Zone/Scrutiny

By Registered Post/Speed Post Only

2CP
To

GATE 2014
A199D97 Chairperson GATE Indian Institute of Technology Bombay Powai, Mumbai 400076

From Chavan Guruprasad Vijay

SHIVAJI CHOWK TAKAWADE TAL-SHIROL DIST-KOLHAPUR TAKAWADE Maharashtra 416121 97621 40081 (Mobile Number) Cut Here

A199D97

Instructions to the Applicant (GATE 2014)

1. This print out should contain the following pages. (a) Page 1 : This page contains Instructions and Address Slip (cut and paste the Address Slip on A4 size envelope). (b) Page 2 : Application form that you have filled online. 2. Bank challan in Triplicate is available as a separate pdf file to be downloaded. This is available only if you have opted for Offline Payment. 3. On the GATE 2014 Application Form, paste a 3.5cm x 4.5cm color photograph with plain background (this should be the same that you have uploaded during application filling). The photograph should be taken in a studio. (a) Write your Enrolment ID. and Name on the reverse side of the photo. (b) Use good quality glue to ensure that the photograph does not separate from the application. (c) Do not pin, staple, sign or attest the photograph. 4. Read the declaration and put your full signature in the box next to it. Please note that signature should not be in capital letters. 5. If you are in the final year or you have a backlog after appearing for the final year examination, you must get your Principals or HODs Signature and Seal in the Certificate from Principal that is provided at the last portion of the application form. Submit the whole form to the Principals office without cutting it. 6. If you have opted for challan payment, wait for 48 hours after your online submission to visit the banks branch. You can visit any branch of the bank printed on your challan. 7. The bank teller will verify the details printed on the challan with the data available in their system and then accept the payment. The bank will retain one copy and give you the remaining two copies: one of which is the GATE Copy that you have to send along with the printed application form and the other is the Candidate Copy for your reference. 8. Keep a photo copy of the completed application form for your reference. 9. Mailing Documents to GATE office. (a) Cut the Address Slip and paste it onto an A4 size envelope (Do not fill address by hand or tamper the address slip). (b) Collect the supporting documents shown under Enclosure Checklist in the application form. Mark the enclosures in the checklist boxes. (c) Do NOT FOLD the application form and Do NOT STAPLE or pin the documents to the form. (d) Send the packet by Speed Post (preferably) or by Registered Post to the address mentioned in the address slip. The application packet should REACH the respective zonal GATE office on or before Thursday, 10 October 2013.

Note: Enrolment ID - A199D97. You should preserve this number for further correspondence.

Zone/Scrutiny

GATE 2014

Applicant's recent photograph

2CP
A199D97
(Enrolment ID) (Full Name of the Applicant)

A199D97

A199D97

3.5 cm x 4.5 cm

Chavan Guruprasad Vijay

A199D97

20 Aug 1992
(D.O.B)

Male
(Gender)

GEN
(Category)

No
(PD Status)

Do not Attest Do not sign on photo Do not staple photo

Indian National

9623594569
(Parent's Mobile Number)

Vijay Shankar Chavan

(Name of the Parent)

Communication Address
SHIVAJI CHOWK TAKAWADE TAL-SHIROL DIST-KOLHAPUR TAKAWADE Maharashtra 416121

GATE Exam Details

GATE Paper Code

EC
Sangli, MH
(Exam City 1)

97621 40081 (Mobile No.) guruprasadchavan1992@gmail.com

Kolhapur, MH
(Exam City 2)

Qualification Details
B.E. Electronics/Comm./Telecomm Engg. Graduated: No; Year of Graduation: 2014 SHIVAJI UNIVERSITY KOLHAPUR ATIGRE Maharashtra 416118

Mumbai, MH
(Exam City 3)

Zonal GATE Office Contact

Chairperson GATE Indian Institute of Technology Bombay Powai, Mumbai 400076

Payment Details

Enclosure Checklist
Stamped Bank Challan: GATE copy

Challan Rs. 1500.00

State Bank of India

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 Information Brochure and I shall abide by the terms and conditions therein. The responsibility of following the GATE 2014 website and meeting various deadlines lies with me. 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 2014. Further, if any suppression or distortion of facts is found after appearing in the exam, any admission/degree/benefit acquired on the basis of GATE 2014 score/marks is liable to be cancelled.

Digital Fingerprint:

fe496ed32ac7be37d783bed50e3eaa73

Date: ....../....../.........

Applicants signature inside the box in black ink

Certificate from Principal

SHIVAJI UNIVERSITY KOLHAPUR, ATIGRE. He is a student of the final year of B.E.

(For use as the eligibility certificate only for final year or backlog applicants)

This is to certify that Chavan Guruprasad Vijay is a student enrolled in

He appeared in the final semester/year exam of the above degree, but has a backlog to be cleared from an earlier semester/year, and therefore cannot produce a course completion certificate.

Date:

Signature of Principal/ HOD

Seal