Joint Entrance Examination (Main) - 2016

CENTRAL BOARD OF SECONDARY EDUCATION

ACKNOWLEDGEMENT PAGE

Application No.

60149199
DO NOT SEND THIS PAGE TO CBSE.

CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.

Personal Details
Name:

SWAMINATHAN R

Date of Birth:

18/01/1998

Mother's Name:

V.S.POORNA

Category

GENERAL

Father's Name:

A.RAMESH

Person with Disability(PwD):

NO

State of Eligibility:

TAMIL NADU

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:

COMPUTER BASED EXAMINATION

Choice of Online Exam Centre:

CHENNAI

Question Paper Medium:

ENGLISH

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:

TAMIL NADU BOARD OF HIGHER SECONDARY EDUCATION

Name of the Qualifying Examination passed / appearing:

Any Public School/ Board/ University examination in India or in any foreign country recognized as equivalent to
the 10+2 system by the Association of Indian Universities (AIU).

Percentage of Marks in Class 12th/Qualifying Exam:

73.5

Roll No. of Class 12th/Qualifying Exam:

809909

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:

GILL ADARSH MATRIC HR SEC SCHOOL 46,V.M.STREET,BALAJI NAGAR,ROYAPETTAH,CHENNAI-14

Candidate's Mailing Address

Address:

3,KARTHIK FLATS,13/27,NALLAPPAN STREET

Locality:

MYLAPORE

City/Town/Village:

CHENNAI

District:

CHENNAI

State:

TAMIL NADU

Pin Code:

600004

Email Address:

swamimessi@gmail.com

Mobile Number:

9884218631

Land Line Number:

--

Guardian Details
Qualification

Occupation

Annual Income

Father's/Guardian's:

GRADUATE

ENGINEERING

RS. 800001 AND ABOVE

Mother's:

GRADUATE

OTHERS (INCLUDING HOUSE WIFE)

--

Payment Mode:

Credit / Debit Card

Transaction ID:

ESMP4193906730

Exam Fee:

500 /-

Date of Transaction:

25-12-2015 18:35:37

Card Type:

VISA/Master Card

--

--

Payment Details

Selected Date for Computer Based Examination of Paper-1

Your selected date for Computer Based Examination:

No date is selected.
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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