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Joint Entrance Examination (Main) April 2019

NATIONAL TESTING AGENCY


CONFIRMATION PAGE

Application No. 190310802945


DO NOT SEND THIS PAGE TO NATIONAL TESTING AGENCY(NTA).
CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF CONFIRMATION PAGE FOR FUTURE REFERENCE.

Personal Details
Name: AATHETHYA V M Date of Birth: 23/01/2002
Mother's Name: MENAKA V Category: GENERAL
Caste Name: NA Father's Name: VENKATESWARAN A
Person with Disability(PwD): NO State of Eligibility: TAMIL NADU
Percentage of Disability: -- Gender: MALE
Are you Diabetic: NO Nationality: INDIAN
Place of Residence: RURAL Do you need scribe: NO

Examination Details
Applying For: JEE(Main) Paper - 1 (B.E./B.Tech.) Only
Mode of Examination: COMPUTER BASED EXAMINATION Question Paper Medium: ENGLISH
1st Choice of Exam City: TIRUCHIRAPPALLI (TAMIL NADU) 2nd Choice of Exam City: THANJAVUR (TAMIL NADU)
3rd Choice of Exam City: MADURAI (TAMIL NADU) 4th Choice of Exam City: NAMAKKAL (TAMIL NADU)

Academic Details
Year of passing class 10th: 2017 Place of 12th class schooling: TOWN
Year of Passing or Appearing class 12th/Qualifying Exam: 2019 Type of Institution of Class 12th/Qualifying Exam: GOVERNMENT
School Board of class 12th/Qualifying Exam: CENTRAL BOARD OF SECONDARY EDUCATION
Name of the Qualifying Exam passed / appearing: The final examination of the 10+2 system, conducted by any recognized central/ state Board, such as Central
Board of Secondary Education, New Delhi; Council for the Indian School Certificate Examinations, New Delhi;
etc.
Percentage of Marks in Class 12th/Qualifying Exam: -- Roll No. of Class 12th/Qualifying Exam: --
Appeared/Appearing for Improvement of Class NO Mode of preperation: SELF STUDY
12th/Qualifying Exam:
Roll Number of Class 12th/Qualifying Exam of --
Improvement Exam:
Name and Address of the School/College from where R.S.K. HIGHER SECONDARY SCHOOL BHEL TOWNSHIP, KAILASAPURAM, TRICHY-14.
passed/appearing:

Candidate's Mailing Address


Country: India State: TAMIL NADU
District: TIRUCHIRAPPALLI Address: 2/26, MELA STREET,
Locality: MANNANKADU City/Town/Village: THANJAVUR
Pin Code: 614613 Email Address: aat*******@gmail.com
Mobile Number: 890****989

Guardian Details
Qualification Occupation Annual Income
Father's/Guardian's: POST GRADUATE AGRICULTURE UPTO 100000
Mother's: GRADUATE OTHERS --

Payment Details
Provider Name: ICICI Bank Payment Mode: Electronic Payment Gateway
Fee Type: Examination Fee for JEE(Main) April 2019 Transaction Amount: 500 /-
Transaction ID: 733799884 Date of Transaction: 06-03-2019 11:26:17
DECLARATION
I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief.
Images Uploaded by Candidate
Candidate Photograph Candidate Signature

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