Instructions and Application Form for GATE 2012

Instructions for the Candidate:

1. 2. Your Login ID is PADI1108. 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 Indian Bank 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.

3. 4.

5. 6. 7.

8.

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.

7.

____________End of Instructions____________

APPLICATION NO. 7026074

GATE COPY

GATE 2012 APPLICATION FORM

Zone: IIT Madras
1. Name of the Candidate as in the 10th Class Certificate 2. Date of Birth (DD/MM/YYYY) 3. Gender 4. Nationality 5. Category 6. Person with Disability (PD) Do You Require a Scribe? 7. Qualifying Degree

Payment Mode: Bank Challan (Indian Bank)

PADIRI JHANSI 11/08/1991 FEMALE INDIAN General Yes No B.E./B.Tech./ B.Sc. (Engg.)/B.Sc.(Tech.)/B.Arch. 9. Choice of GATE Paper 10. E-mail Address

Fee: Rs. 500

Computer Science and Information Technology padirijhansi@gmail.com

11. Address for Correspondence 10-2-100 , T.K.STREET TIRUPATI 12. PINCODE of Address for 517501 Correspondence 13. Year of Degree 14. Discipline 15. Name of Parent 16. State/Union Territory of Permanent Residence 2012 Computer Science & Engineering/Technology P KRISHNA REDDY Andhra Pradesh

8. Choice of Examination City1 Choice of Examination City2

734 - Tirupati 705 - Chittoor

17. Mobile / Landline No.

09642147096

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

19. Photograph

Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS)

3.5 cm x 3.5 cm

734CS7026074

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

APPLICATION NO. 7026074

CANDIDATE COPY

GATE 2012 APPLICATION FORM

Zone: IIT Madras
1. Name of the Candidate as in the 10th Class Certificate 2. Date of Birth (DD/MM/YYYY) 3. Gender 4. Nationality 5. Category 6. Person with Disability (PD) Do You Require a Scribe? 7. Qualifying Degree

Payment Mode: Bank Challan (Indian Bank)

PADIRI JHANSI 11/08/1991 FEMALE INDIAN General Yes No B.E./B.Tech./ B.Sc. (Engg.)/B.Sc.(Tech.)/B.Arch. 9. Choice of GATE Paper 10. E-mail Address

Fee: Rs. 500

Computer Science and Information Technology padirijhansi@gmail.com

11. Address for Correspondence 10-2-100 , T.K.STREET TIRUPATI 12. PINCODE of Address for 517501 Correspondence 13. Year of Degree 14. Discipline 15. Name of Parent 16. State/Union Territory of Permanent Residence 2012 Computer Science & Engineering/Technology P KRISHNA REDDY Andhra Pradesh

8. Choice of Examination City1 Choice of Examination City2

734 - Tirupati 705 - Chittoor

17. Mobile / Landline No.

09642147096

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

19. Photograph

Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS)

3.5 cm x 3.5 cm

734CS7026074

Retain this copy with you for future reference.

BY SPEED / REGISTERED POST (Please do not Courier) GATE 2012 Application Form

To Chairman, GATE Indian Institute of Technology Madras Chennai - 600036

734CS7026074
Do not tamper with the bar code. For GATE official use.

From
PADIRI JHANSI (APPLNO : 7026074) 10-2-100 , T.K.STREET TIRUPATI 517501

PAY IN SLIP

BANK COPY

PAY IN SLIP

GATE COPY PAY IN SLIP

CANDIDATE COPY

APPLICATION FEE PAYABLE AT ALL BRANCHES OF INDIAN BANK Paid into the credit of IIT DELHI GATE 2012 (Challan) A/C no 971937016 , HAUZ KHAS BRANCH NEW DELHI, BRANCH CODE : 1104
Name of the Candidate : PADIRI JHANSI

APPLICATION FEE PAYABLE AT ALL BRANCHES OF INDIAN BANK Paid into the credit of IIT DELHI GATE 2012 (Challan) A/C no 971937016, HAUZ KHAS BRANCH NEW DELHI, BRANCH CODE : 1104
Name of the Candidate : PADIRI JHANSI

APPLICATION FEE PAYABLE AT ALL BRANCHES OF INDIAN BANK Paid into the credit of IIT DELHI GATE 2012 (Challan) A/C no 971937016, HAUZ KHAS BRANCH NEW DELHI, BRANCH CODE : 1104
Name of the Candidate : PADIRI JHANSI

Address for Correspondence :

10-2-100 , T.K.STREET TIRUPATI - 517501

Address for Correspondence :

10-2-100 , T.K.STREET TIRUPATI - 517501

Address for Correspondence :

10-2-100 , T.K.STREET TIRUPATI - 517501

Date of Birth : Mobile / Landline No : E-mail Address :

11/08/1991 09642147096 padirijhansi@gmail.com

Date of Birth : Mobile / Landline No : E-mail Address :

11/08/1991 09642147096 padirijhansi@gmail.com

Date of Birth : Mobile / Landline No : E-mail Address :

11/08/1991 09642147096 padirijhansi@gmail.com

Head : Application Fees : Bank's Charges : Total * : Amount in words : Name of the Receiving Branch : Signature of the candidate : FOR BANKS USE MUP Ref. No: GATE Application Form No. : Branch Code : MU0003142719 Journal No: Signature of cashier : Date :

Amount Rs. 500.00 Rs. 25.00 Rs. 525.00 Rupees Five Hundred and Twenty Five Only. (*Inclusive of Bank Charges)

Head : Application Fees : Bank's Charges : Total * : Amount in words : Name of the Receiving Branch : Signature of the candidate : FOR BANKS USE MUP Ref. No: GATE Application Form No. : Branch Code : MU0003142719 Journal No: Signature of cashier : Date :

Amount Rs. 500.00 Rs. 25.00 Rs. 525.00 Rupees Five Hundred and Twenty Five Only. (*Inclusive of Bank Charges)

Head : Application Fees : Bank's Charges : Total * : Amount in words : Name of the Receiving Branch : Signature of the candidate : FOR BANKS USE MUP Ref. No: GATE Application Form No. : Branch Code : MU0003142719 Journal No: Signature of cashier : Date :

Amount Rs. 500.00 Rs. 25.00 Rs. 525.00 Rupees Five Hundred and Twenty Five Only. (*Inclusive of Bank Charges)

7026074

7026074

7026074