सं युत वे श परीा (मु य)
Joint Entrance Examination (Main)
JEE(Main)
APPLICATION NUMBER 240310050554
DO NOT SEND THIS PAGE TO NATIONAL TESTING AGENCY (NTA).
THE CANDIDATE IS REQUESTED TO RETAIN THE PRINTOUT OF THE CONFIRMATION PAGE FOR FUTURE REFERENCE.
यितगत योरा (Contact Details) वतमान पता (Present Address)
पता (Premises No/ Name)
NO 17
थानीयता (Locality)
SRIRAM ENGINEERING उप-थानीयता (SubCOLLEGE
Locality)(Optional)
ईमेल पता (Email Address)
BINDHUPRADEEP2000@GMAIL.COM
NA
दे श कोड (Country Code)
+91
दे श (Country)
INDIA
राय (State)
TAMILNADU
िजला (District)
Thiruvallur
मोबाइल नंबर (Mobile Number)
+91 - 9952996061
वै किपक संपक सू (Alternate
Contact No.) (Optional)
9677253794
िपन कोड (Pin Code)
602024
थायी पता (Permanent Address)
पता (Premises No/ Name)
NO 17
थानीयता (Locality)
SRIRAM ENGINEERING COLLEGE
उप-थानीयता (SubLocality)(Optional):
NA
दे श (Country)
INDIA
राय (State)
TAMILNADU
िजला (District)
Thiruvallur
िपन कोड (Pin Code)
602024
यितगत योरा (PERSONAL DETAILS)
अयथी का नाम (Candidate's Name)
P MADHAV
अयथी की जम ितिथ (Candidate's
Date of Birth)
26-06-2006
िपता / अिभभावक का नाम (Father /
Guardian Name)
PN PRADEEP
माता / अिभभावक का नाम (Mother /
Guardian Name)
KN BINDHU
िलंग (Gender)
MALE
राटीयता (Nationality )
INDIAN
पहचान के कार (Identity Type)
CLASS XII ADMIT
CARD ISSUED BY THE
BOARD
पहचान संया (Identification
Number)
214267502419
राय / केद शािसत दे श जहाँ से 12वीं /
समक उीण / उपिथत (State/ UT
TAMILNADU
from where 12th/ Equivalent Passed/
Appearing)
े णी (Category )
GENERAL
या आपको मधुमेह ह  (Are You
Diabetic ? )
िनवास की जगह ( Place of Residence
RURAL
)
NO
यिद आप एक Pwd उमीदवार ह , तो या
आपके पास ब चमाक िवकलांगता है (If you
NA
are a Pwd Candidate, do you have
benchmark disability)?
वािषक पािरवािरक आय ( Annual
Family Income )
योयता परीा म कू ली िशा का
तैयारी का तरीका ( Mode of Preparation
Tutorial Classes in School मायम ( Medium of schooling in
)
qualifying exam )
100001-200000
English
परीा कद िववरण (Exam centre Details)
के िलए आवे दन (Apply For)
B.E./B.Tech
परीा के स के िलए आवे दन कर
(Session Of Exam Apply For)
Session 1 & Session 2
िपता / अिभभावक यवसाय (Father /
Guardian Occupation)
MEDICAL
िपता / अिभभावक योयता (Father /
Guardian Qualification)
Matriculate
माता / अिभभावक यवसाय (Mother /
Guardian Occupation)
Business
माता / अिभभावक योयता (Mother /
GRADUATE
Guardian Qualification)
परीा राय-पहला िवकप (Exam State
TAMILNADU
1st Choice )
परीा शहर-पहला िवकप (Exam
City 1st Choice )
CHENNAI
परीा राय-दूसरा िवकप (Exam State
TAMILNADU
2nd Choice )
परीा शहर-दूसरा िवकप (Exam
City 2nd Choice )
VELLORE
परीा राय-तीसरा िवकप (Exam State
TAMILNADU
3rd Choice )
परीा शहर-तीसरा िवकप (Exam
City 3rd Choice )
KANCHIPURAM
परीा राय-चौथा िवकप (Exam State
TAMILNADU
4th Choice )
परीा शहर-चौथा िवकप (Exam
City 4th Choice )
TIRUVANNAMALAI
न प मायम (Question Paper Medium)
English
10वीं या समक योयता िववरण (10th or equivalent Qualification Details)
उीण की िथित (Pass Status)
Passed
उीण / सिमिलत होने का वष (Year
of Passing/Appearing)
2022
योयता परीा (Qualifying Exam)
10 th or equivalent
कू िलंग का थान (Place of
Schooling)
Urban
कू ल / कॉलेज का कार (Type of School
Private Unaided
/ College)
योयता परीा राय (Qualifying
Examination State)
TAMILNADU
