Joint Entrance Examination (Main) - 2016
CENTRAL BOARD OF SECONDARY EDUCATION
ACKNOWLEDGEMENT PAGE
Application No.
60441924
DO NOT SEND THIS PAGE TO CBSE.
CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.
Personal Details
Name:
EVEN TARASH TUDU
Date of Birth:
28/09/1997
Mother's Name:
BIJAMANI TUDU
Category
ST
Father's Name:
DEEPAK KUMAR TUDU
Person with Disability(PwD):
NO
State of Eligibility:
ODISHA
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:
BHUBANESWAR
2nd Choice of Exam Centre:
CUTTACK
3rd Choice of Exam Centre:
BALASORE
4th Choice of Exam Centre:
BERHAMPUR
Academic Details
Year of passing class 10th:
2013
Year of Passing or Appearing class 12th/Qualifying Exam: 2015
Place of 12th class schooling:
CITY
Type of Institution of Class 12th/Qualifying Exam:
GOVERNMENT
School Board of class 12th/Qualifying Exam:
ODISHA COUNCIL OF HIGHER SECONDARY 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:
61.66
Roll No. of Class 12th/Qualifying Exam:
303MA356
Appeared/Appearing for Improvement of Class
12th/Qualifying Exam:
NO
Mode of preperation:
SELF STUDY
Name and Address of the School/College from where
passed/appearing:
BJB JUNIOR COLLEGE, BHUBANESWAR Kalpana Road, Infront Of Court, Bhubaneswar, Odisha 751014
Candidate's Mailing Address
Address:
QRT NO. 346, IMMT COLONY
Locality:
Acharya Vihar
City/Town/Village:
Bhubaneswar
District:
Khurda
State:
ODISHA
Pin Code:
751013
Email Address:
[email protected]
Mobile Number:
9776973476
Land Line Number:
06742379274
Guardian Details
Qualification
Occupation
Annual Income
Father's/Guardian's:
GRADUATE
GOVERNMENT SERVICE
RS. 500001-600000
Mother's:
GRADUATE
OTHERS (INCLUDING HOUSE WIFE)
UPTO 100000
Payment Mode:
HDFC Bank e-Challan
Transaction ID:
60441924
Exam Fee:
500 /-
Branch Name/Code:
1252
Deposit Date:
22/12/2015
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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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