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Instructions and Application Form For GATE 2012
Instructions and Application Form For GATE 2012
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____________End of Instructions____________
GATE COPY
INDIAN General No
11. Address for Correspondence G-37 GOVIND BHAWAN IIT ROORKEE ROORKEE(UK) 12. PINCODE of Address for 247667 Correspondence 13. Year of Degree 14. Discipline 2011 Electronics & Comm./Electronics Engg./Communication Engg./Telecommunication Engg VIJAY KUMAR TIWARI Bihar
15. Name of Parent 7. Qualifying Degree B.E./B.Tech./ B.Sc. (Engg.)/B.Sc.(Tech.)/B.Arch. 16. State/Union Territory of Permanent Residence
09654754521
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
307EC3100410
Send this form along with the necessary documents to IIT Delhi.
CANDIDATE COPY
INDIAN General No
11. Address for Correspondence G-37 GOVIND BHAWAN IIT ROORKEE ROORKEE(UK) 12. PINCODE of Address for 247667 Correspondence 13. Year of Degree 14. Discipline 2011 Electronics & Comm./Electronics Engg./Communication Engg./Telecommunication Engg VIJAY KUMAR TIWARI Bihar
15. Name of Parent 7. Qualifying Degree B.E./B.Tech./ B.Sc. (Engg.)/B.Sc.(Tech.)/B.Arch. 16. State/Union Territory of Permanent Residence
09654754521
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
307EC3100410
BY SPEED / REGISTERED POST (Please do not Courier) GATE 2012 Application Form
To Chairman, GATE Indian Institute of Technology Delhi Hauz Khas, New Delhi - 110016
307EC3100410
Do not tamper with the bar code. For GATE official use.
From
AMIT KUMAR (APPLNO : 3100410) G-37 GOVIND BHAWAN IIT ROORKEE ROORKEE(UK) 247667
PAY IN SLIP
BANK COPY
PAY IN SLIP
CANDIDATE COPY
APPLICATION FEE PAYABLE AT ALL BRANCHES OF INDIAN BANK Paid into the credit of IIT DELHI GATE 2012 (Challan) A/C no 971937016 , HAUZ KHAS BRANCH NEW DELHI, BRANCH CODE : 1104
Name of the Candidate : AMIT KUMAR
APPLICATION FEE PAYABLE AT ALL BRANCHES OF INDIAN BANK Paid into the credit of IIT DELHI GATE 2012 (Challan) A/C no 971937016, HAUZ KHAS BRANCH NEW DELHI, BRANCH CODE : 1104
Name of the Candidate : AMIT KUMAR
APPLICATION FEE PAYABLE AT ALL BRANCHES OF INDIAN BANK Paid into the credit of IIT DELHI GATE 2012 (Challan) A/C no 971937016, HAUZ KHAS BRANCH NEW DELHI, BRANCH CODE : 1104
Name of the Candidate : AMIT KUMAR
G-37 GOVIND BHAWAN IIT ROORKEE Address for Correspondence : ROORKEE(UK) - 247667
G-37 GOVIND BHAWAN IIT ROORKEE Address for Correspondence : ROORKEE(UK) - 247667
Head : Application Fees : Bank's Charges : Total * : Amount in words : Name of the Receiving Branch : Signature of the candidate : FOR BANKS USE MUP Ref. No: GATE Application Form No. : Branch Code : 3100410 Journal No: Signature of cashier : Date :
Amount Rs. 1000.00 Rs. 25.00 Rs. 1025.00 Rupees One thousand and Twenty Five Only. (*Inclusive of Bank Charges)
Head : Application Fees : Bank's Charges : Total * : Amount in words : Name of the Receiving Branch : Signature of the candidate : FOR BANKS USE MUP Ref. No: GATE Application Form No. : Branch Code : 3100410 Journal No: Signature of cashier : Date :
Amount Rs. 1000.00 Rs. 25.00 Rs. 1025.00 Rupees One thousand and Twenty Five Only. (*Inclusive of Bank Charges)
Rupees One thousand and Twenty Five Only. Amount in words : (*Inclusive of Bank Charges) Name of the Receiving Branch :
Signature of the candidate : FOR BANKS USE MUP Ref. No: GATE Application Form No. : Branch Code : 3100410 Journal No: Signature of cashier : Date :