Joint Entrance Examination (Main) - 2018
CENTRAL BOARD OF SECONDARY EDUCATION
ACKNOWLEDGEMENT PAGE
Application No. 80205584
DO NOT SEND THIS PAGE TO CBSE.
CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.
Personal Details
Name: SATYAVOLU SAHITI Date of Birth: 08/11/2000
Mother's Name: SATYAVOLU MYTHILI Category GENERAL
Caste Name NA Father's Name: SATYAVOLU SRINIVAS
Person with Disability(PwD): NO State of Eligibility: ANDHRA PRADESH
Percentage of Disability: -- Gender: FEMALE
Are you Diabetic :: NO Nationality: INDIAN
Place of Residence: URBAN You need scribe/reader ?: NO
Examination Details
Applying 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: VISAKHAPATNAM 2nd Choice of Exam Centre: VIJAYAWADA
3rd Choice of Exam Centre: GUNTUR 4th Choice of Exam Centre: TIRUPATI
Academic Details
Year of passing class 10th: 2016 Place of 12th class schooling: CITY
Year of Passing or Appearing class 12th/Qualifying Exam: 2018 Type of Institution of Class 12th/Qualifying Exam: PRIVATE
School Board of class 12th/Qualifying Exam: ANDHRA PRADESH BOARD OF INTERMEDIATE 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: -- Roll No. of Class 12th/Qualifying Exam: --
Appeared/Appearing for Improvement of Class NO Mode of preperation: SELF STUDY
12th/Qualifying Exam:
Roll Number of Class 12th/Qualifying Examination of
Improvement Examination:
Name and Address of the School/College from where ADITYA JUNIOR COLLEGE SRINAGAR, KAKINADA
passed/appearing:
Candidate's Mailing Address
Country: India State: ANDHRA PRADESH
District: EAST GODAVARI Address: 65-10-1A, S4, SRINILAYAM APARTMENT
Locality: NARASANNANAGAR City/Town/Village: KAKINADA
Pin Code: 533003 Email Address: sri*******@gmail.com
Mobile Number: 817****749
Guardian Details
Qualification Occupation Annual Income
Father's/Guardian's: -- -- --
Mother's: -- -- --
Payment Details
Provider Name: Syndicate Bank Payment Gateway Payment Mode: Electronic Payment Gateway
Fee Type: Examination Fee Transaction Amount: 500 /-
Transaction ID: LSM35876617334 Date of Transaction: 11-12-2017 09:42:52
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) - 2018. I shall abide by the terms and conditions thereon.
Images Uploaded by Candidate
Candidate Photograph Candidate Signature Parent/Guardian Signature
