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Application

This document is an acknowledgment page for the Joint Entrance Examination (Main) - 2018, detailing the application of candidate Satyavolu Siva Teja. It includes personal, examination, academic, mailing, guardian, and payment details, along with a declaration of the accuracy of the information provided. The candidate is applying for JEE(Main) Paper - 1 (B.E./B.Tech.) with selected exam centers in Hyderabad, Visakhapatnam, Warangal, and Vijayawada.

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10 views1 page

Application

This document is an acknowledgment page for the Joint Entrance Examination (Main) - 2018, detailing the application of candidate Satyavolu Siva Teja. It includes personal, examination, academic, mailing, guardian, and payment details, along with a declaration of the accuracy of the information provided. The candidate is applying for JEE(Main) Paper - 1 (B.E./B.Tech.) with selected exam centers in Hyderabad, Visakhapatnam, Warangal, and Vijayawada.

Uploaded by

sivatejasatyavolu08
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Joint Entrance Examination (Main) - 2018

CENTRAL BOARD OF SECONDARY EDUCATION


ACKNOWLEDGEMENT PAGE

Application No. 80379686


DO NOT SEND THIS PAGE TO CBSE.
CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.

Personal Details
Name: SATYAVOLU SIVA TEJA 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: TELANGANA
Percentage of Disability: -- Gender: MALE
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: HYDERABAD 2nd Choice of Exam Centre: VISAKHAPATNAM
3rd Choice of Exam Centre: WARANGAL 4th Choice of Exam Centre: VIJAYAWADA

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: TELANGANA STATE 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: COACHING
12th/Qualifying Exam:
Roll Number of Class 12th/Qualifying Examination of
Improvement Examination:
Name and Address of the School/College from where SRI CHAITANYA JUNIOR KALASALA ROAD NO 1, JUBILEE HILLS, HYDERABAD
passed/appearing:

Candidate's Mailing Address


Country: India State: ANDHRA PRADESH
District: EAST GODAVARI Address: D.NO.65-10-1A, SRI NILAYAM APARTMENTS
Locality: NARASANNA NAGAR City/Town/Village: KAKINADA
Pin Code: 533003 Email Address: siv*******@gmail.com
Mobile Number: 898****429

Guardian Details
Qualification Occupation Annual Income
Father's/Guardian's: POST GRADUATE GOVERNMENT SERVICE RS. 500001-600000
Mother's: POST GRADUATE GOVERNMENT SERVICE RS. 400001 -500000

Payment Details
Provider Name: ICICI Bank Payment Mode: Electronic Payment Gateway
Fee Type: Examination Fee Transaction Amount: 1000 /-
Transaction ID: 425288969 Date of Transaction: 21-12-2017 20:42:07
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

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