7/29/2019 A 199 d 97 Application
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1. This print out should contain the following pages.
(a) Page 1 : This page contains Instructions and Address Slip (cut and paste the Address Slip on A4 size envelope).(b) Page 2 : Application form that you have filled online.
2. Bank challan in Triplicate is available as a separate pdf file to be downloaded. This is available only if you have opted for OfflinePayment.
3. On the GATE 2014 Application Form, paste a 3.5cm x 4.5cm color photograph with plain background (this should be the samethat you have uploaded during application filling). The photograph should be taken in a studio.(a) Write your Enrolment ID. and Name on the reverse side of the photo.(b) Use good quality glue to ensure that the photograph does not separate from the application.(c) Do not pin, staple, sign or attest the photograph.
4. Read the declaration and put your full signature in the box next to it. Please note that signature should not be in capital letters.
5. If you are in the final year or you have a backlog after appearing for the final year examination, you must get your Principals orHODs Signature and Seal in the Certificate from Principal that is provided at the last portion of the application form. Submit the
whole form to the Principals office without cutting it.6. If you have opted for challan payment, wait for 48 hours after your online submission to visit the banks branch. You can visit any
branch of the bank printed on your challan.
7. The bank teller will verify the details printed on the challan with the data available in their system and then accept the payment.The bank will retain one copy and give you the remaining two copies: one of which is the GATE Copy that you have to send alongwith the printed application form and the other is the Candidate Copy for your reference.
8. Keep a photo copy of the completed application form for your reference.
9. Mailing Documents to GATE office.(a) Cut the Address Slip and paste it onto an A4 size envelope (Do not fill address by hand or tamper the address slip).(b) Collect the supporting documents shown under Enclosure Checklist in the application form. Mark the enclosures in the
checklist boxes.(c) Do NOT FOLD the application form and Do NOT STAPLE or pin the documents to the form.
(d) Send the packet by Speed Post (preferably) or by Registered Post to the address mentioned in the address slip. Theapplication packet should REACH the respective zonal GATE office on or before Thursday, 10 October 2013.
Instructions to the Applicant (GATE 2014)
SHIVAJI CHOWK TAKAWADETAL-SHIROLDIST-KOLHAPURTAKAWADEMaharashtra 41612197621 40081 (Mobile Number)
Zone/Scrutiny
2CPBy Registered Post/Speed Post Only
Indian Institute of Technology Bombay
GATE 2014
ToChairperson GATE
A199D97
Powai, Mumbai 400076
Cut Here
Note: Enrolment ID - A199D97. You should preserve this number for further correspondence.
From
Chavan Guruprasad Vijay
A 1 9 9 D 9 7
7/29/2019 A 199 d 97 Application
2/2
(Enrolment ID)A199D97
Zone/Scrutiny
Payment Details Rs. 1500.00
2CP
(D.O.B)
Qualification Details
(Exam City 1)
Chavan Guruprasad Vijay(Full Name of the Applicant)
20 Aug 1992 Male
Indian National
GEN No
B.E.
Vijay Shankar Chavan
Maharashtra 416118
SHIVAJI UNIVERSITY KOLHAPUR
Communication Address
Graduated: No; Year of Graduation: 2014Electronics/Comm./Telecomm Engg.
hereby declare that all the particulars stated in this application form are true to the best of my knowledge andbelief. I have read the Information Brochure and I shall abide by the terms and conditions therein. Theesponsibility of following the GATE 2014 website and meeting various deadlines lies with me. In the event ofuppression or distortion of any fact in my application form, I understand that I will be denied the opportunityo appear in GATE 2014. Further, if any suppression or distortion of facts is found after appearing in thexam, any admission/degree/benefit acquired on the basis of GATE 2014 score/marks is liable to beancelled.
Digitalingerprint:
ChallanState Bank of India
He appeared in the final semester/year exam of the above degree, but has a backlog to be clearedfrom an earlier semester/year, and therefore cannot produce a course completion certificate.
Signature of Principal/ HOD
SHIVAJI CHOWK TAKAWADETAL-SHIROLDIST-KOLHAPURTAKAWADEMaharashtra 41612197621 40081 (Mobile No.)[email protected]
3.5 cm x 4.5 cm
Date: Seal
(For use as the eligibility certificate only for final year or backlog applicants)
Zonal GATE Office Contact Chairperson GATE
Powai, Mumbai 400076
fe496ed32ac7be37d783bed50e3eaa73
Applicant's recent photograph
A199D97
GATE Exam Details
(Exam City 2)
Enclosure Checklist
Certificate from PrincipalThis is to certify that Chavan Guruprasad Vijay is a student enrolled in
Applicants signature inside the box in black inkDate: ....../....../.........
Stamped Bank Challan: GATE copy
He is a student of the final year of B.E.
SHIVAJI UNIVERSITY KOLHAPUR, ATIGRE.
ATIGRE
GATE 2014
Do not AttestDo not sign on photo
(Exam City 3)
(Gender) (Category) (PD Status)
GATE Paper Code
9623594569
EC
Do not staple photo
Sangli, MH
Kolhapur, MH
Mumbai, MH
Indian Institute of Technology Bombay
(Parent's Mobile Number) (Name of the Parent)
A 1 9 9 D 9 7
A199D97