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This document is an application form for preparation of the state merit list based on the NEET(UG)-2020 exam results. It contains personal information of the applicant such as name, date of birth, gender, category, communication details, qualification details including intermediate/12th marks and NEET exam application number, roll number, percentile score and marks obtained. It also lists the documents uploaded including NEET scorecard, residential certificate, and marksheets. The payment status and applicant declaration are also included.

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Vishal Kumar Singh
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© © All Rights Reserved
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59 views3 pages

Application Form Preview

This document is an application form for preparation of the state merit list based on the NEET(UG)-2020 exam results. It contains personal information of the applicant such as name, date of birth, gender, category, communication details, qualification details including intermediate/12th marks and NEET exam application number, roll number, percentile score and marks obtained. It also lists the documents uploaded including NEET scorecard, residential certificate, and marksheets. The payment status and applicant declaration are also included.

Uploaded by

Vishal Kumar Singh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

APPLICATION NO : 1700794

APPLICATION FORM PREVIEW


ONLINE APPLICATION FORM FOR PREPARATION OF STATE MERIT LIST ON THE BASIS OF NEET(UG) - 2020 RESULT

PERSONAL INFORMATION

APPLICATION NO. : 1700794

APPLICANT'S NAME: VISHAL KUMAR SINGH

FATHER'S/GUARDIAN'S NAME: INDRAJEET SINGH

MOTHER'S NAME: USHA DEVI

DATE OF BIRTH: 23-11-1998

GENDER: MALE

RESIDENTIAL STATUS: PERMANENT RESIDENT OF JHARKHAND

CATEGORY: GEN

ECONOMICALLY WEAKER SECTION: NO

PERSONS WITH BENCHMARK DISABILITIES NO


(PWBD):

NATIONALITY: INDIAN

AADHAAR NUMBER: 467966058221

MOBILE NUMBER: 8789319469

EMAIL ID: [email protected]

COMMUNICATION DETAILS: ADDRESS: NEAR RANI SATI MANDIR KARKEND BAZAR P.O.KUSUNDA
LOCALITY: DHANBAD
CITY/TOWN/VILLAGE: DHANBAD
STATE/U.T.:   JHARKHAND (JH)
DISTRICT: DHANBAD
PINCODE: 828116

PERMANENT COMMUNICATION DETAILS: ADDRESS: NEAR RANI SATI MANDIR KARKEND BAZAR P.O.KUSUNDA
LOCALITY: DHANBAD
CITY/TOWN/VILLAGE: DHANBAD
STATE/U.T.:   JHARKHAND (JH)
DISTRICT: DHANBAD
PINCODE: 828116

Qualification Details

COURSE DETAILS

INTERMEDIATE/ 12TH EDUCATIONAL DETAILS

EDUCATIONAL DETAIL INTERMEDIATE / 12TH

PASS STATUS PASSED

NAME OF THE BOARD/UNIVERSITY JAC RANCHI

YEAR OF PASSING 2016

OBTAINED MARKS PERCENTAGE (%) 71.0000

ROLL NO /ENROLL NO 10490

NAME OF INSTITUTE/COLLEGE & ADDRESS P. K. ROY MEMORIAL COLLEGE DHANBAD JHARKHAND


 

SUBJECT   TOTAL MARKS   MARKS OBTAINED   MARKS OBTAINED IN (%)


ENGLISH   100.000   60.000   60.0000000000
PHYSICS   100.000   80.000   80.0000000000
CHEMISTRY   100.000   62.000   62.0000000000
BIOLOGY   100.000   87.000   87.0000000000
    OVERALL PERCENTAGE   72.25

NEET(UG)-2020 APPLICATION NEET(UG)-2020 ROLL NEET(UG)-2020 PERCENTILE TOTAL MARKS OBTAINED(OUT OF 720) IN NEET ALL INDIA
       
NUMBER NUMBER SCORE NEET(UG)-2020 RANK
200410892864   4602003364   74.7927309000   288.00   343726  

UPLOADED CERTIFICATES / DOCUMENTS

SCORE CARD OF NEET(UG) - 2020

RESIDENTIAL CERTIFICATE

INTERMEDIATE/ 12TH MARKS-SHEET

INTERMEDIATE/ 12TH PASSING CERTIFICATE

INTERMEDIATE/ 12TH ADMIT CARD

Payment Status

FEE DETAILS BANK REFERENCE NO. TRANSACTION DATE PAYMENT MODE

00000500.00 JCECEBJEE-OL112842 31-10-2020 ONLINE

Declaration

I HEREBY DECLARE THAT I HAVE READ AND UNDERSTOOD THE CONDITIONS OF ELIGIBILITY FOR PREPARATION OF STATE MERIT LIST ON THE BASIS OF
NEET(UG)-2020. I FULFIL THE MINIMUM ELIGIBILITY CRITERIA AND I HAVE PROVIDED THE NECESSARY INFORMATION IN THIS REGARD. IN THE EVENT OF THE
INFORMATION BEING FOUND INCORRECT OR MISLEADING, MY CANDIDATURE SHALL BE LIABLE TO CANCELLATION AT ANY TIME. FURTHER, I HAVE CAREFULLY READ
ALL THE INSTRUCTIONS AND I ACCEPT THEM AND SHALL NOT RAISE ANY DISPUTE IN FUTURE OVER THE SAME.

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