Joint Entrance Examination (Main) 2019
NATIONAL TESTING AGENCY
CONFIRMATION PAGE
Application No.
190310318138
DO NOT SEND THIS PAGE TO NATIONAL TESTING AGENCY(NTA).
CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF CONFIRMATION PAGE FOR FUTURE REFERENCE.
Personal Details
Name:
ASHUTOSH MOHAPATRA
Date of Birth:
01/08/2001
Mother's Name:
LAXMI PRIYA MOHAPATRA
Category:
GENERAL
Caste Name:
NA
Father's Name:
ANJAN KUMAR MOHAPATRA
Person with Disability(PwD):
NO
State of Eligibility:
WEST BENGAL
Percentage of Disability:
--
Gender:
MALE
Are you Diabetic:
NO
Nationality:
INDIAN
Place of Residence:
URBAN
Do you need scribe:
NO
Examination Details
Applying For:
JEE(Main) Paper - 1 (B.E./B.Tech.) Only
Mode of Examination:
COMPUTER BASED EXAMINATION
Question Paper Medium:
ENGLISH
1st Choice of Exam City:
KOLKATA
2nd Choice of Exam City:
DURGAPUR
3rd Choice of Exam City:
ASANSOL
4th Choice of Exam City:
BARDHMAN
Academic Details
Year of passing class 10th:
2017
Year of Passing or Appearing class 12th/Qualifying Exam: 2019
Place of 12th class schooling:
CITY
Type of Institution of Class 12th/Qualifying Exam:
GOVERNMENT
School Board of class 12th/Qualifying Exam:
CENTRAL BOARD OF SECONDARY EDUCATION
Name of the Qualifying Exam passed / appearing:
The final examination of the 10+2 system, conducted by any recognized central/ state Board, such as Central
Board of Secondary Education, New Delhi; Council for the Indian School Certificate Examinations, New Delhi;
etc.
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:
SELF STUDY
Roll Number of Class 12th/Qualifying Exam of
Improvement Exam:
--
Name and Address of the School/College from where
passed/appearing:
KENDRIYA VIDYALAYA NO.-2 SALT LAKE IC BLOCK SEC-3 OPP. NICCO PARK KOL. 106
Candidate's Mailing Address
Country:
India
State:
ODISHA
District:
KENDRAPARA
Address:
AT-KHANDEITA ,PO- AYATAN
Locality:
RAJKANIKA
City/Town/Village:
KHANDEITA
Pin Code:
754220
Email Address:
mas*******@gmail.com
Mobile Number:
798****282
Guardian Details
Qualification
Occupation
Annual Income
Father's/Guardian's:
MATRICULATE
GOVERNMENT SERVICE
RS. 200001 - 300000
Mother's:
OTHERS
OTHERS
--
Provider Name:
State Bank of India (MOPS)
Payment Mode:
Electronic Payment Gateway
Fee Type:
Examination Fee
Transaction Amount:
500 /-
Transaction ID:
CPJ8164409
Date of Transaction:
14/09/2018 21:58:49
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.
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