Instructions and Application Form for GATE 2012

Instructions for the Candidate:

1. 2. Your Login ID is SHAI12043. 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. 8011119

GATE COPY

GATE 2012 APPLICATION FORM

Zone: IIT Roorkee
1. Name of the Candidate as in the 10th Class Certificate 2. Date of Birth (DD/MM/YYYY) 3. Gender

Payment Mode: Bank Challan (Indian Bank)

SHAILENDRA SINGH 12/04/1990 MALE 9. Choice of GATE Paper 10. E-mail Address

Fee: Rs. 1000

Electrical Engineering shailusingh90@gmail.com

4. Nationality 5. Category 6. Person with Disability (PD)

INDIAN OBC(Non-Creamy Layer) No

11. Address for Correspondence S/O MR. MADANPAL SINGH VILL.- AJNARA POST- AJNARA DISTT.- BULANDSHAHAR 12. PINCODE of Address for 203150 Correspondence 13. Year of Degree 14. Discipline 15. Name of Parent 2012 Electrical Engg/Electrical and Electronics Engg./Power Engg MADANPAL SINGH Uttar Pradesh

7. Qualifying Degree

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

16. State/Union Territory of Permanent Residence

8. Choice of Examination City1 Choice of Examination City2

818 - Noida 304 - Delhi Central

17. Mobile / Landline No.

09313031118

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

818EE8011119

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

APPLICATION NO. 8011119

CANDIDATE COPY

GATE 2012 APPLICATION FORM

Zone: IIT Roorkee
1. Name of the Candidate as in the 10th Class Certificate 2. Date of Birth (DD/MM/YYYY) 3. Gender

Payment Mode: Bank Challan (Indian Bank)

SHAILENDRA SINGH 12/04/1990 MALE 9. Choice of GATE Paper 10. E-mail Address

Fee: Rs. 1000

Electrical Engineering shailusingh90@gmail.com

4. Nationality 5. Category 6. Person with Disability (PD)

INDIAN OBC(Non-Creamy Layer) No

11. Address for Correspondence S/O MR. MADANPAL SINGH VILL.- AJNARA POST- AJNARA DISTT.- BULANDSHAHAR 12. PINCODE of Address for 203150 Correspondence 13. Year of Degree 14. Discipline 15. Name of Parent 2012 Electrical Engg/Electrical and Electronics Engg./Power Engg MADANPAL SINGH Uttar Pradesh

7. Qualifying Degree

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

16. State/Union Territory of Permanent Residence

8. Choice of Examination City1 Choice of Examination City2

818 - Noida 304 - Delhi Central

17. Mobile / Landline No.

09313031118

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

818EE8011119

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 Roorkee Roorkee - 247667

818EE8011119
Do not tamper with the bar code. For GATE official use.

From
SHAILENDRA SINGH (APPLNO : 8011119) S/O MR. MADANPAL SINGH VILL.- AJNARA POST- AJNARA DISTT.- BULANDSHAHAR 203150

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 : SHAILENDRA SINGH

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 : SHAILENDRA SINGH

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 : SHAILENDRA SINGH

Address for Correspondence :

S/O MR. MADANPAL SINGH VILL.- AJNARA Address for Correspondence : POST- AJNARA DISTT.- BULANDSHAHAR 203150

S/O MR. MADANPAL SINGH VILL.- AJNARA Address for Correspondence : POST- AJNARA DISTT.- BULANDSHAHAR 203150

S/O MR. MADANPAL SINGH VILL.- AJNARA POST- AJNARA DISTT.- BULANDSHAHAR 203150

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

12/04/1990 09313031118 shailusingh90@gmail.com

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

12/04/1990 09313031118 shailusingh90@gmail.com

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

12/04/1990 09313031118 shailusingh90@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 : MU0003141170 Journal No: Signature of cashier : Date :

Amount Rs. 1000.00 Rs. 25.00 Rs. 1025.00

Head : Application Fees : Bank's Charges : Total * :

Amount Rs. 1000.00 Rs. 25.00 Rs. 1025.00 Rupees One thousand 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 : MU0003141170 Journal No: Signature of cashier : Date :

Amount Rs. 1000.00 Rs. 25.00 Rs. 1025.00 Rupees One thousand and Twenty Five Only. (*Inclusive of Bank Charges)

Rupees One thousand and Twenty Five Only. Amount in words : (*Inclusive of Bank Charges) Name of the Receiving Branch :

Signature of the candidate : FOR BANKS USE MUP Ref. No: GATE Application Form No. : Branch Code : MU0003141170 Journal No: Signature of cashier : Date :

8011119

8011119

8011119