Instructions and Application Form for GATE 2012

Instructions for the Candidate:
1. 2. Your Login ID is ANIL3112. 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. 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.

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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). Candiates with backlog: copy of final semester/year marks sheet or course completion certificate or a letter from principal.

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____________End of Instructions____________

Choice of Examination City1 Choice of Examination City2 708 .E.O KALAMASSERY.PIN-683503 12. Year of Degree 14. Name of the Candidate as in the 10th Class Certificate 2. 09633808097 I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. FAWAZ K.COCHIN KERALA. any admission/degree acquired on the basis of GATE 2012 score is liable to be cancelled. Nationality 5.(Tech.Sc. PINCODE of Address for 683503 Correspondence 13. Signature 19. 1000 Civil Engineering cusatsoece@gmail. Photograph Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS) 3. E-mail Address Fee: Rs./Construction Engg. Address for Correspondence C/0-MD. MUNNI SAH Bihar 15. I have read the contents of GATE 2012 website and I shall abide by the terms and conditions therein. 7048869 GATE COPY GATE 2012 APPLICATION FORM Zone: IIT Madras 1.HMT COLONY P.Sc.Ernakulam 718 . Discipline 2012 Civil/Civil & Environmental/Structural Engg. Mobile / Landline No.5 cm 708CE7048869 Send this form along with the necessary documents to IIT Madras. Name of Parent 7.5 cm x 3. 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.)/B. Person with Disability (PD) INDIAN OBC(Non-Creamy Layer) No 11./B. (Engg.Arch. Further.Tech. Choice of GATE Paper 10. Date of Birth (DD/MM/YYYY) 3.Kozhikode 17. State/Union Territory of Permanent Residence 8. Place : Date : 18. 16.)/B.APPLICATION NO.com 4./ B. Qualifying Degree B. I understand that I will be denied the opportunity to appear in GATE 2012. Category 6.A KARIYATT HOUSE. Gender Payment Mode: Bank Challan (SBI) ANIL KUMAR GUPTA 31/12/1987 MALE 9. .

I understand that I will be denied the opportunity to appear in GATE 2012. State/Union Territory of Permanent Residence 8./ B.5 cm x 3.(Tech.APPLICATION NO.O KALAMASSERY.Ernakulam 718 . Person with Disability (PD) INDIAN OBC(Non-Creamy Layer) No 11. Choice of Examination City1 Choice of Examination City2 708 . Choice of GATE Paper 10. MUNNI SAH Bihar 15.Tech.com 4. Address for Correspondence C/0-MD.Kozhikode 17. Qualifying Degree B. Name of Parent 7. Mobile / Landline No. 09633808097 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.HMT COLONY P. Name of the Candidate as in the 10th Class Certificate 2. Gender Payment Mode: Bank Challan (SBI) ANIL KUMAR GUPTA 31/12/1987 MALE 9. if any such suppression or distortion of facts is found after appearing in the exam.Sc. 16. PINCODE of Address for 683503 Correspondence 13. Signature 19.)/B.COCHIN KERALA. 1000 Civil Engineering cusatsoece@gmail. Nationality 5. Further. E-mail Address Fee: Rs.E.Sc.)/B.A KARIYATT HOUSE. . Photograph Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS) 3. In the event of suppression or distortion of any fact in my application form./B. Category 6. Date of Birth (DD/MM/YYYY) 3. Place : Date : 18. 7048869 CANDIDATE COPY GATE 2012 APPLICATION FORM Zone: IIT Madras 1. (Engg.Arch. FAWAZ K.5 cm 708CE7048869 Retain this copy with you for future reference.PIN-683503 12. I have read the contents of GATE 2012 website and I shall abide by the terms and conditions therein./Construction Engg. Year of Degree 14. Discipline 2012 Civil/Civil & Environmental/Structural Engg.

