Professional Documents
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3. 4.
5. 6. 7.
8.
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____________End of Instructions____________
GATE COPY
11. Address for Correspondence A-26/5, PANDIT NEHRU GALI, STREET NO.1, NORTH CHHAJJUPUR, DELHI-110094 12. PINCODE of Address for 110094 Correspondence 13. Year of Degree 14. Discipline 15. Name of Parent 2012 Computer Science & Engineering/Technology VIRENDER KUMAR ROHILLA Delhi
7. Qualifying Degree
09868838662
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
305CS3058336
Send this form along with the necessary documents to IIT Delhi.
CANDIDATE COPY
11. Address for Correspondence A-26/5, PANDIT NEHRU GALI, STREET NO.1, NORTH CHHAJJUPUR, DELHI-110094 12. PINCODE of Address for 110094 Correspondence 13. Year of Degree 14. Discipline 15. Name of Parent 2012 Computer Science & Engineering/Technology VIRENDER KUMAR ROHILLA Delhi
7. Qualifying Degree
09868838662
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
305CS3058336
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
305CS3058336
Do not tamper with the bar code. For GATE official use.
From
RAHUL ROHILLA (APPLNO : 3058336) A-26/5, PANDIT NEHRU GALI, STREET NO.1, NORTH CHHAJJUPUR, DELHI-110094 110094
CASH VOUCHER
CANDIDATE COPY
Challan can be deposited minimum one day after the generation of challan.
Name of the Candidate : RAHUL ROHILLA Address for Correspondence :
Challan can be deposited minimum one day after the generation of challan.
Name of the Candidate : RAHUL ROHILLA
Challan can be deposited minimum one day after the generation of challan.
Name of the Candidate : RAHUL ROHILLA
A-26/5, PANDIT NEHRU GALI, STREET NO.1, Address for Correspondence : NORTH CHHAJJUPUR, DELHI-110094 110094
A-26/5, PANDIT NEHRU GALI, STREET NO.1, Address for Correspondence : NORTH CHHAJJUPUR, DELHI-110094 110094
A-26/5, PANDIT NEHRU GALI, STREET NO.1, NORTH CHHAJJUPUR, DELHI-110094 110094 -
09868838662 a.catamount@gmail.com
09868838662 a.catamount@gmail.com
09868838662 a.catamount@gmail.com
OBC(Non-Creamy Layer) Rs.1025/- * Rupees One thousand and Twenty Five Only. (*Application Fees Including Bank Charges)
OBC(Non-Creamy Layer) Rs.1025/- * Rupees One thousand and Twenty Five Only. (*Application Fees Including Bank Charges)
OBC(Non-Creamy Layer) Rs.1025/- * Rupees One thousand and Twenty Five Only. (*Application Fees Including Bank Charges)
JOURNAL NUMBER
JOURNAL NUMBER
JOURNAL NUMBER
Signature of the Candidate/Remitter For Receiving Branch use only 1. Please note to write the Journal Number in all the challans. 2. Please feed the Application No. in REG/ID/Ref No. Column.
Signature of the Candidate/Remitter For Receiving Branch use only 1. Please note to write the Journal Number in all the challans. 2. Please feed the Application No. in REG/ID/Ref No. Column.
Signature of the Candidate/Remitter For Receiving Branch use only 1. Please note to write the Journal Number in all the challans. 2. Please feed the Application No. in REG/ID/Ref No. Column.
SEAL / DATE
AUTHORISED SIGNATORY
SEAL / DATE
AUTHORISED SIGNATORY
SEAL / DATE
AUTHORISED SIGNATORY