2/14/2018 NEET- 2018: Confirmation Page for Application Number :40292579

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CONFIRMATION PAGE - NEET (UG) 2018

Application / Registration No. 40292579

अ थ का नाम (Candidate's Name) VIJAY ज ितिथ (Date of Birth) 11/10/1999

माता का नाम (Mother's Name) JAGDEVI िलंग (Gender) Male

िपता का नाम (Father's Name) YADAVRAO वग (Category) OBC

क ा बारहवीं / यो ता परी ा उ ीण करने /परी ा का वष

िद ां ग
(Year of Passing/Appearing Class-XII/Qualifying 2017 No
(Person with disability)
Exam)

पा ता का रा /दे श
Karnataka रा ीयता (Nationality) Indian
(State/Country of Eligibility)

ा ां क का ितशत ( % of Marks obtained in Class

प का मा म (Medium of Question Paper))# English 76.66
12th)

मोबाइल नंबर (Mobile No.) 91xxxxxx1782 ईमेल पता (Email Address) vjxxxxxx@gmail.com

परी ा के के िवक (Choice of Examination

(1) HYDERABAD ( 5127) (2) GULBARGA ( 5054) (3) BANGALORE ( 5050)
Centre)

DECLARATION: - I hereby solemnly and sincerely affirm that all the particulars stated by me in the Application Form are true and correct. Even the spelling
of names and category are also correct also. I have not concealed any information. However, if any information furnished herein is found fraudulent, incorrect
or untrue, I will be liable for criminal prosecution which will result in cancellation of my candidature. Further that the selection and admission to the course is
liable to be cancelled. I agree to abide by the Rules and Regulations governing the Examination as contained in the Information Bulletin for NEET- 2018 which
I have gone through carefully. I further declare that I have not submitted any other application for NEET-2018 and mobile number and email address given in
the form are correct and my own or of my parents'.

Signature

Photo

Complete mailing address:

Address 104, GANDHI CHOWK, KEB OFFICE

City AURAB B

State /Country Karnataka Pin Code 585326

Details of Transaction(SBI Bank).

Transaction ID.: IGACXIVMX0 Total Amount: 1400 Date of Transaction: 2/14/2018 11:32:40 AM

Card Type : VISA/Master Card

Registration No: Printed On : 14/02/2018

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2/14/2018 NEET- 2018: Confirmation Page for Application Number :40292579

40292579

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