ONLINE Application for GATE 2011

Instructions for the Candidate:

1. Your Login ID is ALLI0709. Remember your password and do not disclose it to anyone.
2. There are 4 Pages in this file. These pages should be printed on A4 sheets.
3. Page - 1: Instructions for the candidate to be retained by you carefully
4. Page - 2 : Application Form (GATE Copy)
a. Paste your recent color photo (3cm x 4cm) in designated place
b. Sign at designated places
5. Page - 3 : Application Form (CANDIDATE Copy) to be retained by you for your reference
6. Page - 4 : Address slip to be pasted on the A4 size envelope
7. Insert completed Application Form (GATE Copy) and attested copies of all applicable documents
(SC/ST/PD Certificate, Affidavit for change of name) into A4 size envelope, without folding and send by
Speed Post (preferably) or by Registered Post to Chairman, GATE, IIT Bombay

List of Documents to be sent to GATE IIT Bombay:

1. Application Form (GATE Copy)
2. Attested Copy of SC/ST/PD Certificate (if applicable)
3. Attested Copy of affidavit for change of name (if applicable)

Page - 1
 GATE IIT Bombay COPY
APPLICATION FORM FOR GATE 2011
Application No: 2104711 Payment Mode: ICICI Payment Gateway

Zone: IIT Bombay Application Fee: Rs. 800/- Payment Reference No: 201009279092966

1. Name of the Candidate as in ALLI ROHAN CHANDRASHEKHAR 11. Address 33/2/7 GEETA NAGAR,
the 10th Class Certificate
NEAR WALCHAND COLLEGE,

NEW PACCHA PETH,

2. Date of Birth (DD/MM/YYYY) 07/09/1987 SOLAPUR,MAHARASHTRA

PINCODE 413006
3. Gender MALE

4. Nationality INDIAN 14. Year of Degree 2010

15. Discipline Electronics & Comm./Electronics

5. Category OBC(Non-Creamy Layer) Engg./Comm.
Engg./Telecommunication Engg.
6. Person with Disability (PD) No

Do You Require a Scribe? No 16. Name of Parent CHANDRASHEKHAR RAGHAVALU

ALLI
7. Qualifying Degree B.E./B.Tech./ B.Sc. 17. State/Union Territory of Maharashtra
(Engg.)/B.Sc.(Tech.)/B.Arch. Permanent Residence

18. Phone / Mobile 09767420088

8. Choice of Examination City1 223 - Solapur
Number
19. PINCODE of Address 413006
Choice of Examination City2 218 - Pune for Correspondence

9. Choice of GATE Paper EC - Electronics and Communication

Engineering
10. E-mail Address rcalli_87@yahoo.com

I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. 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 2011.
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 2011 score is liable to be cancelled.

Place:
Date:
Full Signature of the Candidate
(do not sign in capital letters)

12. Photograph

Paste a front
facial high
contrast recent
13. Full Signature of the Candidate color photograph
2104711 using black ball point pen only 3cm x 4cm
(do not sign in capital letters) without any
signature or
attestation

Send this form along with the necessary documents to IIT Bombay

Page - 2
 CANDIDATE COPY
APPLICATION FORM FOR GATE 2011
Application No: 2104711 Payment Mode: ICICI Payment Gateway

Zone: IIT Bombay Application Fee: Rs. 800/- Payment Reference No: 201009279092966

1. Name of the Candidate as in ALLI ROHAN CHANDRASHEKHAR 11. Address 33/2/7 GEETA NAGAR,
the 10th Class Certificate
NEAR WALCHAND COLLEGE,

NEW PACCHA PETH,

2. Date of Birth (DD/MM/YYYY) 07/09/1987 SOLAPUR,MAHARASHTRA

PINCODE 413006
3. Gender MALE

4. Nationality INDIAN 14. Year of Degree 2010

15. Discipline Electronics & Comm./Electronics

5. Category OBC(Non-Creamy Layer) Engg./Comm.
Engg./Telecommunication Engg.
6. Person with Disability (PD) No

Do You Require a Scribe? No 16. Name of Parent CHANDRASHEKHAR RAGHAVALU

ALLI
7. Qualifying Degree B.E./B.Tech./ B.Sc. 17. State/Union Territory of Maharashtra
(Engg.)/B.Sc.(Tech.)/B.Arch. Permanent Residence

18. Phone / Mobile 09767420088

8. Choice of Examination City1 223 - Solapur
Number
19. PINCODE of Address 413006
Choice of Examination City2 218 - Pune for Correspondence

9. Choice of GATE Paper EC - Electronics and Communication

Engineering
10. E-mail Address rcalli_87@yahoo.com

I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. 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 2011.
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 2011 score is liable to be cancelled.

Place:
Date:
Full Signature of the Candidate
(do not sign in capital letters)

12. Photograph

Paste a front
facial high
contrast recent
13. Full Signature of the Candidate color photograph
2104711 using black ball point pen only 3cm x 4cm
(do not sign in capital letters) without any
signature or
attestation

Retain this page for your reference

Page - 3
 BY SPEED POST / REGISTERED POST

GATE 2011
GATE PAPER CODE EC To

EXAM CITY OF FIRST Chairman, GATE

CHOICE 223
Indian Institute of Technology Bombay

Powai, Mumbai

From
PINCODE 4 0 0 0 7 6
ALLI ROHAN CHANDRASHEKHAR

33/2/7 GEETA NAGAR,

APPLICATION NO
NEAR WALCHAND COLLEGE,

NEW PACCHA PETH,

SOLAPUR,MAHARASHTRA 2 1 0 4 7 1 1
PINCODE 4 1 3 0 0 6

Page - 4