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GATE COPY
11. Address for Correspondence # 403 LIG, 7 TH CROSS, 3 RD MAIN, NK RAJ URS ROAD SHARADA DEVI NAGAR MYSORE 12. PINCODE of Address for 570022 Correspondence 13. Year of Degree 14. Discipline 15. Name of Parent 2007 Mechanical Engineering GOVINDARAJU Karnataka
7. Qualifying Degree
09019577313
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 :
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112ME1098160
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CANDIDATE COPY
11. Address for Correspondence # 403 LIG, 7 TH CROSS, 3 RD MAIN, NK RAJ URS ROAD SHARADA DEVI NAGAR MYSORE 12. PINCODE of Address for 570022 Correspondence 13. Year of Degree 14. Discipline 15. Name of Parent 2007 Mechanical Engineering GOVINDARAJU Karnataka
7. Qualifying Degree
09019577313
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 :
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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
112ME1098160
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112ME1098160
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