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Instructions and Application Form for GATE 2012

Instructions for the Candidate:
1. 2. Your Login ID is JEET01072. 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.

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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).

____________End of Instructions____________

Arch. Gender Payment Mode: Bank Challan (SBI) JEETU 01/07/1988 MALE 9. Further.com 4./Power Engg LETE MR OMPRAKASH Uttar Pradesh 7. Year of Degree 14. Name of Parent 2011 Electrical Engg/Electrical and Electronics Engg. Choice of Examination City1 Choice of Examination City2 510 .Lucknow 17.(Tech. Signature 19. E-mail Address Fee: Rs. I have read the contents of GATE 2012 website and I shall abide by the terms and conditions therein. 08799269646 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.Kanpur 511 . State/Union Territory of Permanent Residence 8.E. Qualifying Degree B.5 cm 510EE5007422 Send this form along with the necessary documents to IIT Kanpur.)/B. Photograph Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS) 3. Place : Date : 18. 16. 500 Electrical Engineering jeetukumar031@gmail. if any such suppression or distortion of facts is found after appearing in the exam. Address for Correspondence 58-ALIMCO HOUSING SOCIETY VINAYAK PUR KANPUR NAGAR KANPUR 12.5 cm x 3.)/B. Discipline 15. Name of the Candidate as in the 10th Class Certificate 2.Sc. . Mobile / Landline No. (Engg. Date of Birth (DD/MM/YYYY) 3./ B. Person with Disability (PD) INDIAN Scheduled Caste No 11. any admission/degree acquired on the basis of GATE 2012 score is liable to be cancelled. Choice of GATE Paper 10. PINCODE of Address for 208002 Correspondence 13.Sc. 5007422 GATE COPY GATE 2012 APPLICATION FORM Zone: IIT Kanpur 1.Tech. In the event of suppression or distortion of any fact in my application form. Nationality 5. Category 6.APPLICATION NO./B.

Name of Parent 2011 Electrical Engg/Electrical and Electronics Engg. (Engg.E. I have read the contents of GATE 2012 website and I shall abide by the terms and conditions therein. 16. . Name of the Candidate as in the 10th Class Certificate 2.5 cm x 3. PINCODE of Address for 208002 Correspondence 13. Mobile / Landline No.Kanpur 511 . Place : Date : 18. Signature 19. Year of Degree 14.APPLICATION NO. 08799269646 I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief.Lucknow 17. 5007422 CANDIDATE COPY GATE 2012 APPLICATION FORM Zone: IIT Kanpur 1.)/B.Sc. E-mail Address Fee: Rs. Further.)/B.Sc. Choice of Examination City1 Choice of Examination City2 510 . if any such suppression or distortion of facts is found after appearing in the exam. Category 6. Discipline 15. Nationality 5./ B. Photograph Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS) 3.Arch. Person with Disability (PD) INDIAN Scheduled Caste No 11.5 cm 510EE5007422 Retain this copy with you for future reference. Date of Birth (DD/MM/YYYY) 3.(Tech. In the event of suppression or distortion of any fact in my application form.Tech.com 4./Power Engg LETE MR OMPRAKASH Uttar Pradesh 7. 500 Electrical Engineering jeetukumar031@gmail. I understand that I will be denied the opportunity to appear in GATE 2012. Address for Correspondence 58-ALIMCO HOUSING SOCIETY VINAYAK PUR KANPUR NAGAR KANPUR 12. Gender Payment Mode: Bank Challan (SBI) JEETU 01/07/1988 MALE 9. Choice of GATE Paper 10. Qualifying Degree B. any admission/degree acquired on the basis of GATE 2012 score is liable to be cancelled./B. State/Union Territory of Permanent Residence 8.

From JEETU (APPLNO : 5007422) 58-ALIMCO HOUSING SOCIETY VINAYAK PUR KANPUR NAGAR KANPUR 208002 . For GATE official use.BY SPEED / REGISTERED POST (Please do not Courier) GATE 2012 Application Form To Chairman. GATE Indian Institute of Technology Kanpur Kanpur .208016 Do not tamper with the bar code.

Column. : Date of Birth : 8888 16 5007422 01/07/1988 Last date for acceptance of challan in bank : 24 October 2011. Please feed the Application No. (*Application Fees Including Bank Charges) Category : Amount : Amount in words : Scheduled Caste Rs. Name of the Candidate : JEETU Address for Correspondence : Challan can be deposited minimum one day after the generation of challan. Name of the Candidate : JEETU 58-ALIMCO HOUSING SOCIETY VINAYAK PUR KANPUR NAGAR KANPUR . Please note to write the Journal Number in all the challans.com Mobile / Landline No: E Mail ID : 08799269646 jeetukumar031@gmail. 2. Please note to write the Journal Number in all the challans.208002 58-ALIMCO HOUSING SOCIETY VINAYAK Address for Correspondence : PUR KANPUR NAGAR KANPUR . Please feed the Application No. CASH CAN BE TENDERED AT ANY SBI BRANCH GATE 2012 – Application Fee Payment Challan Use CBS Screen No. in REG/ID/Ref No.208002 Mobile / Landline No: E Mail ID : 08799269646 jeetukumar031@gmail. : Date of Birth : 8888 16 5007422 01/07/1988 Challan can be deposited minimum one day after the generation of challan.525/. : FEE Type : Registration ID / Ref No.com Mobile / Landline No: E Mail ID : 08799269646 jeetukumar031@gmail.* Rupees Five Hundred and Twenty Five Only. Column.com Category : Amount : Amount in words : Scheduled Caste Rs. : FEE Type : Registration ID / Ref No.525/. 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. : FEE Type : Registration ID / Ref No. CASH CAN BE TENDERED AT ANY SBI BRANCH GATE 2012 – Application Fee Payment Challan Use CBS Screen No. Please note to write the Journal Number in all the challans. (*Application Fees Including Bank Charges) Category : Amount : Amount in words : Scheduled Caste Rs. in REG/ID/Ref No. Signature of the Candidate/Remitter For Receiving Branch use only 1. Column. 2. Name of the Candidate : JEETU Address for Correspondence : Challan can be deposited minimum one day after the generation of challan. : Date of Birth : 8888 16 5007422 01/07/1988 Last date for acceptance of challan in bank : 24 October 2011.525/.* Rupees Five Hundred and Twenty Five Only.208002 58-ALIMCO HOUSING SOCIETY VINAYAK PUR KANPUR NAGAR KANPUR . 2.CASH VOUCHER BANK COPY CASH VOUCHER GATE COPY CASH VOUCHER CANDIDATE COPY Last date for acceptance of challan in bank : 24 October 2011.* Rupees Five Hundred and Twenty Five Only. in REG/ID/Ref No. SEAL / DATE AUTHORISED SIGNATORY SEAL / DATE AUTHORISED SIGNATORY SEAL / DATE AUTHORISED SIGNATORY . Signature of the Candidate/Remitter For Receiving Branch use only 1. Please feed the Application No.