Instructions and Application Form for GATE 2012

Instructions for the Candidate:
1. 2. Your Login ID is DIPE0502. Remember your password and do not disclose it to anyone. There are 5 pages in this pdf file. These pages should be printed on A4 size white sheets using a laser/ink jet printer. Page - 1: Instructions for the candidate to be retained by the candidate. Page - 2 : Application Form (GATE Copy). a. Paste your recent color photo (3.5cm x 3.5cm) in the designated place. Before pasting, please write your name and application number on the backside of the photo with black ball point pen. b. Sign at the designated place. 5. 6. 7. Page - 3 : Application Form (Candidate copy) to be retained by the candidate. Page - 4 : Address page to be pasted on a 10 inch X 12 inch size laminated envelope. Page - 5 : Bank challan in triplicate. Take it to any SBI branch and pay the application fee plus the bank service charge. The Bank will retain its copy and will return the remaining two copies to you. Out of these two copies, retain the Candidate's copy with you and attach the GATE copy with the Application Form. Without folding, insert the completed Application Form (GATE copy) and attested copies of all the application documents (SC/ST/PD certificate, copy of degree certificate etc.) into a 10 inch X 12 inch laminated envelope and send by Speed Post (preferably) or by Registered Post using the address printed on page-4 so as to reach the respective Zonal GATE office on or before 24th October 2011. Application sent through courier will not be accepted.

3. 4.

8.

Put List of Documents to be attached with the Application Form:
1. 2. 3. 4. 5. 6. Application Form (GATE Copy) Bank Challan (GATE Copy) Self Attested Copy of SC/ST/PD certificate (if applicable) Self Attested Copy of affidavit for change of name (if applicable) Self Attested Copy of the degree certificate if the year of qualifying degree is 2011 or earlier. If the year of qualifying degree is 2012 or later, a certificate signed by the principal of the college clearly indicating the year of qualifying degree (format available on GATE website).

____________End of Instructions____________

Gender Payment Mode: Bank Challan (SBI) DIPESH KUMAR 05/02/1986 MALE 9. 16. Person with Disability (PD) INDIAN OBC(Non-Creamy Layer) No 12. 08600309539 I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. I understand that I will be denied the opportunity to appear in GATE 2012. Name of the Candidate as in the 10th Class Certificate 2.A. Nationality 5.ETZ.08730C IBM INDIA PVT. Mobile / Landline No. 2009540 GATE COPY GATE 2012 APPLICATION FORM Zone: IIT Bombay 1.C.PUNE. 1000 Computer Science and Information Technology dipesh. .5 cm 222CS2009540 Send this form along with the necessary documents to IIT Bombay. Further. LTD.5 cm x 3. Address for Correspondence DIPESH KUMAR .Pune 217 . I have read the contents of GATE 2012 website and I shall abide by the terms and conditions therein. Date of Birth (DD/MM/YYYY) 3./M. Discipline 15. Category 6.HINJEWADI. State/Union Territory of Permanent Residence 8.PHASE2. PLOT-3. Signature 19.A./M. E-mail Address Fee: Rs. Choice of GATE Paper 10.APPLICATION NO. Choice of Examination City1 Choice of Examination City2 222 .ceg@gmail.Sc. Name of Parent 7. RAJIV GANDHI INFOTECH PARK.com 11. In the event of suppression or distortion of any fact in my application form. if any such suppression or distortion of facts is found after appearing in the exam. Photograph Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS) 3. Place : Date : 18. any admission/degree acquired on the basis of GATE 2012 score is liable to be cancelled. Qualifying Degree M. EMP ID . PINCODE of Address for Correspondence 13. 411057 2011 Computer Science & Engineering/Technology NAWAL KISHORE SHARMA Jharkhand 4. Year of Degree 14.Nagpur 17.

Further. Mobile / Landline No.A.PUNE.Nagpur 17.APPLICATION NO.ETZ. LTD. 2009540 CANDIDATE COPY GATE 2012 APPLICATION FORM Zone: IIT Bombay 1.Pune 217 .08730C IBM INDIA PVT. Place : Date : 18. 16. Qualifying Degree M.5 cm x 3. PINCODE of Address for Correspondence 13. Name of the Candidate as in the 10th Class Certificate 2. EMP ID .A. In the event of suppression or distortion of any fact in my application form. E-mail Address Fee: Rs. Signature 19. Choice of Examination City1 Choice of Examination City2 222 . Nationality 5. Category 6. Gender Payment Mode: Bank Challan (SBI) DIPESH KUMAR 05/02/1986 MALE 9. Date of Birth (DD/MM/YYYY) 3. 08600309539 I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. any admission/degree acquired on the basis of GATE 2012 score is liable to be cancelled. if any such suppression or distortion of facts is found after appearing in the exam./M.PHASE2./M. 1000 Computer Science and Information Technology dipesh. RAJIV GANDHI INFOTECH PARK. Year of Degree 14. I have read the contents of GATE 2012 website and I shall abide by the terms and conditions therein.com 11. Choice of GATE Paper 10. PLOT-3. 411057 2011 Computer Science & Engineering/Technology NAWAL KISHORE SHARMA Jharkhand 4.5 cm 222CS2009540 Retain this copy with you for future reference. Discipline 15.HINJEWADI. Photograph Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS) 3.C. Name of Parent 7. Address for Correspondence DIPESH KUMAR . .Sc.ceg@gmail. I understand that I will be denied the opportunity to appear in GATE 2012. State/Union Territory of Permanent Residence 8. Person with Disability (PD) INDIAN OBC(Non-Creamy Layer) No 12.

