Post on 27-Jan-2016
Joint Entrance Examination (Main) - 2016CENTRAL BOARD OF SECONDARY EDUCATION
ACKNOWLEDGEMENT PAGE
Application No. 60441924DO NOT SEND THIS PAGE TO CBSE.
CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.
Personal DetailsName: 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 DetailsApplying 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 DetailsYear of passing class 10th: 2013 Place of 12th class schooling: CITY
Year of Passing or Appearing class 12th/Qualifying Exam: 2015 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 Class12th/Qualifying Exam:
NO Mode of preperation: SELF STUDY
Name and Address of the School/College from wherepassed/appearing:
BJB JUNIOR COLLEGE, BHUBANESWAR Kalpana Road, Infront Of Court, Bhubaneswar, Odisha 751014
Candidate's Mailing AddressAddress: QRT NO. 346, IMMT COLONY Locality: Acharya Vihar
City/Town/Village: Bhubaneswar District: Khurda
State: ODISHA Pin Code: 751013
Email Address: event2do@gmail.com Mobile Number: 9776973476
Land Line Number: 06742379274
Guardian DetailsQualification Occupation Annual Income
Father's/Guardian's: GRADUATE GOVERNMENT SERVICE RS. 500001-600000
Mother's: GRADUATE OTHERS (INCLUDING HOUSE WIFE) UPTO 100000
Payment DetailsPayment Mode: HDFC Bank e-Challan Transaction ID: 60441924
Exam Fee: 500 /- Branch Name/Code: 1252
Deposit Date: 22/12/2015 -- --
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 bothJEE(Main) and JEE(Advanced) - 2016. I shall abide by the terms and conditions thereon.
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