JNEE - 2013 - form B
संयुक्त राष्ट्रीय महिला प्रवेश परीक्षा-2013

Applicant Details

1.1 Course applied for:   Stream Choice:
1. 2 .
1.2 Course Type:      
1.3 Candidate Name: Upload your photo:
1.4 Hostel Accommodation (Please Tick, If Any Specific Preference)  
Type : Room Capacity :
1.5 Reference Name: (if any)  
1.6 Date of Birth:      

Parent's Information

1.7 Father’s / Husband’s Name: E-mail :
       Occupation:   Mobile :
1.8  Mother’s Name : E-Mail :
       Occupation:   Mobile :

Postal Address / Permanent Address

1.9  Address:  
       District:   City:  
       Pin Code:   State:  
       Mobile:   Telephone No.:  
1.10 Caste Category:   If Other Specify:  

1.11 Academic Information

Course Program Session (Year) University / Board Medium of Instruction Marks / Percentage Obtained
Post Graduation

1.12 Detail of Entrance Examination

Central Level Exam: Examination Name: Year: Score:
State Level Exam: Examination Name: Year: Score:
University Level Exam: Examination Name: Year: Score:

1.13 Documents Information

10+2 Mark sheet ( If applicable )
Graduation Mark sheet ( If applicable)
Score Card of Entrance Exam ( If applicable)

1.14 Payment Details

Cost of Application Form is - Rs. 200

Mode of Payment:
Cheque/DD No. Name of Bank Date of Deposit
Verification Code : verification image, type it in the box