Application Form

Zone/Scrutiny Code

6OB T349N70

T349N70 (Enrollment ID)

LAKSHMI DURGA ANAND KUMAR SAMUDRAPU

(Full Name of the Applicant)

28 May 2003 Male OBC-NCL

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

Indian +91-9494842354 SAMUDRAPU ANIL KUMAR

National (Parent/Guardian's Mobile Number) (Parent/Guardian's Name)

Communication Address GATE Exam Details

H.NO-3-71,venkateswara poultry farm GATE Paper Code
near mahamkallimma temple,mahadevapatnam
undi mandal,westgodavari
Mahadevapatnam
Andhra Pradesh 534199
CE
+91-9494842354 (Mobile No.) (Civil Engineering)
anandkumarsamudrapu143@gmail.com

Exam City 1 : Tadepalligudem (AP)

Qualification Details Exam City 2 : Visakhapatnam (AP)
B. Tech Exam City 3 : Vizianagaram (AP)
Civil Engg.
Graduated: No; Year of Graduation: 2024 Zonal GATE Office Contact
SAGI RAMA KRISHNAM RAJU ENGINEERING COLLEGE GATE Office
Indian Institute of Technology Kharagpur
China amiram.,West godavari Kharagpur 721302
Andhra Pradesh 534204
gateonline@adm.iitkgp.ac.in, 03222-282091

DECLARATION
I confirm that I fulfil the eligibility criteria to appear for the Graduate Aptitude Test in Engineering (GATE 2024) examination. I have read the Information
Brochure and filled up the GATE 2024 Application Form myself. I agree to strictly comply with the code of conduct for GATE 2024 examination as detailed in
the Information Brochure. I confirm that the information provided by me in this form is correct. I also confirm that I am NOT filling more than one Application
Form for myself.
If any of the information provided by me is found to be incorrect later, I understand that my candidature for GATE 2024 may be cancelled, before, during, or
after the examination, including the time after generation of my GATE 2024 Score Card. Further, I understand that I may be liable for legal action for
providing false information. GATE 2024 Examination Body’s decision will be final and legally binding on me.
I also understand that GATE is NOT an admission ensuring examination, and qualifying in GATE examination does NOT guarantee admission, scholarship,
or a job. GATE 2024 Examination Body shall NOT be liable for any legal obligations arising out of this matter.
I am aware that the data provided by me during the application process as well as my GATE results may be shared for admission or recruitment purposes.

e-Signature : null
Digital Fingerprint : c7e00f9b198034f1ed6ef95f45d24fc3

PROVISIONAL APPLICATION SUBJECT TO PAYMENT