Joint Entrance Examination (Main) - 2016

CENTRAL BOARD OF SECONDARY EDUCATION

ACKNOWLEDGEMENT PAGE

Application No.

60573404
DO NOT SEND THIS PAGE TO CBSE.

CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.

Personal Details
Name:

ADITYA VINAYAK OTAVKAR

Date of Birth:

24/01/1999

Mother's Name:

VAISHNAVI VINAYAK OTAVKAR

Category

GENERAL

Father's Name:

VINAYAK VYANKOJI OTAVKAR

Person with Disability(PwD):

NO

State of Eligibility:

MAHARASTRA

Percentage of Disability:

--

Gender:

MALE

Are you the only child?:

NO

Nationality:

INDIAN

Place of Residence:

URBAN

Aadhaar Number (UIDAI):

--

You need scribe/reader ?:

NO

Examination Details
Applying For:

JEE(Main) Paper - 1 (B.E./B.Tech.) Only

Mode of Examination:

PEN AND PAPER BASED EXAMINATION

Question Paper Medium:

ENGLISH

1st Choice of Exam Centre:

MUMBAI

2nd Choice of Exam Centre:

THANE

3rd Choice of Exam Centre:

NASIK

4th Choice of Exam Centre:

PUNE

Academic Details
Year of passing class 10th:

2013

Year of Passing or Appearing class 12th/Qualifying Exam: 2016

Place of 12th class schooling:

CITY

Type of Institution of Class 12th/Qualifying Exam:

GOVERNMENT

School Board of class 12th/Qualifying Exam:

MAHARASTRA STATE BOARD OF SECONDARY AND HIGHER SECONDARY EDUCATION

Name of the Qualifying Examination passed / appearing:

Any Public School/ Board/ University examination in India or in any foreign country recognized as equivalent to
the 10+2 system by the Association of Indian Universities (AIU).

Percentage of Marks in Class 12th/Qualifying Exam:

--

Roll No. of Class 12th/Qualifying Exam:

--

Appeared/Appearing for Improvement of Class

12th/Qualifying Exam:

NO

Mode of preperation:

COACHING

Name and Address of the School/College from where

passed/appearing:

JAI BHARAT HIGH SCHOOL AND JR COLLEGE O-B 8 1-10 MULUND COLONY MUMBAI 400082

Candidate's Mailing Address

Address:

ARUNODAY TOWER A/403 KOKAN NAGAR

Locality:

BHANDUP WEST

City/Town/Village:

MUMBAI

District:

KURLA

State:

MAHARASTRA

Pin Code:

400078

Email Address:

aditya24011999@gmail.com

Mobile Number:

9757086890

Land Line Number:

02225946205

Guardian Details
Qualification

Occupation

Annual Income

Father's/Guardian's:

GRADUATE

GOVERNMENT SERVICE

RS. 300001 -400000

Mother's:

OTHERS

GOVERNMENT SERVICE

RS. 300001 -400000

Payment Mode:

Credit / Debit Card

Transaction ID:

ESM24176309024

Exam Fee:

1000 /-

Date of Transaction:

16-12-2015 22:15:58

Card Type:

VISA/Master Card

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Payment Details

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) - 2016. I shall abide by the terms and conditions thereon.

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