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Instructions and Application Form for GATE 2012

Instructions for the Candidate:
1. 2. Your Login ID is SBAL1701. Remember your password and do not disclose it to anyone. There are 4 pages in this pdf file. These pages should be printed on A4 size white sheets using a laser/ink jet printer. Page - 1: Instructions for the candidate to be retained by the candidate. Page - 2 : Application Form (GATE Copy). a. Paste your recent color photo (3.5cm x 3.5cm) in the designated place. Before pasting, please write your name and application number on the backside of the photo with black ball point pen. b. Sign at the designated place. 5. 6. 7. Page - 3 : Application Form (Candidate copy) to be retained by the candidate. Page - 4 : Address page to be pasted on a 10 inch X 12 inch size laminated envelope. Without folding, insert the completed Application Form (GATE copy) and attested copies of all the application documents (SC/ST/PD certificate, copy of degree certificate etc.) into a 10 inch X 12 inch laminated envelope and send by Speed Post (preferably) or by Registered Post using the address printed on page-4 so as to reach the respective Zonal GATE office on or before 24th October 2011. Application sent through courier will not be accepted.

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List of Documents to be attached with the Application Form:
1. 2. 3. 4. 5. Application Form (GATE Copy) Self Attested Copy of SC/ST/PD certificate (if applicable) Self Attested Copy of affidavit for change of name (if applicable) Self Attested Copy of the degree certificate if the year of qualifying degree is 2011 or earlier. If the year of qualifying degree is 2012 or later, a certificate signed by the principal of the college clearly indicating the year of qualifying degree (format available on GATE website). Candiates with backlog: copy of final semester /year marks sheet or course completion certificate or a letter from principal.

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____________End of Instructions____________

/ B. 1000 Mechanical Engineering abasbalu@gmail. In the event of suppression or distortion of any fact in my application form. 16. State/Union Territory of Permanent Residence 8. any admission/degree acquired on the basis of GATE 2012 score is liable to be cancelled.Tirunelveli 17.5 cm x 3.com 4. Signature 19. Person with Disability (PD) INDIAN General No 11. Gender Payment Mode: Payment Gateway Payment Reference No: MSBI1004560221 S BALU 17/01/1988 MALE 9. Discipline 15. Choice of Examination City1 Choice of Examination City2 407 . I have read the contents of GATE 2012 website and I shall abide by the terms and conditions therein. 4016702 GATE COPY GATE 2012 APPLICATION FORM Zone: IIT Guwahati 1. Year of Degree 14. Further. Category 6.Sc. Mobile / Landline No.)/B. 08822182088 I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief.(Tech. Address for Correspondence 4A RAJIV GANDHI NAGAR PETTAI TIRUNELVELI TAMILNADU 12.APPLICATION NO. PINCODE of Address for 627004 Correspondence 13.Guwahati 733 .Tech. Place : Date : 18. Name of the Candidate as in the 10th Class Certificate 2. Date of Birth (DD/MM/YYYY) 3.)/B. Choice of GATE Paper 10. Qualifying Degree B. Name of Parent 2009 Mechanical Engineering A SUKUMAR Tamil Nadu 7.Sc. I understand that I will be denied the opportunity to appear in GATE 2012. if any such suppression or distortion of facts is found after appearing in the exam. E-mail Address Fee: Rs. (Engg. Photograph Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS) 3.5 cm 407ME4016702 Send this form along with the necessary documents to IIT Guwahati.Arch.E. ./B. Nationality 5.

Sc. State/Union Territory of Permanent Residence 8. Signature 19.5 cm x 3. Category 6. Nationality 5. 4016702 CANDIDATE COPY GATE 2012 APPLICATION FORM Zone: IIT Guwahati 1.)/B. In the event of suppression or distortion of any fact in my application form.5 cm 407ME4016702 Retain this copy with you for future reference.Tirunelveli 17.Guwahati 733 .APPLICATION NO.Sc. Name of Parent 2009 Mechanical Engineering A SUKUMAR Tamil Nadu 7. Address for Correspondence 4A RAJIV GANDHI NAGAR PETTAI TIRUNELVELI TAMILNADU 12./B. Date of Birth (DD/MM/YYYY) 3. Name of the Candidate as in the 10th Class Certificate 2.com 4. Qualifying Degree B. I understand that I will be denied the opportunity to appear in GATE 2012. Choice of Examination City1 Choice of Examination City2 407 . (Engg. Place : Date : 18.)/B.(Tech. I have read the contents of GATE 2012 website and I shall abide by the terms and conditions therein. Further. PINCODE of Address for 627004 Correspondence 13.E. Photograph Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS) 3. 08822182088 I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. Person with Disability (PD) INDIAN General No 11. any admission/degree acquired on the basis of GATE 2012 score is liable to be cancelled. Mobile / Landline No. 16. Discipline 15. Year of Degree 14./ B. if any such suppression or distortion of facts is found after appearing in the exam.Tech.Arch. Choice of GATE Paper 10. 1000 Mechanical Engineering abasbalu@gmail. E-mail Address Fee: Rs. Gender Payment Mode: Payment Gateway Payment Reference No: MSBI1004560221 S BALU 17/01/1988 MALE 9. .

781039 407ME4016702 Do not tamper with the bar code. For GATE official use.BY SPEED / REGISTERED POST (Please do not Courier) GATE 2012 Application Form To Chairman. GATE Indian Institute of Technology Guwahati Guwahati . From S BALU (APPLNO : 4016702) 4A RAJIV GANDHI NAGAR PETTAI TIRUNELVELI TAMILNADU 627004 .

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