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JEE (Main) AcknowledgementPage

Manjunath S applied for the Joint Entrance Examination (Main) in 2014. He provided personal details like name, date of birth, gender, nationality, and place of residence. He applied for the computer-based exam in English for the B.E./B.Tech. paper to be taken in Mysore. He passed class 10 in 2012 from a village school and was appearing for class 12 exams in 2014 from a private Karnataka Board school. He paid the exam fee of Rs. 600 through a bank e-challan and selected April 19, 2014 as his exam date. He declared that all the information provided was true to the best of his knowledge.

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Manjunath Sripathy
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130 views1 page

JEE (Main) AcknowledgementPage

Manjunath S applied for the Joint Entrance Examination (Main) in 2014. He provided personal details like name, date of birth, gender, nationality, and place of residence. He applied for the computer-based exam in English for the B.E./B.Tech. paper to be taken in Mysore. He passed class 10 in 2012 from a village school and was appearing for class 12 exams in 2014 from a private Karnataka Board school. He paid the exam fee of Rs. 600 through a bank e-challan and selected April 19, 2014 as his exam date. He declared that all the information provided was true to the best of his knowledge.

Uploaded by

Manjunath Sripathy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Joint Entrance Examination (Main) - 2014

CENTRAL BOARD OF SECONDARY EDUCATION


ACKNOWLEDGEMENT PAGE
Application No. 40184820
DO NOT SEND THIS PAGE TO CBSE.
CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.
Personal Details
Name: MANJUNATH.S Date of Birth: 05/06/1996
Mother's Name: NETHRAVATHI Category GENERAL
Father's Name: SRIPATHY.V Person with Disability(PwD): NO
State of Eligibility: KARNATAKA Percentage of Disability: --
Gender: MALE Are you the only child?: NO
Nationality: INDIAN Place of Residence: RURAL
Aadhaar Number (UIDAI): -- You need scribe/reader ?: NO
Examination Details
Applying For: JEE(Main) Paper - 1 (B.E./B.Tech.) Only
Mode of Examination: COMPUTER BASED EXAMINATION Question Paper Medium: ENGLISH
Choice of Online Exam Centre: MYSORE
Academic Details
Year of passing class 10th: 2012 Place of 12th class schooling: VILLAGE
Year of Passing or Appearing class 12th/Qualifying Exam: 2014 Type of Institution of Class 12th/Qualifying Exam: PRIVATE
School Board of class 12th/Qualifying Exam: KARNATAKA BOARD OF PRE UNIVERSITY EDUCATION
Name of the Qualifying Examination passed / appearing: Intermediate or two-year Pre-University examination conducted by a recognized Board/ University.
Percentage of Marks in Class 12th/Qualifying Exam: -- Roll Number of Class 12th/Qualifying Exam: --
Appearing for Improvement of Class 12th/Qualifying
Exam:
NO Mode of preperation: OTHERS
Name and Address of the School/College from where
passed / appearing:
Vidyodaya P.U. College Vidyodaya Boys P.U. College, Byrapura Grama, T.Narasipura, Mysore dist., Karnataka
Candidate's Mailing Address
Address: Manjunath.S, s/o Sripathy.V, 735/2, PLD Bank Road Locality: New Extension
City/Town/Village: T.Narasipura District: Mysore
State: KARNATAKA Pin Code: 571124
Email Address: [email protected] Mobile Number: 9449778191
Land Line Number: --
Guardian Details
Qualification Occupation Annual Income
Father's/Guardian's: GRADUATE BUSINESS --
Mother's: GRADUATE -- --
Payment Details
Payment Mode: Syndicate Bank e-Challan Transaction ID: 17120082716
Exam Fee: 600 /- Branch Name/Code: NA
Deposit Date: 17/12/2013 -- --
Selected Date for Computer Based Examination of Paper-1
Your selected date for Computer Based Examination: 19/04/2014
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) - 2014. I shall abide by the terms and conditions thereon.
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