JANUARY JEE(MAIN) 2020

Confirmation Page

Application No. 2003 1086 2665 -

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

Personal Details
Candidate's Name SHANMUGARAJ D Date of Birth 19-06-2002
Mother's Name LOGA D Category OBC- NCL (Central List)
Father's Name DEENADAYALAN G Gender Male
If you are a PwD Candidate, do you have No Nationality Indian
benchmark disability (40% or more /
“Severe” where percentage is not defined)
?
Place of Residence Urban State Code of Eligibility TAMIL NADU
Are You Diabetic? NO Mode of Preparation Self Study

Apply For
Apply For B.E./B.Tech., B. Arch and B.Planning All Question Paper Medium English
Exam City 1st TAMIL NADU - KANCHIPURAM Exam City 2nd TAMIL NADU - CHENNAI
Exam City 3rd TAMIL NADU - VELLORE Exam City 4th TAMIL NADU - SALEM

Additional Details
Are you a Twin No

Contact Details
Address 83/6 SADRAS ROAD Locality THIRUKAZHUKUNDRAM
City/Town/Village THIRUKAZHUKUNDRAM District KANCHIPURAM
State/UT TAMIL NADU Pin Code 603109
Email Address rjd***********@gmail.com Mobile Number (+91) 709****070
Land Line No. with 9894978321
STD code or any
other Contact No.

Fee Payment Details

Payment Mode: Pay through SBI(MOPS) Transaction ID: CPV1173248
Exam Fee: 1300 /- Date of Transaction: 29/09/2019 20:41:12
Fee Submitted On: 29/09/2019
DECLARATION
I hereby declare that all the particulars given by me in this form are true to the best of my knowledge and belief and any mistake / misinformation, detected at the time
of admission or at any stage in future, will result in the cancellation of admission/candidature. I have read the information bulletin and understood all the procedures. In
case I furnish any false information, my result will not be declared/ my candidature will automatically stand cancelled. I shall abide by terms and conditions therein.

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Photograph Signature

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Photograph,Signature

IP Address : 42.111.159.166 Date of Downloading : 29/09/2019 08:41:35 PM