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6CP
To
GATE 2013
Chairman GATE Indian Institute of Technology Kharagpur Kharagpur, 721302
From Vasudevan S
3/14 ELAMANUR KUDI STREET THIRUPPARAI THURAI TRUCHIRAPPALLI Tamil Nadu, 639115
195 Q 554 A
89004 79332
(Mobile No.)
Cut Here
Note: Application ID - 195 Q 554 A. You should preserve this number for further correspondence.
Zone/Scrutiny Code
6CP
195 Q 554 A
4.5 cm x 3.5 cm
(Application ID)
Vasudevan S
(Full Name of Applicant)
195 Q 554 A
12 Jun 1991
(D.O.B)
Male
(Name of Parent)
OBC-NC
Indian National
K Subramaniyan
Communication Address
3/14 ELAMANUR KUDI STREET THIRUPPARAI THURAI TRUCHIRAPPALLI Tamil Nadu, 639115 India
Kharagpur, WB
(Exam City 1)
Tiruchirapalli, TN
(Exam City 2) Scribe Assistance Required:
No
Qualification Details
M.Sc/M.A./MCA Chemistry Graduated: No, Year of Graduation: 2013 IIT KHARAGPUR KHARAGPUR West Bengal, 721302
Enclosure Checklist
Stamped Bank Challan: GATE copy
Payment Details
I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. I have read the Information Brochure and I shall abide by the terms and conditions therein. In the event of suppression or distortion of any fact in my application form, I understand that I will be denied the opportunity to appear in GATE 2013. Further, if any suppression or distortion of facts is found after appearing in the exam, any admission/degree acquired on the basis of GATE 2013 score is liable to be cancelled.
Date: ....../....../............
Principal Certificate
IIT KHARAGPUR, KHARAGPUR.
(For use as the eligibility certificate only for final year or backlog applicants)
He is a student of the final year of M.Sc/M.A./MCA. He appeared in the final semester/year exam of the above degree, but has a backlog to be cleared from an earlier semester/year, and therefore cannot produce a course completion certificate.
Date:
Seal