By Registered Post/Speed Post Only

Zone/Scrutiny

6CP

GATE 2014
Chairperson GATE
Indian Institute of Technology Kharagpur
Kharagpur 721302

A181H87

To

From
Jogeswar Prusty
C/O-PRASANTA KUMAR PRUSTY
AT/PO-KUABUDA
VIA-CHANDUA
BARIPADA
Orissa 757014
75041 36648 (Mobile Number)

A181H87

Cut Here

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 - A181H87. You should preserve this number for further correspondence.

Zone/Scrutiny

GATE 2014

6CP

A181H87

A181H87

A181H87

Applicant's recent photograph

(Enrolment ID)

Jogeswar Prusty
(Full Name of the Applicant)

3.5 cm x 4.5 cm

A181H87

09 Jun 1987

Male

OBC

No

(D.O.B)

(Gender)

(Category)

(PD Status)

Indian National

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

9937328710

Prasanta Kumar Prusty

(Parent's Mobile Number)

(Name of the Parent)

Communication Address

GATE Exam Details

C/O-PRASANTA KUMAR PRUSTY

AT/PO-KUABUDA
VIA-CHANDUA
BARIPADA
Orissa 757014

GATE Paper Code

ME
Bhubaneswar, OR

75041 36648 (Mobile No.)

jogeswarprusty.prusty@gmail.com

(Exam City 1)

Cuttack, OR

Qualification Details

(Exam City 2)

Kolkata, WB

B.Tech
Mechanical Engg.
Graduated: No; Year of Graduation: 2014
PARALA MAHARAJA ENGG COLLEGE
BERHAMPUR
Orissa 761003

(Exam City 3)

Zonal GATE Office Contact

Chairperson GATE
Indian Institute of Technology Kharagpur
Kharagpur 721302

Payment Details

Enclosure Checklist

Challan Rs. 1500.00

State Bank of India

Stamped Bank Challan: GATE copy

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:

0428b1513fb769fe72b5c2a809b92fb0

Certificate from Principal

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

Applicants signature inside the box in black ink

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

This is to certify that Jogeswar Prusty is a student enrolled in

PARALA MAHARAJA ENGG COLLEGE, BERHAMPUR.
He is a student of the final year of B.Tech.
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