ONLINE Application for GATE 2011

Instructions for the Candidate:

1. Your Login ID is TSIV2209. Remember your password and do not disclose it to anyone.
2. There are 4 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 - 4 : Address slip to be pasted on the A4 size envelope
7. 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, IISc Bangalore

List of Documents to be sent to GATE IISc Bangalore:

1. Application Form (GATE Copy)
2. Attested Copy of SC/ST/PD Certificate (if applicable)
3. Attested Copy of affidavit for change of name (if applicable)

Page - 1
 GATE IISc Bangalore COPY
APPLICATION FORM FOR GATE 2011
Application No: 1116741 Payment Mode: HDFC Payment Gateway

Zone: IISc Bangalore Application Fee: Rs. 800/- Payment Reference No: 028214182143

1. Name of the Candidate as in T SIVASAKTHI KUMARAN 11. Address NO15, 2ND MAIN ROAD
the 10th Class Certificate
BARATHIDASAN NAGAR

MUDALIARPET

2. Date of Birth (DD/MM/YYYY) 22/09/1987 PONDICHERRY

PINCODE 605004
3. Gender MALE

4. Nationality INDIAN 14. Year of Degree 2009

15. Discipline Instrumentation/ Electronics/Control

5. Category OBC(Non-Creamy Layer)

6. Person with Disability (PD) No

Do You Require a Scribe? No 16. Name of Parent TAMILARASAN

7. Qualifying Degree B.E./B.Tech./ B.Sc. 17. State/Union Territory of Puducherry (Pondicherry)

(Engg.)/B.Sc.(Tech.)/B.Arch. Permanent Residence

18. Phone / Mobile 09160984060

8. Choice of Examination City1 108 - Hyderabad
Number
19. PINCODE of Address 605004
Choice of Examination City2 112 - Secunderabad for Correspondence

9. Choice of GATE Paper IN - Intrumentation Engineering

10. E-mail Address sskumaran_eie27@yahoo.co.in

I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. 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 2011.
Further, if any such suppression or distortion of facts is found after appearing in the exam, any admission/degree acquired on the basis of
GATE 2011 score is liable to be cancelled.

Place:
Date:
Full Signature of the Candidate
(do not sign in capital letters)

12. Photograph

Paste a front
facial high
contrast recent
13. Full Signature of the Candidate color photograph
1116741 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 IISc Bangalore

Page - 2
 CANDIDATE COPY
APPLICATION FORM FOR GATE 2011
Application No: 1116741 Payment Mode: HDFC Payment Gateway

Zone: IISc Bangalore Application Fee: Rs. 800/- Payment Reference No: 028214182143

1. Name of the Candidate as in T SIVASAKTHI KUMARAN 11. Address NO15, 2ND MAIN ROAD
the 10th Class Certificate
BARATHIDASAN NAGAR

MUDALIARPET

2. Date of Birth (DD/MM/YYYY) 22/09/1987 PONDICHERRY

PINCODE 605004
3. Gender MALE

4. Nationality INDIAN 14. Year of Degree 2009

15. Discipline Instrumentation/ Electronics/Control

5. Category OBC(Non-Creamy Layer)

6. Person with Disability (PD) No

Do You Require a Scribe? No 16. Name of Parent TAMILARASAN

7. Qualifying Degree B.E./B.Tech./ B.Sc. 17. State/Union Territory of Puducherry (Pondicherry)

(Engg.)/B.Sc.(Tech.)/B.Arch. Permanent Residence

18. Phone / Mobile 09160984060

8. Choice of Examination City1 108 - Hyderabad
Number
19. PINCODE of Address 605004
Choice of Examination City2 112 - Secunderabad for Correspondence

9. Choice of GATE Paper IN - Intrumentation Engineering

10. E-mail Address sskumaran_eie27@yahoo.co.in

I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. 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 2011.
Further, if any such suppression or distortion of facts is found after appearing in the exam, any admission/degree acquired on the basis of
GATE 2011 score is liable to be cancelled.

Place:
Date:
Full Signature of the Candidate
(do not sign in capital letters)

12. Photograph

Paste a front
facial high
contrast recent
13. Full Signature of the Candidate color photograph
1116741 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 - 3
 BY SPEED POST / REGISTERED POST

GATE 2011
GATE PAPER CODE IN To

EXAM CITY OF FIRST Chairman, GATE

CHOICE 108
Indian Institute of Science Bangalore

Bangalore

From
PINCODE 5 6 0 0 1 2
T SIVASAKTHI KUMARAN

NO15, 2ND MAIN ROAD

APPLICATION NO
BARATHIDASAN NAGAR

MUDALIARPET

PONDICHERRY 1 1 1 6 7 4 1
PINCODE 6 0 5 0 0 4

Page - 4