SUBMITTED ON : gate.iitd.ac.

in ORGANISING INSTITUTE: INDIAN INSTITUTE OF TECHNOLOGY DELHI

ONLINE APPLICATION FORM FOR JMET 2011

COMPLETE MAILING ADDRESS INCLUDING NAME PHOTOGRAPH
NAME: ANUPAM KAYAL
ADDRESS:
B-15, SRINIKETAN, DUTTAPARA,
BARUIPUR, KOLKATA-700144

PIN CODE: 700144

118167

NOTE: Congratulations! Your application is successfully submitted. No need to mail this to GATE Office, IIT Delhi.

APPLICATION NUMBER : 118167

NAME OF THE CANDIDATE : ANUPAM KAYAL
EXAMINATION CITY (1st Choice) : Kolkata
EXAMINATION CITY (2nd Choice) : Kharagpur
DATE OF ONLINE SUBMISSION (dd/mm/yy) : 27/09/10 AMOUNT : Rs. 375 Only
QUALIFYING DEGREE : B.E./B.Tech./ B.Sc. (Engg.)
QUALIFYING YEAR : 2008
OTHER DETAILS : MOBILE No. : 9163498008
Email Id : anup_kayal02@rediffmail.com
NAME OF PARENT : PARANTAP KAYAL
DATE OF BIRTH (dd/mm/yy) : 22/10/1985
GENDER :M
NATIONALITY : Indian
PERSON WITH DISABILITY :N
CATEGORY : SC
STATE/UT OF PERMANENT ADDRESS : West Bengal :

DECLARATION BY THE CANDIDATE :

I hereby declare that all the particulars stated in this Application Form are true to the best of my knowledge and belief . I
have read the online information on JMET 2011 and I shall abide by the terms and conditions therein. 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
JMET 2011. Further, if any such suppression or distortion of facts is discovered after appearing in JMET 2011, any
admission/degree acquired on the basis of JMET 2011 score is liable for cancellation.

FULL SIGNATURE OF THE CANDIDATE