Mumbai . PLOT-3. For GATE official use.ETZ.PHASE-2. From DIPESH KUMAR (APPLNO : 2009540) DIPESH KUMAR . 411057 . LTD.HINJEWADI.BY SPEED / REGISTERED POST (Please do not Courier) GATE 2012 Application Form To Chairman.400076 Do not tamper with the bar code.PUNE. RAJIV GANDHI INFOTECH PARK.08730C IBM INDIA PVT. GATE Indian Institute of Technology Bombay Powai. EMP ID .

Name of the Candidate : DIPESH KUMAR Address for Correspondence : Challan can be deposited minimum one day after the generation of challan. in REG/ID/Ref No. LTD. Column. : FEE Type : Registration ID / Ref No.* Rupees One thousand and Twenty Five Only.ETZ.PHASE-2.CASH VOUCHER BANK COPY CASH VOUCHER GATE COPY CASH VOUCHER CANDIDATE COPY Last date for acceptance of challan in bank : 24 October 2011. 411057 DIPESH KUMAR .1025/. PLOT-3. (*Application Fees Including Bank Charges) Category : Amount : Amount in words : OBC(Non-Creamy Layer) Rs. RAJIV GANDHI INFOTECH PARK. Please note to write the Journal Number in all the challans. Please note to write the Journal Number in all the challans.HINJEWADI. : FEE Type : Registration ID / Ref No. : Date of Birth : 8888 16 2009540 05/02/1986 Challan can be deposited minimum one day after the generation of challan.PHASE-2. Please note to write the Journal Number in all the challans. EMP ID . : Date of Birth : 8888 16 2009540 05/02/1986 Last date for acceptance of challan in bank : 24 October 2011.PHASE-2.* Rupees One thousand and Twenty Five Only. EMP ID . Column. : FEE Type : Registration ID / Ref No.* Rupees One thousand and Twenty Five Only. LTD. CASH CAN BE TENDERED AT ANY SBI BRANCH GATE 2012 – Application Fee Payment Challan Use CBS Screen No.PUNE.ETZ.HINJEWADI. Name of the Candidate : DIPESH KUMAR Address for Correspondence : Challan can be deposited minimum one day after the generation of challan. LTD. 411057 Mobile / Landline No: E Mail ID : 08600309539 dipesh. Please feed the Application No. RAJIV GANDHI INFOTECH PARK.PUNE.ceg@gmail.com Mobile / Landline No: E Mail ID : 08600309539 dipesh.ETZ.1025/. Signature of the Candidate/Remitter For Receiving Branch use only 1. Signature of the Candidate/Remitter For Receiving Branch use only 1. : Date of Birth : 8888 16 2009540 05/02/1986 Last date for acceptance of challan in bank : 24 October 2011.1025/. Please feed the Application No.08730C IBM INDIA PVT. Name of the Candidate : DIPESH KUMAR DIPESH KUMAR .HINJEWADI. in REG/ID/Ref No. 2. CASH CAN BE TENDERED AT ANY SBI BRANCH GATE 2012 – Application Fee Payment Challan Use CBS Screen No. 2. (*Application Fees Including Bank Charges) JOURNAL NUMBER JOURNAL NUMBER JOURNAL NUMBER Signature of the Candidate/Remitter For Receiving Branch use only 1.08730C IBM INDIA PVT. PLOT-3. (*Application Fees Including Bank Charges) Category : Amount : Amount in words : OBC(Non-Creamy Layer) Rs. CASH CAN BE TENDERED AT ANY SBI BRANCH GATE 2012 – Application Fee Payment Challan Use CBS Screen No.08730C IBM INDIA Address for Correspondence : PVT. PLOT-3. in REG/ID/Ref No.com Mobile / Landline No: E Mail ID : 08600309539 dipesh. Column. 2. RAJIV GANDHI INFOTECH PARK.PUNE.com Category : Amount : Amount in words : OBC(Non-Creamy Layer) Rs. EMP ID . SEAL / DATE AUTHORISED SIGNATORY SEAL / DATE AUTHORISED SIGNATORY SEAL / DATE AUTHORISED SIGNATORY . 411057 DIPESH KUMAR .ceg@gmail. Please feed the Application No.ceg@gmail.

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