By Registered Post/Speed Post Only

Zone/Scrutiny Code

1AL

GATE 2013
To
Chairman GATE
Indian Institute of Science, Bangalore
Bengaluru, 560012

From
Josyula S L Tejaswi
19-11-27/1
MUTCHIMULLIROAD
RAMACHANDRAPURAM
RAMACHANDRAPURAM
Andhra Pradesh, 533255

96036 19219

144 Q 966 J

(Mobile No.)

Cut Here

Instructions to the Applicant (GATE 2013)

1. This print out should contain the following pages.
(a) This page: Address Slip and Instructions.
(b) Application form, filled with the information you provided online.
(c) Bank Challan in Triplicate (available as a separate file for download from the
GATE Online Application Interface), if you have chosen Offline Challan Payment (Not applicable for female candidates).
2. On the GATE copy of the Application Form, paste a 4.5cm x 3.5cm printed copy of the SAME color
photograph you uploaded online.
(a) Use good quality glue to ensure that the photograph does not separate from the application.
(b) Do not pin, stapple, sign, or attest the photograph.
3. Read the declaration and put your signature in the box next to it.
4. If you are in the final year or you have a backlog after appearing for the final year exam, you must get your
Principals or HODs sign and seal in the last portion of the application form. Submit the whole form
to the Principals office without cutting it.
5. If you have opted for Challan payment, wait for 48 hours after your online submission to visit the banks
branch. You can visit any branch of the bank printed on your challan.
6. The bank teller will verify the details printed on the challan with the data available on their computer and
then accept the payment. The bank will retain one copy and give you back the remaining copies: one of
which you have to send along with the printed application form and the other is for your reference.
7. Mailing Documents to GATE office.
(a) Cut the Address Slip and paste it onto an A4 sized envelope (Do not fill address by hand or tamper the
address slip).
(b) Collect the supporting documents shown under Enclosure Checklist in the application form (if you
have uploaded the soft copy of the documents online, you need not send a hard copy). Mark the check
list boxes.
(c) Do NOT FOLD the application form and Do NOT STAPLE or pin the documents to the form.
(d) Send the packet by Speed Post (preferably) or by Registered Post to the address mentioned. The
application packet should REACH the respective GATE office on or before Monday, 8 October 2012.

Note: Application ID - 144 Q 966 J. You should preserve this number for further correspondence.

GATE 2013
Application Form

Zone/Scrutiny Code

1AL
144 Q 966 J

Applicant's recent photograph

4.5 cm x 3.5 cm

(Application ID)

Josyula S L Tejaswi
(Full Name of Applicant)

144 Q 966 J

28 Jul 1991

Female

Do not Attest
Do not sign on photo

GEN

(D.O.B)

Indian National

Josyula Subrahmanyam
(Name of Parent)

Communication Address

GATE Exam Details

19-11-27/1
MUTCHIMULLIROAD
RAMACHANDRAPURAM
RAMACHANDRAPURAM
Andhra Pradesh, 533255
India

EE

(GATE Paper code)

Hyderabad, AP
(Exam City 1)

Kakinada, AP
(Exam City 2)

tejujosh91@gmail.com
96036 19219 (Mobile No.)

Scribe Assistance Required:

No

Zonal GATE Office Contact

Qualification Details

Chairman GATE
Indian Institute of Science, Bangalore
Bengaluru, 560012

B.Tech
Electrical Engg./Electrical and Electronics Engg./Power
Graduated: Yes, Year of Graduation: 2012
KAKINADA INSTITUTE OF TECHNOLOGICAL
RAMACHANDRAPURAM
Andhra Pradesh, 533255

Docs Uploaded

Eligibility Certificate

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 Information Brochure 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 2013. Further, if any suppression or distortion of facts is found after appearing
in the exam, any admission/degree acquired on the basis of GATE 2013 score is liable to be cancelled.

Digital Fingerprint: 2fbae15a66d4aa8f99ed0d04c0bfaf37

Date: ....../....../............

This space is intentionally left blank

Applicants signature inside the box in black ink