Jcece Engineering Form - Jharkhand

FORM - 1
Application No.
>kj[k.M ljdkj
>kj[k.M la;qä ços'k çfr;ksfxrk ijh{kk i"kZn] /kqokZ] jk¡ph
(Office Use Only)
>kj[k.M la;qä ços'k çfr;ksfxrk ijh{kk&2009
JHARKHAND COMBINED ENTRANCE COMPETITIVE EXAM- 2009
vkosnu&i=
¼lk{kkRdkj ds le; Hkjk tk;sxk½
Selected for admission against ....................................................................Category seat at
................................................................................. Institute/College in ........................................................................... Branch/ Course.
...................................................
vkosnd dk gLrk{kj
¼lk{kkRdkj ds le;½
¼vH;FkhZ bls vius gkFkksa ls Hkjsa½
...................................................
vkoaVu inkf/kdkjh dk gLrk{kj
ijh{kk fu;a=d
>k-l-ç-ç-ijh- i"kZn
01. vH;FkhZ dk uke (Name of the Candidate) :-
(a) vaxzsth ds cM+s v{kjksa esa
(In Block Letter of English) :-
(b) fgUnh esa (In Hindi) :
02. fyax ¼iqŒ@L=hŒ½ Sex (M / F) 03. ck¡;s gkFk ds vaxwBs dk fu'kku
04. firk dk iwjk uke
Name of Father :...........................................................
05. ekrk dk iwjk uke
Name of Mother :...........................................................
06. firk dk O;olk;
Occupation of Father :------------------------------------------------------- 07. dksfV ¼Category½ (Gen/SC/ST/BC/MBC)..........................
08. tUe frfFk (Date of Birth) frfFk (Date) ekg (Month) o"kZ (Year)
09. LFkk;h irk (Permanent Address) .................................................................................................................
1 9
.................................................................................................................
....................................................................Pin Code
nwjHkk"k la0 (Telephone No.) ..............................................................................................................

10. 'kS{kf.kd ;ksX;rk (Educational Qualification)
Lrj
Level
ek/;fed
Matric
baVj ;k +2
Inter or +2
11. vH;FkhZ dk ?kks"k.kk %&
ijh{kk esa fy;s x;s fo"k;
(Subjects taken in
the Exam.)
Ldwy@egkfo|ky; dk uke
Name of the School/ College
mÙkh.kZ@lfEefyr gksus dk o"kZ
Year of passing/ appearing
eSa-----------------------------------------------------------------------------------------------------
Jh-----------------------------------------------------------------------------------------iq=@iq=h] ,rn~
}kjk ?kksf"kr djrk gw¡ @djrh gw¡ dh mijksDr dh xbZ çfof"V lR;
,oa lgh gS rFkk nkos ds lEcU/k esa lHkh çek.k&i= eSa lk{kkRdkj
ds le; ewy :i esa çLrqr d:¡xk@d:¡xhA ;fn] mijksDr fooj.k
xyr gqbZ ;k okafNr ewy çek.k&i= ugh çLrqr dj ik;k@ik;h
rks eSa viuk ços'k lEcU/kh nkok NksM+ nw¡xk@nw¡xh ,oa fof/kd
dkjZokbZ dk Hkkxh cuw¡xk@cuw¡xhA lkFk gh çrhKk djrk gw¡ fd u
gh eSa ços'k ds ckn jSfxax esa Hkkx ywaxk u gh lg;ksx d:¡xk@d:¡xhA
;fn ,slk ik;k tkrk gS rks eSa laLFkku ls fu"dklu dk Hkkxh
cuw¡xk@cuw¡xhA
Paste recent Postcard size photograph dully
attested by head of the last institution attendent
or gazetted officer with seal and name.
(Don't attest on the face of photograph)
vH;FkhZ dk gLrk{kj %
vaxzsth esa ---------------------------------------------------------------------------------------------
fgUnh esa ----------------------------------------------------------------------------------------------
fnukad -------------------------------------------------- LFkku ---------------------------------
I, ............................................... certify that the photo
pasted above belongs to Shri/Miss/
Mrs..............................................................................
Name of the attesting officer
Signature & Seal
¼flQZ lEcfU/kr laLFkkuksa ds fy,½
Jh@lqJh@Jhefr ________________________________________________________Js.kh _________________ es/kk
Øekad_________________________________'kk[kk@ikB~;Øe esa ukekadu lHkh okaNuh; çek.k&i=ksa dh tk¡p dj yh x;hA
laLFkku dk eqgj
gLrk{kj
çkpk;Z@funs'kd

dEI;wVj QkeZ uañ&2 esa Hkjs tkus okys
dksMksa dh fooj.kh
(I) ikB~;Øe çkFkfedrk dksM
ikB~;Øe dk uke dksM
,e0ch0ch0,l0 1
i'kqikyu 2
Ñf"k 3
okfudh 4
vfHk;a=.k ¼ljdkjh½ 5
vfHk;a=.k ¼futh½ 6
(III) fodykaxrk dksM
fodykaxrk dksM fodykaxrk
çdkj
çdkj
dksM
va/kkiu 1 'kkfjjhd fo- 3
cgjkiu 2 dksbZ ugha 4
(IV) SMQ ¼lSU; deZpkjh dksVk½ çkFkfedrk dksM
(i) 'kghn@viax gq, lSfudksa ds cPps 1
(ii) HkwriwoZ lSfudksa ds cPpsA 2
(iii) lsuk esa lsokjr tokuksa ds cPpsA 3
(iv) lsuk esa lsokjr vf/kdkfj;ksa ds cPpsA 4
(v) HkwriwoZ lSfudA 5
(vi) vkfJrA 6
(vii) buesa ls dksbZ ughaA 7
(II) ijh{kk dsUnzksa ds uke ,oa dksM
dsUnz dksM dsUnz dksM
jk¡ph 14 gtkjhckx 04
/kuckn
te'ksniqj
nqedk
12
18
11
cksdkjks 13

Section - A
APPLICATION FORM No. II
J.C.E.C.E. -2009
(Please fill in English capital letters in self handwriting only)
Side - 1
Write 1 for +2 passed
Write 2 for Appearing
If passed write percentage of marks
Subject Group Code applied for
(Write for PCM-1 for PCB-2 for PCMB-3)
APPLICATION No.
REGISTRATION No.
For Office use only
1. Name of the Candidate (as per 10th class records) .
2. Father's Name (as per 10th class records).
3. Date of Birth
Day Month Year
4. Sex 5. Category
6. PH.
Handicaped
7. If SMQ
write SMQ Code
I II III
Male = M
Female = F
Gen-1 SC-2
ST-3 BC-4
MBC-5
(see back side (see back side
Table No. III) for SMQ code) Table IV
8. Write three priority code for
Stream
See back side of this page
9. Exam. Centre City .Code
See back side of this page
First Second
10. DD No. .............................. DD Date .......................... DD Amount ................................. Bank Name .................................
11. Declaration of the Candidate : I declare that informations furnished above are correct and all certificates in original
is lying with me or I am able to procure required certificates and will be produced at the time of counselling. I shall
forfeit my candidature as well as will be liable for legal action in case any of them is proved to be false at any stage
of admission or thereafter or if I will not produced relevant required original certificates.
Place :
Date : Signature of Parent/Guardian Signature of the Candidate
Section - B
LEFT THUMB IMPRESSION.
13. Photograph
12. Address for Correspondence (IN CAPITAL LETTERS)
Name :
Father's Name :
Paste the B/W passport
size Photograph with
date of photograph.
Postal Address :
14. Signature of the Candidate
PIN CODE