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ONLINE Application for GATE 2011

Instructions for the Candidate:

1. Your Login ID is MANU29012. Remember your password and do not disclose it to anyone.
2. There are 5 Pages in this file. These pages should be printed on A4 sheets.
3. Page - 1: Instructions for the candidate to be retained by you carefully
4. Page - 2 : Application Form (GATE Copy)
a. Paste your recent color photo (3cm x 4cm) in designated place
b. Sign at designated places
5. Page - 3 : Application Form (CANDIDATE Copy) to be retained by you for your reference
6. Page - 5 : Bank challan in triplicate. Take it to any SBI branch and pay the fee. The Bank will retain a
copy with them and will return two copies to you. In those two copies, retain the Candidate's copy with
you and attach Institute's copy with Application Form

7. Page - 4 : Address slip to be pasted on the A4 size envelope
8. Insert completed Application Form (GATE Copy) and attested copies of all applicable documents
(SC/ST/PD Certificate, Affidavit for change of name) into A4 size envelope, without folding and send by
Speed Post (preferably) or by Registered Post to Chairman, GATE, IIT Madras

List of Documents to be sent to GATE IIT Madras:
1. Application Form (GATE Copy)
2. Bank Challan (Institute's Copy)
3. Attested Copy of SC/ST/PD Certificate (if applicable)
4. Attested Copy of affidavit for change of name (if applicable)

Page - 1

Sc. Address MADHAVAPPALLY(H) the 10th Class Certificate NELLIPPARA(P. Date of Birth (DD/MM/YYYY) 29/01/1989 KANNUR PINCODE 670571 3. 17.O) ALAKODE(VIA) 2. Choice of GATE Paper CS . Gender MALE 4.Coimbatore for Correspondence 9. Person with Disability (PD) No Do You Require a Scribe? No 16. GATE IIT Madras COPY APPLICATION FORM FOR GATE 2011 Application No: 7174771 Payment Mode: Bank Challan (State Bank of India) Zone: IIT Madras Application Fee: Rs. Photograph Paste a front facial high contrast recent 13. State/Union Territory of Kerala (Engg. Name of the Candidate as in MANU CHERIAN 11.Computer Science and Information Technology 10. 800/- 1.)/B.)/B.E. Phone / Mobile 09400455644 8./B. Place: Date: Full Signature of the Candidate (do not sign in capital letters) 12.Tech.Ernakulam Number 19. Discipline Computer Science & 5. E-mail Address manuseeks@live.(Tech. PINCODE of Address 670571 Choice of Examination City2 706 . Qualifying Degree B. In the event of suppression or distortion of any fact in my application form.in I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief./ B. I understand that I will be denied the opportunity to appear in GATE 2011. any admission/degree acquired on the basis of GATE 2011 score is liable to be cancelled. Name of Parent CHERIAN THOMAS 7.Arch.2 .Sc. Permanent Residence 18. Year of Degree 2012 15. Choice of Examination City1 708 . Full Signature of the Candidate color photograph 7174771 using black ball point pen only 3cm x 4cm (do not sign in capital letters) without any signature or attestation Send this form along with the necessary documents to IIT Madras Page . Nationality INDIAN 14. Further. Category General Engg./Technology 6. if any such suppression or distortion of facts is found after appearing in the exam.

if any such suppression or distortion of facts is found after appearing in the exam. Full Signature of the Candidate color photograph 7174771 using black ball point pen only 3cm x 4cm (do not sign in capital letters) without any signature or attestation Retain this page for your reference Page .)/B. Permanent Residence 18. Choice of Examination City1 708 . Place: Date: Full Signature of the Candidate (do not sign in capital letters) 12. Gender MALE 4. any admission/degree acquired on the basis of GATE 2011 score is liable to be cancelled. Name of the Candidate as in MANU CHERIAN 11. Category General Engg.)/B./B./ B. Nationality INDIAN 14.(Tech. State/Union Territory of Kerala (Engg.Tech. Qualifying Degree B. CANDIDATE COPY APPLICATION FORM FOR GATE 2011 Application No: 7174771 Payment Mode: Bank Challan (State Bank of India) Zone: IIT Madras Application Fee: Rs.Ernakulam Number 19.Sc. 17. E-mail Address manuseeks@live. PINCODE of Address 670571 Choice of Examination City2 706 . Name of Parent CHERIAN THOMAS 7.Computer Science and Information Technology 10.in I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. Phone / Mobile 09400455644 8.Arch.E. Year of Degree 2012 15. Discipline Computer Science & 5.Coimbatore for Correspondence 9.3 . I understand that I will be denied the opportunity to appear in GATE 2011. Photograph Paste a front facial high contrast recent 13.O) ALAKODE(VIA) 2. Choice of GATE Paper CS .Sc./Technology 6. Address MADHAVAPPALLY(H) the 10th Class Certificate NELLIPPARA(P. Further. Date of Birth (DD/MM/YYYY) 29/01/1989 KANNUR PINCODE 670571 3. In the event of suppression or distortion of any fact in my application form. Person with Disability (PD) No Do You Require a Scribe? No 16. 800/- 1.

