Instructions and Application Form for GATE 2012

Instructions for the Candidate:

1.

Your Login ID is ANKI06032. Remember your password and do not disclose it to anyone.

2.

There are 4 pages in this pdf file. These pages should be printed on A4 size white sheets using a
laser/ink jet printer.

3.

Page - 1: Instructions for the candidate to be retained by the candidate.

4.

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.

Page - 3 : Application Form (Candidate copy) to be retained by the candidate.

6.

Page - 4 : Address page to be pasted on a 10 inch X 12 inch size laminated envelope.

7.

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.

List of Documents to be attached with the Application Form:

1.

Application Form (GATE Copy)

2.

Self Attested Copy of SC/ST/PD certificate (if applicable)

3.

Self Attested Copy of affidavit for change of name (if applicable)

4.

Self Attested Copy of the degree certificate if the year of qualifying

degree is 2011 or earlier.

5.

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____________

Put

GATE COPY

APPLICATION NO. 8006008

GATE 2012 APPLICATION FORM

Zone: IIT Roorkee

Payment Mode: Payment Gateway

Fee: Rs. 1000

Payment Reference No: MSBI0994583951

1. Name of the Candidate as in
the 10th Class Certificate

ANKIT JAIN

9. Choice of GATE Paper

Civil Engineering

2. Date of Birth (DD/MM/YYYY)

06/03/1985

10. E-mail Address

ankit_jain_amu@yahoo.co.in

3. Gender

MALE

4. Nationality

INDIAN

11. Address for Correspondence 45 B PRAKASH KUNJ

GUPTA COLONY
T P NAGAR
MEERUT
12. PINCODE of Address for
250002
Correspondence

5. Category

General

13. Year of Degree

2009

6. Person with Disability (PD)

No

14. Discipline

Civil/Civil &
Environmental/Structural
Engg./Construction Engg.

15. Name of Parent

ASHOK JAIN

7. Qualifying Degree

B.E./B.Tech./ B.Sc.
(Engg.)/B.Sc.(Tech.)/B.Arch.

16. State/Union Territory of

Permanent Residence

Uttar Pradesh

8. Choice of Examination City1

816 - Meerut

17. Mobile / Landline No.

01212510724

Choice of Examination City2

510 - Kanpur

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 contents of GATE 2012 website 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 2012. Further, if any such suppression or distortion of facts is found after
appearing in the exam, any admission/degree acquired on the basis of GATE 2012 score is liable to be
cancelled.
Place :
Date :

18. Signature

Full Signature of the candidate using

BLACK INK PEN only
(do not sign in CAPITAL LETTERS)

19. Photograph

3.5 cm x 3.5 cm

816CE8006008

Send this form along with the necessary documents to IIT Roorkee.

CANDIDATE COPY

APPLICATION NO. 8006008

GATE 2012 APPLICATION FORM

Zone: IIT Roorkee

Payment Mode: Payment Gateway

Fee: Rs. 1000

Payment Reference No: MSBI0994583951

1. Name of the Candidate as in
the 10th Class Certificate

ANKIT JAIN

9. Choice of GATE Paper

Civil Engineering

2. Date of Birth (DD/MM/YYYY)

06/03/1985

10. E-mail Address

ankit_jain_amu@yahoo.co.in

3. Gender

MALE

4. Nationality

INDIAN

11. Address for Correspondence 45 B PRAKASH KUNJ

GUPTA COLONY
T P NAGAR
MEERUT
12. PINCODE of Address for
250002
Correspondence

5. Category

General

13. Year of Degree

2009

6. Person with Disability (PD)

No

14. Discipline

Civil/Civil &
Environmental/Structural
Engg./Construction Engg.

15. Name of Parent

ASHOK JAIN

7. Qualifying Degree

B.E./B.Tech./ B.Sc.
(Engg.)/B.Sc.(Tech.)/B.Arch.

16. State/Union Territory of

Permanent Residence

Uttar Pradesh

8. Choice of Examination City1

816 - Meerut

17. Mobile / Landline No.

01212510724

Choice of Examination City2

510 - Kanpur

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 contents of GATE 2012 website 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 2012. Further, if any such suppression or distortion of facts is found after
appearing in the exam, any admission/degree acquired on the basis of GATE 2012 score is liable to be
cancelled.
Place :
Date :

18. Signature

Full Signature of the candidate using

BLACK INK PEN only
(do not sign in CAPITAL LETTERS)

816CE8006008

Retain this copy with you for future reference.

19. Photograph

3.5 cm x 3.5 cm

BY SPEED / REGISTERED POST

(Please do not Courier)
GATE 2012 Application Form

To
Chairman, GATE
Indian Institute of Technology Roorkee
Roorkee - 247667

Do not tamper with the bar code. For GATE official use.

From
ANKIT JAIN (APPLNO : 8006008)
45 B PRAKASH KUNJ
GUPTA COLONY
T P NAGAR
MEERUT
250002