From ANIL KUMAR GUPTA (APPLNO : 7048869) C/0-MD.HMT COLONY P.O KALAMASSERY. FAWAZ K.BY SPEED / REGISTERED POST (Please do not Courier) GATE 2012 Application Form To Chairman. For GATE official use. GATE Indian Institute of Technology Madras Chennai .A KARIYATT HOUSE.COCHIN KERALA.PIN-683503 683503 .600036 708CE7048869 Do not tamper with the bar code.

Please feed the Application No. CASH CAN BE TENDERED AT ANY SBI BRANCH GATE 2012 – Application Fee Payment Challan Use CBS Screen No.683503 C/0-MD.* Rupees One thousand and Twenty Five Only.1025/. (*Application Fees Including Bank Charges) JOURNAL NUMBER JOURNAL NUMBER JOURNAL NUMBER Signature of the Candidate/Remitter For Receiving Branch use only 1.O KALAMASSERY. 2.com Mobile / Landline No: E Mail ID : 09633808097 cusatsoece@gmail. in REG/ID/Ref No. Please note to write the Journal Number in all the challans.* Rupees One thousand and Twenty Five Only.1025/. Column. Name of the Candidate : ANIL KUMAR GUPTA Address for Correspondence : Challan can be deposited minimum one day after the generation of challan.HMT COLONY P.A KARIYATT HOUSE. CASH CAN BE TENDERED AT ANY SBI BRANCH GATE 2012 – Application Fee Payment Challan Use CBS Screen No. Signature of the Candidate/Remitter For Receiving Branch use only 1.com Mobile / Landline No: E Mail ID : 09633808097 cusatsoece@gmail.A KARIYATT HOUSE. : Date of Birth : 8888 16 7048869 31/12/1987 Last date for acceptance of challan in bank : 24 October 2011. (*Application Fees Including Bank Charges) Category : Amount : Amount in words : OBC(Non-Creamy Layer) Rs.COCHIN KERALA.PIN-683503 . Name of the Candidate : ANIL KUMAR GUPTA Address for Correspondence : Challan can be deposited minimum one day after the generation of challan. Please note to write the Journal Number in all the challans.COCHIN KERALA. in REG/ID/Ref No. : Date of Birth : 8888 16 7048869 31/12/1987 Last date for acceptance of challan in bank : 24 October 2011.COCHIN KERALA. : FEE Type : Registration ID / Ref No.HMT COLONY P. Please feed the Application No.com Category : Amount : Amount in words : OBC(Non-Creamy Layer) Rs. Please feed the Application No.O KALAMASSERY. FAWAZ K.O KALAMASSERY.* Rupees One thousand and Twenty Five Only. SEAL / DATE AUTHORISED SIGNATORY SEAL / DATE AUTHORISED SIGNATORY SEAL / DATE AUTHORISED SIGNATORY . : FEE Type : Registration ID / Ref No. : Date of Birth : 8888 16 7048869 31/12/1987 Challan can be deposited minimum one day after the generation of challan. in REG/ID/Ref No. Signature of the Candidate/Remitter For Receiving Branch use only 1. Column. (*Application Fees Including Bank Charges) Category : Amount : Amount in words : OBC(Non-Creamy Layer) Rs.A KARIYATT HOUSE. Name of the Candidate : ANIL KUMAR GUPTA C/0-MD.PIN-683503 .HMT Address for Correspondence : COLONY P. CASH CAN BE TENDERED AT ANY SBI BRANCH GATE 2012 – Application Fee Payment Challan Use CBS Screen No.683503 C/0-MD.PIN-683503 . FAWAZ K.1025/. 2. : FEE Type : Registration ID / Ref No. Column.683503 Mobile / Landline No: E Mail ID : 09633808097 cusatsoece@gmail.CASH VOUCHER BANK COPY CASH VOUCHER GATE COPY CASH VOUCHER CANDIDATE COPY Last date for acceptance of challan in bank : 24 October 2011. FAWAZ K. 2. Please note to write the Journal Number in all the challans.

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