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IITM - M.Tech Application

M.Tech. 2013 Admissions (Regular)

GATE Office - IIT Madras - Chennai 600 036
Application form for Admission to M.Tech. Programmes for the year 2013 1. Application Number: 49905 2. Name: Rama Ravi Teja 3. GATE 2013 Reg.No: EE 11582239 (Score: 440) 4. Category/PD: OBC (Non-Creamy) / No 5. Gender / Nationality: Male / Indian 6. Date of Birth: 14/10/91 7. Qualifying Degree: B.E. 8. Qualifying Discipline: Paste your recent Passport Size Electrical & Electronics Engineering Photo Here (EE) 9. Qualifying Status: Final Year Exam NOT Yet Appeared 10. Qual. Month / Year: Jun - 2013 11. Marks / CGPA: 76 % 12. College / Inst. Name / chaitanya bharathi institute of technology / osmania university University: 13. M.Tech. Course Codes: (As per order of preference) 1st Choice EE2Y 14. Address: 2nd Choice EE4Y 3rd Choice 4th Choice 5th Choice 6th Choice 7th Choice 8th Choice

H NO10-5-779/37/A VENKATNAGAR,THUKARAMGATE NORTH LALAGUDA SECUNDERABAD PIN: 500017 15. Email Id: ramaa.raviteja@gmail.com 16(a). Phone Number: 16(b). Mobile: 8121815201 17. Demand Draft Details: (in favour of "The Registrar, IIT Madras" payable at Chennai; Write AppNo and Name on the reverse side of the DD) DD Number DD Date Drawn on DD Amount (Rs.)
De claration by the Applicant I have not been admitted to any academic programme in the country on the basis of GATE SCORE(s) for the year(s) given in this application. I declare that no part of my degree is through correspondence programme. If selected for admission, I agree to abide by the rules and regulations of the Institute. I certify that the information furnished in this application is true to the best of my know ledge and belief. I understand that furnishing false information w ill lead to forfeiture of admission, if offered.

Place: Date: Candidate

Signature of the

Note: Send this form after entering the particulars of DD and affixing the photograph and signature, along w ith copy of SC/ST/OBC (Non-Cream y Layer) certificate in proper form at, if applicable, and DD for Rs.200 (Rs.100 for SC/ST/PD) draw n in favour of "The Registrar, IIT Madras" payable at Chennai BY SPEED POST ONLY to 'The Chairm an, M.Tech. Adm ission Com m ittee, GATE Office, IIT Madras, Chennai 600 036' to reach on or before 05-04-2013.

mtechadm.iitm.ac.in/gform5.php?appno=105667499051276356

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