : - Kindly check following details in Confirmation Page :

Candidate’s Name, Mother’s Name, Father’ s Name, Date of Birth, Gender, Category, PwD, Choice of Examination Cities and Medium of Question Paper. In case of any
discrepancy, these may please be corrected during 14th January, 2019 to 31st January, 2019. No corrections shall be allowed under any circumstances after this date.

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