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CONFIRMATION PAGE - NEET (UG) - 2020

Application No. 200410124157  

अ यथ का नाम (Candidate's Name) SOURAV SINGH ज म त थ (Date of Birth) 19/08/2002

माता का नाम (Mother's Name) KUSUM DEVI लग (Gender) Male

पता का नाम (Father's Name) MAHESH SINGH वग (Category) UR

क ा बारहव / यो यता परी ा उ ीण करने /परी ा का वष द ांग

(Year of Passing/Appearing Class-XII/Qualifying 2020 Person with Disability (PwD)(if disability is 40% or No
Exam) above) :

पा ता का रा य/दे श
Delhi रा ीयता (Nationality) Indian
(State/Country of Eligibility)

ा तांक का तशत ( % of Marks obtained in Class

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

मोबाइल नंबर (Mobile No.) 91xxxxxx8592 ईमेल पता (Email Address) Sixxxxxxxxxxxxx@gmail.com

परी ा शहर के वक प (Choice of Examination City)

(1) DELHI/NEW DELHI ( 2001) (2) GHAZIABAD ( 4404) (3) NOIDA/GREATER NOIDA ( 4410) (4) FARIDABAD ( 2301)

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) - 2020 which I have gone through carefully. I further declare that I have not submitted any other application for
NEET (UG) -2020  and mobile number and email address given in the form are correct and my own or of my parents.

Signature Left Hand Thumb Impression

Photo

Permanent address:

Address B-210, Gazipur village, Kala niketan international school

City GAZIPUR ,EAST DELHI

State /Country Delhi Pin Code 110096

Details of Transaction(PayTM)

Transaction ID:20191228111212800110168875305259281 Total Amount:1500 Date of Deposit :28/12/2019

Application No: 200410124157                                                       Printed On : 28/12/2019 10:46:07

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 15th January, 2020 to 31st January, 2020. No corrections shall be allowed under any circumstances after this date.