Professional Documents
Culture Documents
3. 4.
Put
7.
____________End of Instructions____________
GATE COPY
INDIAN General No
11. Address for Correspondence 4A RAJIV GANDHI NAGAR PETTAI TIRUNELVELI TAMILNADU 12. PINCODE of Address for 627004 Correspondence 13. Year of Degree 14. Discipline 15. Name of Parent 2009 Mechanical Engineering A SUKUMAR Tamil Nadu
7. Qualifying Degree
08822182088
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 contents of GATE 2012 website 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 GATE 2012. Further, if any such suppression or distortion of facts is found after appearing in the exam, any admission/degree acquired on the basis of GATE 2012 score is liable to be cancelled. Place : Date :
18. Signature
19. Photograph
Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS)
3.5 cm x 3.5 cm
407ME4016702
Send this form along with the necessary documents to IIT Guwahati.
CANDIDATE COPY
INDIAN General No
11. Address for Correspondence 4A RAJIV GANDHI NAGAR PETTAI TIRUNELVELI TAMILNADU 12. PINCODE of Address for 627004 Correspondence 13. Year of Degree 14. Discipline 15. Name of Parent 2009 Mechanical Engineering A SUKUMAR Tamil Nadu
7. Qualifying Degree
08822182088
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 contents of GATE 2012 website 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 GATE 2012. Further, if any such suppression or distortion of facts is found after appearing in the exam, any admission/degree acquired on the basis of GATE 2012 score is liable to be cancelled. Place : Date :
18. Signature
19. Photograph
Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS)
3.5 cm x 3.5 cm
407ME4016702
BY SPEED / REGISTERED POST (Please do not Courier) GATE 2012 Application Form
407ME4016702
Do not tamper with the bar code. For GATE official use.
From
S BALU (APPLNO : 4016702) 4A RAJIV GANDHI NAGAR PETTAI TIRUNELVELI TAMILNADU 627004