You are on page 1of 4

Instructions and Application Form for GATE 2012

Instructions for the Candidate:
1. 2. Your Login ID is PRAS07084. Remember your password and do not disclose it to anyone. There are 4 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. 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.

List of Documents to be attached with the Application Form:
1. 2. 3. 4. 5. Application Form (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.

Put

7.

____________End of Instructions____________

Address for Correspondence QUARTER NUMBER . I understand that I will be denied the opportunity to appear in GATE 2012. any admission/degree acquired on the basis of GATE 2012 score is liable to be cancelled.Raipur 217 . if any such suppression or distortion of facts is found after appearing in the exam. Date of Birth (DD/MM/YYYY) 3. Photograph Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS) 3.APPLICATION NO.)/B. PINCODE of Address for 490009 Correspondence 13.5 cm 613BT6068271 Send this form along with the necessary documents to IIT Kharagpur.5 cm x 3. (Engg.Sc.Nagpur 17. In the event of suppression or distortion of any fact in my application form. E-mail Address Fee: Rs. Choice of GATE Paper 10. .11 SECTOR .1/D STREET .Arch. Category 6. Qualifying Degree B.Sc. Nationality 5.com 4. Gender Payment Mode: Payment Gateway Payment Reference No: MSBI1003776617 PRASHANT PATIL 07/08/1989 MALE 9. 1000 Biotechnology prashant7889@gmail.Tech. Person with Disability (PD) INDIAN General No 11.(Tech.E. I have read the contents of GATE 2012 website and I shall abide by the terms and conditions therein. Further.)/B. Discipline 15. 09179038453 I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. Name of Parent 2011 Biotechnology DIGAMBER PATIL Chattisgarh 7. 16./ B. Name of the Candidate as in the 10th Class Certificate 2. Mobile / Landline No. Year of Degree 14.8 BHILAI DIST-DURG 12. Choice of Examination City1 Choice of Examination City2 613 . 6068271 GATE COPY GATE 2012 APPLICATION FORM Zone: IIT Kharagpur 1. State/Union Territory of Permanent Residence 8. Signature 19. Place : Date : 18./B.

In the event of suppression or distortion of any fact in my application form.Raipur 217 . Discipline 15. Category 6. Choice of Examination City1 Choice of Examination City2 613 . Person with Disability (PD) INDIAN General No 11. E-mail Address Fee: Rs. 16. Choice of GATE Paper 10.com 4.5 cm x 3.)/B.Sc. 09179038453 I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief.11 SECTOR . Gender Payment Mode: Payment Gateway Payment Reference No: MSBI1003776617 PRASHANT PATIL 07/08/1989 MALE 9. 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.Tech. Name of Parent 2011 Biotechnology DIGAMBER PATIL Chattisgarh 7.5 cm 613BT6068271 Retain this copy with you for future reference. 1000 Biotechnology prashant7889@gmail. I understand that I will be denied the opportunity to appear in GATE 2012./ B. Address for Correspondence QUARTER NUMBER . Photograph Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS) 3.E. Mobile / Landline No. Date of Birth (DD/MM/YYYY) 3.APPLICATION NO. I have read the contents of GATE 2012 website and I shall abide by the terms and conditions therein. Place : Date : 18. State/Union Territory of Permanent Residence 8. Further. . Name of the Candidate as in the 10th Class Certificate 2. (Engg. 6068271 CANDIDATE COPY GATE 2012 APPLICATION FORM Zone: IIT Kharagpur 1.1/D STREET ./B. Qualifying Degree B. Nationality 5. Year of Degree 14. PINCODE of Address for 490009 Correspondence 13. Signature 19.8 BHILAI DIST-DURG 12.)/B.Sc.Nagpur 17.Arch.(Tech.

8 BHILAI DIST-DURG 490009 . GATE Indian Institute of Technology Kharagpur Kharagpur .BY SPEED / REGISTERED POST (Please do not Courier) GATE 2012 Application Form To Chairman. For GATE official use. From PRASHANT PATIL (APPLNO : 6068271) QUARTER NUMBER .1/D STREET .721302 613BT6068271 Do not tamper with the bar code.11 SECTOR .

Related Interests