JNEE - Admission with Scholarship and with Fee Relaxation - form B
संयुक्त राष्ट्रीय महिला प्रवेश परीक्षा-2013

Applicant Details 1.1 Course applied for:   ----Select---- B.Arch B.Com(Hons) B.Com(Pass) B.Com-LLB B.Design B.Design-MBA B.Pharma B.Pharma-MBA B.Sc B.Sc- MLT B.Tech B.Tech-M.Tech/MBA BA (Hons) BA-LLB BBA BBA-LLB BCA BJMC BPT D.Pharma DET-B.Tech DET-B.Tech-M.Tech/MBA Dip in Arch(DA) Dip in Eng Tech(DET) Dip in Int.Des(DID) LLB LLM M.Pharma M.Pharma ( Part Time ) M.Pharma+PhD M.Sc M.Sc+PhD M.Tech M.Tech+PhD M.Tech-(Part Time) MA MA+ PhD MBA MBA(Part Time) MBA+PGDBM MBA+PhD MCA MCA Int MJMC MJMC(Part Time) MJMC+PhD Stream Choice: 1. --Select-- 2 . --Select-- 1.2 Course Type:   -----Select------- Normal Integrated- Dual Degree     1.3 Candidate Name: Upload your photo: 1.4 Hostel Accommodation (Please Tick, If Any Specific Preference)   Type : --Select-- Air Cooled Air Condition Room Capacity : --Select-- 1 2 3 4 5 6 7 8 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:   ---Select State--- Andaman and Nicobar Islands Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhattisgarh Dadra and Nagar Haveli Daman and Diu Delhi Goa Gujarat Haryana Himachal Pradesh Jammu and Kashmir Jharkhand Karnataka Kerala Lakshadweep Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Pondicherry Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttarakhand Uttar Pradesh West Bengal        Email:              Mobile:   Telephone No.:   1.10 Caste Category:   ---Select--- General SC ST OBC Other (Specify) If Other Specify:   1.11 Academic Information Course Program Session (Year) University / Board Medium of Instruction Marks / Percentage Obtained Matriculation(10th) Year 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 Intermediate(12th) Year 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 Graduation Year 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 Post Graduation Year 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 Others Year 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1.12 Detail of Entrance Examination Central Level Exam: Examination Name: Year: Year 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 Score: State Level Exam: Examination Name: Year: Year 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 Score: University Level Exam: Examination Name: Year: Year 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 Score: 1.13 Documents Information 10th Mark sheet 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: ---Select--- Cash Cheque/DD Online Payment Cheque/DD No. Name of Bank Date of Deposit   Verification Code :