योयता परीा िजला (Qualifying
Examination District)
कू ल बोड (School Board)
CENTRAL BOARD OF SECONDARY
EDUCATION
का 10वीं की माकशीट/माणप के
अनुसार िवालय/कॉलेज का नाम
MAHarishi vidya mandir
(School/College name should be as
senior secondary school
per Class 10th Mark sheet/certificate)
कू ल / कॉलेज का पता (School /
College Address)
melpakkam , poonamalee taluk
कू ल / कॉलेज िपनकोड (School / College
600077
Pincode)
रोल नंबर 10वीं माणप के अनुसार
(Roll number as per 10th
certificate)
20193771
पिरणाम मोड (Result Mode)
Percentage
पूणा क (Total Marks)
500.0
381.0
ितशत (Percentage)
76.20
ातांक (Obtain Marks)
Thiruvallur
th
12वीं या समक योयता िववरण (12 or equivalent Qualification Details)
उीण / सिमिलत होने का वष (Year
of Passing/Appearing)
उीण की िथित (Pass Status)
Appearing
योयता परीा (Qualifying Exam)
The final examination of
the 10+2 system,
conducted by any
recognized Central/ State
Board, such as the Central
कू िलंग का थान (Place of
Board of Secondary
Schooling)
Education, New Delhi;
Council for the Indian
School Certificate
Examinations, New Delhi
etc.
2024
Urban
कू ल / कॉलेज का कार (Type of School
योयता परीा राय (Qualifying
Government Aided Private
/ College)
Examination State)
TAMILNADU
योयता परीा िजला (Qualifying
Examination District)
CENTRAL BOARD OF SECONDARY
EDUCATION
Thiruvallur
कू ल बोड (School Board)
का 12वीं की माकशीट/माणप के
ADITYA VIDYASHRAM
अनुसार िवालय/कॉलेज का नाम
कू ल / कॉलेज का पता (School /
GURUGRAM CAMPUS
(School/College name should be as
College Address)
E TECHNO
per Class 12th Mark sheet/certificate)
कू ल / कॉलेज िपनकोड (School / College
600077
Pincode)
रोल नंबर 12वीं माणप के अनुसार
(Roll number as per 12th
certificate)
avadi , chennai
NA
अितिरत जानकािरयां (Additional Details)
या आप जु ड़वा ह और दोनों जे ईई (मे न) - 2024 के िलए आवे दन कर रहे
NO
ह (Are you a Twin and both applying for JEE (MAIN) – 2024)?
आपातकालीन संपक िववरण प (Emergency Contact Details)
दे श (Country)
INDIA
दे श कोड (Country Code)
+91
मोबाइल नंबर (Mobile Number)
9952906938
ईमेल आईडी (Email ID)
daredevil26062006@gmail.com
उमीदवार ारा अपलोड की गई छिवयां (IMAGES UPLOADED BY THE CANDIDATE)
PHOTO
SIGNATURE
शु क भु गतान िववरण (Fee Payment Details)
भु गतान का कार (Payment Mode)
Online
लेन-दे न आईडी (Transaction ID)
IGAQKGFLR2
परीा शु क (Exam Fee)
2000.0
शु क जमा िकया गया (Fee Submitted
On)
04-11-2023 20:45:13 PM
लेन-दे न की ितिथ (Date of
Transaction)
01-01-1900 00:00:00 AM
घोषणा (Declaration)
I declare that information furnished by me in the application form is true in all respect and nothing is concealed. In case any entry or information is found to
be false, this shall entail automatic cancellation of my admission besides rendering me liable to such actions as deemed fit by the University. I hereby
undertake that I have carefully gone through the eligibility conditions prescribed in the prospectus for the programme. I am applying after satisfying that I
meet the eligibility conditions. If at any stage it is found that I do not fullfill the minimum prescribed criteria, my admission, if granted, shall stand cancelled
and I shall have no right to admission whatsoever.
IP Address : 45.120.58.124
Date of Downloading : 01-12-2023 18:11:00 PM