Is below attached photo s application form for iit jam exm

Zone/Scrutiny Code JAM 2021 1OB2 S120J32 S120J32 (Enrolment ID) Keerthireddy M R (Full Name of the Applicant) 28 Mar 2001 Female OBC-NCL (D.0.B) (Gender) (Category) Indian National 9902269293 Ravichandra M G (Mobile Number of Parent/Guardian)) (Name of Parent/Guardian) Communication Address JAM Exam Detalls GURUKULA BEHIND MANASA HOSPITAL MANASA LAYOUT GAURIBIDANUR CHIKKABALLAPUR DISTRICT GAURIBIDANUR Karnataka 561208 JAM Paper Code(s) PH, CY 81055 00508 (Mobile No.) keerthireddymr 28@gmai 1 .com Physics, Chemistry Qualfication Detalls Bengaluru (KA) (Exam City 1) Mysuru (Mysore, KA) (Exam City 2) B.Sc. PHYSICS CHEMISTRY MATHEMATICS Graduated: No; Year of Graduation: 2021 REVA UNIVERSITY Mangaluru (Mangalore, KA) Exam City 3) YELAHANKA Karnataka 560064 JAM 2021 Office Contact Organizing Chairperson, JAM 2021 Indian Institute of Science, Bangalore Bengaluru - 560012 Payment Detalls Payment Mode Transaction Ref. No. Transaction Date 2/10/20 11:40 AM Amount Payment For Online CPAAIIITD5 INR 1050.00 Registration I have fully read and understood the Information Brochure and I shall abide by the Terms and Conditions therein. The responsibility of folowing JAM 2021 website and meeting various deadlines lies with me. 1 understand that the communications from JAM 2021f would be sent by email sms/ web and JAM 2021 will not be held responsible for internet/ mobile network faiure for the same. Keati Reddy MR I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. in the event of suppression or distortion of any fact in my application form, I understand that I will be denied the opportunity to appear in JAM 2021. Further. fany suppression or distortion of facts is found after appeaning in the exam, any admission/ degree/ beneft acquired on the basis of JAM 2021 score/ marks is liable to be canceled 877306041f0a2a5d3a63d32318e621ed Digital Fingerprint: