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8/2/2019 GATE2012_7183913
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8.
Page - 4 : Address page to be pasted on a 10 inch X 12 inch size laminated envelope.
7.
Instructions for the Candidate:
1.
2.
Page - 1: Instructions for the candidate to be retained by the candidate.3.
4.
5.
a. Paste your recent color photo (3.5cm x 3.5cm) in the designated place. Before pasting, please writeyour name and application number on the backside of the photo with black ball point pen.
6.
There are 5 pages in this pdf file. These pages should be printed on A4 size white sheets using alaser/ink jet printer.
Page - 2 : Application Form (GATE Copy).
Page - 3 : Application Form (Candidate copy) to be retained by the candidate.
Instructions and Application Form for GATE 2012
Your Login ID is ATHI05093. Remember your password and do not disclose it to anyone.
Without folding, insert the completed Application Form (GATE copy) and attested copies of all theapplication 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
Page - 5 : Bank challan in triplicate. Take it to any SBI branch and pay the application fee plus the bankservice charge. The Bank will retain its copy and will return the remaining two copies to you. Out ofthese two copies, retain the Candidate's copy with you and attach the GATE copy with the ApplicationForm.
b. Sign at the designated place.
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laminated envelope and send by Speed Post (preferably) or by Registered Post using the address
Electrical EngineeringATHISHA U SName of the Candidate as inthe 10th Class Certificate
Choice of GATE Paper1. 9.
GATE COPYAPPLICATION NO. 7183913
GATE 2012 APPLICATION FORM
Zone: IIT Madras Payment Mode: Bank Challan (SBI) Fee: Rs. 1000
Date of Birth (DD/MM/YYYY)2. E-mail Address [email protected]/09/1987 10.
Gender3. FEMALE Address for Correspondence KRISHNA VILASAM VEEDU11.
K.V.ROAD
EVRA 264
JAGATHY,THYCAUD.P.O
Category
Person with Disability (PD)
Nationality
Year of Degree
Discipline
5.
6.
4.
13.
14.
General
No
INDIAN
2010
Electrical Engg/Electrical andElectronics Engg./Power Engg
PINCODE of Address forCorrespondence
12. 695014
Qualifying Degree
Choice of Examination City1
Choice of Examination City2
Name of Parent
State/Union Territory ofPermanent Residence
7.
8.
15.
16.B.E./B.Tech./ B.Sc.(Engg.)/B.Sc.(Tech.)/B.Arch.
730 - Thiruvananthapuram
715 - Kollam
M V SANKARAN KUTTY
Kerala
I hereby declare that all the particulars stated in this application form are true to the best of my knowledge andbelief. I have read the contents of GATE 2012 website and I shall abide by the terms and conditions therein. Inthe event of suppression or distortion of any fact in my application form, I understand that I will be denied theopportunity to appear in GATE 2012 Further if any such suppression or distortion of facts is found after
Mobile / Landline No.17. 09995325711
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Electrical EngineeringATHISHA U SName of the Candidate as inthe 10th Class Certificate
Choice of GATE Paper1. 9.
CANDIDATE COPYAPPLICATION NO. 7183913
GATE 2012 APPLICATION FORM
Zone: IIT Madras Payment Mode: Bank Challan (SBI) Fee: Rs. 1000
Date of Birth (DD/MM/YYYY)2. E-mail Address [email protected]/09/1987 10.
Gender3. FEMALE Address for Correspondence KRISHNA VILASAM VEEDU11.
K.V.ROAD
EVRA 264
JAGATHY,THYCAUD.P.O
Category
Person with Disability (PD)
Nationality
Year of Degree
Discipline
5.
6.
4.
13.
14.
General
No
INDIAN
2010
Electrical Engg/Electrical andElectronics Engg./Power Engg
PINCODE of Address forCorrespondence
12. 695014
Qualifying Degree
Choice of Examination City1
Choice of Examination City2
Name of Parent
State/Union Territory ofPermanent Residence
7.
8.
15.
16.B.E./B.Tech./ B.Sc.(Engg.)/B.Sc.(Tech.)/B.Arch.
730 - Thiruvananthapuram
715 - Kollam
M V SANKARAN KUTTY
Kerala
I hereby declare that all the particulars stated in this application form are true to the best of my knowledge andbelief. I have read the contents of GATE 2012 website and I shall abide by the terms and conditions therein. Inthe event of suppression or distortion of any fact in my application form, I understand that I will be denied theopportunity to appear in GATE 2012 Further if any such suppression or distortion of facts is found after
Mobile / Landline No.17. 09995325711
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To
BY SPEED / REGISTERED POST(Please do not Courier)
Chairman, GATE
GATE 2012 Application Form
Indian Institute of Technology Madras
FromATHISHA U S (APPLNO : 7183913)
KRISHNA VILASAM VEEDU
Chennai - 600036
Do not tamper with the bar code. For GATE official use.
730EE7183913
K.V.ROAD
EVRA 264
JAGATHY,THYCAUD.P.O
695014
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