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Zone/Scrutiny GATE 2017

2GE R490B44
R490B44 (Enrollment ID)

Dere Vaibhav Kisan

(Full Name of the Applicant)

02 Jan 1996 Male GEN No

(D.O.B) (Gender) (Category) (PD Status)

Indian National +919969049838 Dere Kisan Bhagoji

(Parent's Mobile Number) (Name of the Parent)

Communication Address GATE Exam Details

Rh-57,Room no.9,Dnyansarita chs GATE Paper Code
near model college ,MIDC
Maharashtra 421201
+919920578560 (Mobile No.)
(Mechanical Engineering) Navi Mumbai, MH
(Exam City 1)

Qualification Details Mumbai, MH

(Exam City 2)
Mechanical Engg. Thane, MH
(Exam City 3)
Graduated: No; Year of Graduation: 2017
ARMIET Zonal GATE Office Contact
SHAHPUR Chairperson GATE
Maharashtra 421601 Indian Institute of Technology Bombay
Powai, Mumbai 400076
Payment Details
Online Rs. 1500.00
Payment Ref. No.: CP60591344

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 2017 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 2017. 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 2017 score/marks is liable to be

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