Instructions and Application Form for GATE 2012

Instructions for the Candidate:
1. 2. Your Login ID is YNAG2102. 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____________

Gender Payment Mode: Bank Challan (SBI) Y NAGESH 21/02/1982 MALE 9. Name of Parent 2003 Mechanical Engineering Y BIKSHAPATHI Andhra Pradesh 7.E. Signature 19. Mobile / Landline No. E-mail Address Fee: Rs.Sc. I have read the contents of GATE 2012 website and I shall abide by the terms and conditions therein.)/B. 1000 Mechanical Engineering nagesh. (Engg. Nationality 5./B. if any such suppression or distortion of facts is found after appearing in the exam. . Person with Disability (PD) INDIAN OBC(Non-Creamy Layer) No 11. I understand that I will be denied the opportunity to appear in GATE 2012.com 4. State/Union Territory of Permanent Residence 8. Choice of Examination City1 Choice of Examination City2 108 .APPLICATION NO.Visakhapatnam 17. Address for Correspondence H-NO-5-2-3 RAMALAYAM STREET KUKATPALLY HYDERABAD 12.5 cm 108ME1021703 Send this form along with the necessary documents to IISc Bangalore. Choice of GATE Paper 10. 16. Discipline 15. Place : Date : 18.Arch. any admission/degree acquired on the basis of GATE 2012 score is liable to be cancelled.)/B. In the event of suppression or distortion of any fact in my application form./ B. Date of Birth (DD/MM/YYYY) 3. Qualifying Degree B.Tech. Year of Degree 14. Name of the Candidate as in the 10th Class Certificate 2. 1021703 GATE COPY GATE 2012 APPLICATION FORM Zone: IISc Bangalore 1.(Tech. PINCODE of Address for 500072 Correspondence 13. Further.Hyderabad 621 . Category 6.sapmm@gmail. 09989701740 I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief.5 cm x 3.Sc. Photograph Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS) 3.

Nationality 5. Mobile / Landline No. PINCODE of Address for 500072 Correspondence 13. Year of Degree 14. Further.APPLICATION NO.5 cm 108ME1021703 Retain this copy with you for future reference. Name of the Candidate as in the 10th Class Certificate 2./ B. Choice of Examination City1 Choice of Examination City2 108 . 16.sapmm@gmail. Date of Birth (DD/MM/YYYY) 3. 1021703 CANDIDATE COPY GATE 2012 APPLICATION FORM Zone: IISc Bangalore 1. Address for Correspondence H-NO-5-2-3 RAMALAYAM STREET KUKATPALLY HYDERABAD 12. Qualifying Degree B. Gender Payment Mode: Bank Challan (SBI) Y NAGESH 21/02/1982 MALE 9. if any such suppression or distortion of facts is found after appearing in the exam. Place : Date : 18.Sc.(Tech. Category 6.E. In the event of suppression or distortion of any fact in my application form. . Discipline 15. State/Union Territory of Permanent Residence 8. 09989701740 I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief.Arch.5 cm x 3.Hyderabad 621 . any admission/degree acquired on the basis of GATE 2012 score is liable to be cancelled.Visakhapatnam 17. Person with Disability (PD) INDIAN OBC(Non-Creamy Layer) No 11. E-mail Address Fee: Rs.Sc. 1000 Mechanical Engineering nagesh.com 4. I understand that I will be denied the opportunity to appear in GATE 2012.Tech. Choice of GATE Paper 10.)/B./B. Photograph Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS) 3.)/B. I have read the contents of GATE 2012 website and I shall abide by the terms and conditions therein. Signature 19. Name of Parent 2003 Mechanical Engineering Y BIKSHAPATHI Andhra Pradesh 7. (Engg.

For GATE official use.BY SPEED / REGISTERED POST (Please do not Courier) GATE 2012 Application Form To Chairman. From Y NAGESH (APPLNO : 1021703) H-NO-5-2-3 RAMALAYAM STREET KUKATPALLY HYDERABAD 500072 . GATE Indian Institute of Science Bangalore .560012 108ME1021703 Do not tamper with the bar code.

Name of the Candidate : Y NAGESH Challan can be deposited minimum one day after the generation of challan.500072 Mobile / Landline No: E Mail ID : 09989701740 nagesh.1025/. CASH CAN BE TENDERED AT ANY SBI BRANCH GATE 2012 – Application Fee Payment Challan Use CBS Screen No.1025/. 2.* Rupees One thousand and Twenty Five Only. Name of the Candidate : Y NAGESH Address for Correspondence : Challan can be deposited minimum one day after the generation of challan. (*Application Fees Including Bank Charges) Category : Amount : Amount in words : OBC(Non-Creamy Layer) Rs. in REG/ID/Ref No.500072 H-NO-5-2-3 RAMALAYAM H-NO-5-2-3 RAMALAYAM STREET KUKATPALLY HYDERABAD . 2. Please note to write the Journal Number in all the challans. : FEE Type : Registration ID / Ref No. CASH CAN BE TENDERED AT ANY SBI BRANCH GATE 2012 – Application Fee Payment Challan Use CBS Screen No. 2. Please feed the Application No. SEAL / DATE AUTHORISED SIGNATORY SEAL / DATE AUTHORISED SIGNATORY SEAL / DATE AUTHORISED SIGNATORY . Please note to write the Journal Number in all the challans. : FEE Type : Registration ID / Ref No.500072 H-NO-5-2-3 RAMALAYAM S T R E E T Address for Correspondence : KUKATPALLY HYDERABAD . Signature of the Candidate/Remitter For Receiving Branch use only 1. Column. Signature of the Candidate/Remitter For Receiving Branch use only 1.* Rupees One thousand and Twenty Five Only. Name of the Candidate : Y NAGESH S T R E E T Address for Correspondence : KUKATPALLY HYDERABAD . Please feed the Application No. Column. CASH CAN BE TENDERED AT ANY SBI BRANCH GATE 2012 – Application Fee Payment Challan Use CBS Screen No. (*Application Fees Including Bank Charges) JOURNAL NUMBER JOURNAL NUMBER JOURNAL NUMBER Signature of the Candidate/Remitter For Receiving Branch use only 1. : Date of Birth : 8888 16 1021703 21/02/1982 Last date for acceptance of challan in bank : 24 October 2011. in REG/ID/Ref No.sapmm@gmail. in REG/ID/Ref No.com Mobile / Landline No: E Mail ID : 09989701740 nagesh. : FEE Type : Registration ID / Ref No. : Date of Birth : 8888 16 1021703 21/02/1982 Last date for acceptance of challan in bank : 24 October 2011.sapmm@gmail.com Category : Amount : Amount in words : OBC(Non-Creamy Layer) Rs.com Mobile / Landline No: E Mail ID : 09989701740 nagesh. Column. (*Application Fees Including Bank Charges) Category : Amount : Amount in words : OBC(Non-Creamy Layer) Rs.sapmm@gmail.* Rupees One thousand and Twenty Five Only. Please feed the Application No. Please note to write the Journal Number in all the challans.1025/.CASH VOUCHER BANK COPY CASH VOUCHER GATE COPY CASH VOUCHER CANDIDATE COPY Last date for acceptance of challan in bank : 24 October 2011. : Date of Birth : 8888 16 1021703 21/02/1982 Challan can be deposited minimum one day after the generation of challan.

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