Академический Документы
Профессиональный Документы
Культура Документы
3. 4.
5. 6. 7.
8.
7.
____________End of Instructions____________
GATE COPY
11. Address for Correspondence SAROJ COLONY NEAR GANESH NAGAR SUTGIRINI ROAD, AMRAVATI 12. PINCODE of Address for 444606 Correspondence 13. Year of Degree 14. Discipline 15. Name of Parent 2012 Mechanical Engineering DILIP HARISHCHNDRA DESHMUKH Maharashtra
7. Qualifying Degree
09766296318
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
204ME2079037
Send this form along with the necessary documents to IIT Bombay.
CANDIDATE COPY
11. Address for Correspondence SAROJ COLONY NEAR GANESH NAGAR SUTGIRINI ROAD, AMRAVATI 12. PINCODE of Address for 444606 Correspondence 13. Year of Degree 14. Discipline 15. Name of Parent 2012 Mechanical Engineering DILIP HARISHCHNDRA DESHMUKH Maharashtra
7. Qualifying Degree
09766296318
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
204ME2079037
BY SPEED / REGISTERED POST (Please do not Courier) GATE 2012 Application Form
204ME2079037
Do not tamper with the bar code. For GATE official use.
From
RASIKA DILIPRAO DESHMUKH (APPLNO : 2079037) SAROJ COLONY NEAR GANESH NAGAR SUTGIRINI ROAD, AMRAVATI 444606
CASH VOUCHER
CANDIDATE COPY
Challan can be deposited minimum one day after the generation of challan.
Name of the Candidate : RASIKA DILIPRAO DESHMUKH Address for Correspondence :
Challan can be deposited minimum one day after the generation of challan.
Name of the Candidate : RASIKA DILIPRAO DESHMUKH
Challan can be deposited minimum one day after the generation of challan.
Name of the Candidate : RASIKA DILIPRAO DESHMUKH
SAROJ COLONY NEAR GANESH NAGAR Address for Correspondence : SUTGIRINI ROAD, AMRAVATI - 444606
SAROJ COLONY NEAR GANESH NAGAR Address for Correspondence : SUTGIRINI ROAD, AMRAVATI - 444606
09766296318 rasikadeshmukh2@gmail.com
09766296318 rasikadeshmukh2@gmail.com
09766296318 rasikadeshmukh2@gmail.com
OBC(Non-Creamy Layer) Rs.1025/- * Rupees One thousand and Twenty Five Only. (*Application Fees Including Bank Charges)
OBC(Non-Creamy Layer) Rs.1025/- * Rupees One thousand and Twenty Five Only. (*Application Fees Including Bank Charges)
OBC(Non-Creamy Layer) Rs.1025/- * Rupees One thousand and Twenty Five Only. (*Application Fees Including Bank Charges)
JOURNAL NUMBER
JOURNAL NUMBER
JOURNAL NUMBER
Signature of the Candidate/Remitter For Receiving Branch use only 1. Please note to write the Journal Number in all the challans. 2. Please feed the Application No. in REG/ID/Ref No. Column.
Signature of the Candidate/Remitter For Receiving Branch use only 1. Please note to write the Journal Number in all the challans. 2. Please feed the Application No. in REG/ID/Ref No. Column.
Signature of the Candidate/Remitter For Receiving Branch use only 1. Please note to write the Journal Number in all the challans. 2. Please feed the Application No. in REG/ID/Ref No. Column.
SEAL / DATE
AUTHORISED SIGNATORY
SEAL / DATE
AUTHORISED SIGNATORY
SEAL / DATE
AUTHORISED SIGNATORY