Website: www.cbse.nic.

in
Email: jeeobserver17@gmail.com Phone: 0120-2427771

Central Board of Secondary Education

(An Autonomous Organization Under the Union Ministry of Human Resource Development (Govt. of India)
H-149, Sector – 63, Noida 201309 (UP).
ACCEPTANCE FORM
Sh. Rajbir Singh,
Executive Director, (JAB)
Central Board of Secondary Education,
H-149 Sector - 63,
Noida 201309 (UP).

Subject: Appointment of Observer for JEE (Main) to be held on 8th April 2018 (Sunday) – reg.

Sir/Madam,

I hereby convey my acceptance to act as Observer for the JEE (Main) to be held on 8th APRIL 2018(Sunday),
conducted by the Central Board of Secondary Education (CBSE).My appointment and any other information relating to
this examination will be kept as strictly confidential. Further, I undertake to perform this work perfectly in accordance with
the instructions of the Board.
I certify that I have no near relative appearing for JEE (Main) 2018 and I also certify that I have not written any
book, Guide or Notes for this examination. Please mention the choice of city for performing JEE (Main) 2018 duty of
observer within the radius of 300Km as per list overleaf : Patna_/ _Ranchi.
Yours faithfully,

Name:_Dr. Ajay Kumar________

Designation:__Assistant Professor_____

Date of Birth :05/06/1978_________

Correspondence Address : Civil Engineering Department_______

_____NIT Patna, Patna-800005,Bihar_______

Ph. No.: ________________; Mob. No: _07549990794_____Email Id : SAJAYDCE@GMAIL.COM

Official address:___Same as Correspondence Address

Ph. Nos.: ________________ Mob. No:__ 07549990794____Email Id : AJAY@NITP.AC.IN

3 0 0 7 9 6 1 9 0 1 7
Bank Account No.

S B I N 0 0 0 3 1 1 3
IFSC Code of Bank

Bank Name: ___ State Bank of India, Chauhatta______________

Bank Address: _______Ashok Rajpath, Patna_______

CERTIFICATE BY THE HEAD OF INSTITUTION / UNIVERSITY / ORGANIZATION

This is to certify that above particulars are correct as per our official record. In case of retired, please get it certified from
your last organization/institution.
(Signature
with Seal)
Note:
1) If you had performed the duty as observer during JEE (Main) – 2017 , place of duty ____________________.
2) Please attach a photocopy of cheque/ cancelled Cheque along with the acceptance to verify the account details.
3) List of tentative cities of examination mentioned overleaf.
4) In case you will be attaining the age of 70 years on 01/04/2018, they will not be considered for appointment as
observer.
5) Person whose near relation(s) is/are appearing at the JEE(Main) 2018 at any of the centre in India are not
eligible to be appointed as observer.
6) You may send the acceptance proforma by speed post or by email on jeeobserver2018@gmail.com