JET 2020

Application Form

FTII, Pune
SRFTI, Kolkata

447688
* Application No.

* Course(s) Selected Group-A: Screen Acting

Test Centre Details

Group-A: 15-Feb-2020 Preference 1: Mumbai
* Date of Written Test * Test Centre City Name
(Saturday) Afternoon Preference 2: Pune

Personal Particulars
* Name VIVEK KUMAR
* Mother's Name PRATIMA DEVI * Father's Name DILEEP PRASAD SAH
* Date of Birth 18-Dec-1987 * Category OBC(Non Creamy)
Note: The application is based on your self declaration as belonging to the category applied for and the requisite certification for the
same. If, at any later date, it is found that any or all of the declarations made by you in the application form is/are
false/untrue/suppressed/ due to error(s) of omission/fraudulence, etc., your candidature would automatically be cancelled leading
further to forfeiture of fee.
* Gender Male * Nationality INDIAN
* Are you person with disablity (PwD)? NO
* Address for Communication FLAT NO 810 SRA 1ST BUILDING
SHIVSHAKTI CHSL NEAR MOVIE TIME
MALAD WEST MUMBAI
MUMBAI
Maharashtra-400064
Email-ID iamveevek@gmail.com Alternate Email-ID vivekvishesh@gmail.com
Contact No. - * Mobile No.: 9916160691

Qualification Details:
Main Percentage/
Qualification Qualification/Degree Board/ Marking Exam Year of
Subjects/ CGPA/ Division
Level Name University Scheme Status Passing
Specialization Grade
BIHAR
SCHOOL
10th* MATRICULATION ALL Percentage - 2003 57.42 Second
EXAMINATION
BOARD PATNA
BIHAR
10+2/ INTERMEDIATE PHYSICS
INTERMEDIATE OF
Equivalent EDUCATION CHEMISTRY Percentage - 2006 45.44 Second
SCIENCE
Diploma * COUNCIL MATHEMATICS
PATNA
BHUPENDRA
NARAYAN
BACHELOR OF MANDAL
Graduation* Commerce Percentage Passed 2009 63 First
COMMERCE UNIVERSITY
MADHEPURA
BIHAR
Any Training: I HAVE LEARNT DANCE FROM SHIAMAK DAVAR DANCE INSTITUTE MUMBAI AND FROM SOUL TO SOLE DANCE ACADEMY
MUMBAI. I HAVE BEEN DOING THEATER FOR THE LAST 2 YEARS WITH NADIRA ZAHEER BABBARS EKJUTE THEATER GROUP MUMBAI.
Extra Information:

Mode of Payment: --> Credit/Debit Card

* Transaction Reference No. 14309465 * Payment Date 1/28/2020 2:20:48 PM
Receipt No/ 002901563084/
* * Amount 2000
PG Ref.No. 70002003730

I hereby agree to the JET 2020 guidelines and affirm that the statement made and information furnished by me in the Online
Application Form is true, complete and correct to the best of my knowledge and belief. In the event of any information being
found false or incorrect or ineligibility being detected before or after the examination, my candidature will be rejected and action
can be taken against me. I have read the JET- 2018 information bulletin carefully and I hereby undertake to abide by the same. I
further declare that I fulfill all the conditions of eligibility regarding educational qualifications, etc. prescribed for FTII/SRFTI
admissions.

You are NOT required to send Application Form/any documents/receipt to FTII/SRFTI.

Place
Date
Signature of Applicant
(Application submitted on Tuesday, January 28, 2020 14:24)

(Please Print the form for further reference)