4 .O) ALAKODE(VIA) KANNUR 7 1 7 4 7 7 1 PINCODE 6 7 0 5 7 1 Page . BY SPEED POST / REGISTERED POST GATE 2011 GATE PAPER CODE CS To EXAM CITY OF FIRST Chairman. GATE CHOICE 708 Indian Institute of Technology Madras Chennai From PINCODE 6 0 0 0 3 6 MANU CHERIAN MADHAVAPPALLY(H) APPLICATION NO NELLIPPARA(P.

30.00 Total Rs.670571 ALAKODE(VIA) KANNUR .98353XXXXXX 2. Signature of the Candidate/Remitter Signature of the Candidate/Remitter Signature of the Candidate/Remitter For Receiving Branch use only For Receiving Branch use only For Receiving Branch use only APPLICATION NUMBER JOURNAL NUMBER APPLICATION NUMBER JOURNAL NUMBER APPLICATION NUMBER JOURNAL NUMBER 7174771 7174771 7174771 1.30/. Amount in words : Rupees eight hundred and thirty only.670571 ALAKODE(VIA) KANNUR .to your Branch Commission 1. in REG/ID/Ref No. 800.00 Amount in words : Rupees eight hundred and thirty only. 31372883605 GATE 2011 FEE COLLECTION A/C NO. 830.in Category : General Category : General Category : General Physically Disabled : No Physically Disabled : No Physically Disabled : No Head Amount Credit to Head Amount Credit to Head Amount Credit to Application Fees Rs.CASH VOUCHER BANK'S COPY CASH VOUCHER INSTITUTE’S COPY CASH VOUCHER CANDIDATE'S COPY BRANCH (CODE NO.800. Please note to write the Journal Number in all the challans.00 98353XXXXXX Bank's Charges Rs. 830.in E-mail Address: manuseeks@live. 2.00 Total Rs. Column 3.in E-mail Address: manuseeks@live.O) MADHAVAPPALLY(H) NELLIPPARA(P. Column 3. Column and Name of the Candidate in the menu while posting.00 31372883605 Application Fees Rs.to your Branch Commission 1.98353XXXXXX A/c No. Please feed the Application No.00 98353XXXXXX Bank's Charges Rs. and Name of the Candidate in the menu while posting. 31372883605 GATE 2011 FEE COLLECTION A/C NO. ) BRANCH (CODE NO. 30.O) MADHAVAPPALLY(H) NELLIPPARA(P.30/. in REG/ID/Ref No.00 98353XXXXXX Total Rs.O) ALAKODE(VIA) KANNUR . 31372883605 Name of the Candidate MANU CHERIAN Name of the MANU CHERIAN Name of the MANU CHERIAN Present Address Present Address Present Address MADHAVAPPALLY(H) NELLIPPARA(P. ) GATE 2011 – Online Application Fee Payment GATE 2011 – Online Application Fee Payment GATE 2011 – Online Application Fee Payment GATE 2011 FEE COLLECTION A/C NO.00 31372883605 Application Fees Rs. 3. in REG/ID/Ref No. Please feed the Application No.30/.to your Branch Commission A/c No. Please note to write the Journal Number in all the challans. 30.98353XXXXXX A/c No.670571 Date of Birth 29/01/1989 Date of Birth 29/01/1989 Date of Birth 29/01/1989 Mobile / Landline No: 09400455644 Mobile / Landline No: 09400455644 Mobile / Landline No: 09400455644 E-mail Address: manuseeks@live.00 31372883605 Bank's Charges Rs. Please credit Rs. 800. Please feed the Application No. Please credit Rs. ) BRANCH (CODE NO. Please credit Rs. and Name of the Candidate in the menu while posting. 2. Amount in words : Rupees eight hundred and thirty only. 830. Please note to write the Journal Number in all the challans. SEAL / DATE AUTHORISED SIGNATORY SEAL / DATE AUTHORISED SIGNATORY SEAL / DATE AUTHORISED SIGNATORY .