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1. Joint Entrance Examination (Main) - 2014
CENTRAL BOARD OF SECONDARY EDUCATION
ACKNOWLEDGEMENT PAGE
Application No. 40888796
DO NOT SEND THIS PAGE TO CBSE.
CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.
Personal Details
Name: MAHAJAN AKSHATA SOPAN Date of Birth: 29/09/1996
Mother's Name: MAHAJAN BHARTI SOPAN Category OBC- NCL (CENTRAL LIST)
Father's Name: MAHAJAN SOPAN RAGHUNATH Person with Disability(PwD): NO
State of Eligibility: MAHARASTRA Percentage of Disability: --
Gender: FEMALE Are you the only child?: NO
Nationality: INDIAN Place of Residence: URBAN
Aadhaar Number (UIDAI): 215299794455 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: MUMBAI 2nd Choice of Exam Centre: NAVI MUMBAI
3rd Choice of Exam Centre: THANE 4th Choice of Exam Centre: NASIK
Academic Details
Year of passing class 10th: 2012 Place of 12th class schooling: CITY
Year of Passing or Appearing class 12th/Qualifying Exam: 2014 Type of Institution of Class 12th/Qualifying Exam: GOVERNMENT
School Board of class 12th/Qualifying Exam: MAHARASTRA STATE BOARD OF SECONDARY AND 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: -- Roll Number of Class 12th/Qualifying Exam: --
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:
RAMNIVAS RUIA JUNIOR COLLEGE MATUNGA EAST MUMBAI 400019
Candidate's Mailing Address
Address: BLDG NO 11 R NO 219 MBPT NEW COLONY Locality: NADKARNI PARK WADALA EAST
City/Town/Village: MUMBAI District: MUMBAI CITY
State: MAHARASTRA Pin Code: 400037
Email Address: sopanrmahajan@gmail.com Mobile Number: 9969987674
Land Line Number: 02224170236
Guardian Details
Qualification Occupation Annual Income
Father's/Guardian's: OTHERS GOVERNMENT SERVICE RS. 300001 -400000
Mother's: MATRICULATE OTHERS (INCLUDING HOUSE WIFE) UPTO 100000
Payment Details
Payment Mode: Credit / Debit Card Transaction ID: MSPD3194855554
Exam Fee: 500 /- Date of Transaction: 14-12-2013 19:44:40
Card Type: VISA/Master Card -- --
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) - 2014. I shall abide by the terms and conditions thereon.
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