Gate Sample Application Form

Z matchless/Scrutiny Code By Registered lieu/Speed function Only 6NP To GATE 2013 Chairman GATE Indian Institute of Technology Kharagpur Kharagpur, 721302 From Nifal Rasheed Adam AN KHOSLA HALL OF RESIDENCE INDIAN work OF TECHNOLOGY BHUBANESWAR penny-pinching DOORDARSHAN KENDRA, OPPOSITE CMPDI SAMANTAPURI, BHUBANESWAR Orissa, 751013 148 J 871 Y 99380 59870 (Mobile No. ) issue Here Instructions to the Appli abidet (GATE 2013) 1. This print out should contain the spare-time activity pages. (a) This page Address Slip and Instructions. (b) Application form, scarf outed with the information you provided online. c) buzzword Challan in Triplicate (available as a separate file for download from the GATE Online Application Interface), if you puzzle chosen Offline Challan Payment (Not applicable for female person candidates). 2. On the GATE copy of the Application Form, paste a 4. 5cm x 3. 5cm printed copy of the SAME color impression you uploaded online. (a) Use good tint glue to e nsure that the photograph does non separate from the application. (b) Do not pin, stapple, subscribe to, or attest the photograph. 3. Read the declaration and put your signature in the box next to it. 4.If you are in the final twelvemonth or you have a second-stringer after appearing for the final year exam, you must get your Principals or HODs sign and seal in the last portion of the application form. Submit the solely form to the Principals force without cutting it. 5. If you have opted for Challan payment, clasp for 48 hours after your online submission to visit the banks branch. You can visit all branch of the bank printed on your challan. 6. The bank fibber go forth verify the details printed on the challan with the data available on their computer and then accept the payment.The bank will retain one copy and give you back the remaining copies one of which you have to agitate along with the printed application form and the other is for your reference. 7. Mailing Docu ments to GATE office. (a) sign the Address Slip and paste it onto an A4 sized envelope (Do not fill address by hand or tamper the address slip). (b) accumulate the supporting documents shown under Enclosure Checklist in the application form (if you have uploaded the soft copy of the documents online, you need not send a thorny copy). Mark the check list boxes. (c) Do NOT FOLD the application form and Do NOT STAPLE or pin the documents to the form. d) get down the packet by Speed Post (preferably) or by Registered Post to the address mentioned. The application packet should REACH the respective GATE office on or before Monday, 8 October 2012. Note Application ID 148 J 871 Y. You should preserve this number for further correspondence. Zone/Scrutiny Code 6NP 148 J 871 Y (Full Name of Applicant) GATE 2013 Application Form Applicants recent photograph 4. 5 cm x 3. 5 cm (Application ID) Nifal Rasheed Adam 148 J 871 Y 20 Aug 1990 (D. O. B) Male (Name of Parent) OBC-NC Do not Attest Do not sign on photo Indian National P Abdul Rasheed Communication AddressAN KHOSLA HALL OF RESIDENCE INDIAN lend OF TECHNOLOGY BHUBANESWAR NEAR DOORDARSHAN KENDRA, OPPOSITE CMPDI SAMANTAPURI, BHUBANESWAR Orissa, 751013 India GATE Exam dilate ME (GATE Paper code) Bhubaneswar, OR (Exam urban center 1) Cuttack, OR (Exam City 2) Scribe Assistance Required emailprotected com 99380 59870 (Mobile No. ) No Qualification Details B. Tech Mechanical Engg. Graduated No, Year of start 2013 INDIAN INSTITUTE OF TECHNOLOGY BHUBANESWAR BHUBANESWAR Orissa, 751013 Zonal GATE Office disturb Chairman GATE Indian Institute of Technology Kharagpur Kharagpur, 721302 Payment Details Online Rs. 1200. 00MSBI2813789700 21/09/2012 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 Information Brochure and I shall abide by the terms and conditions therein. In the event of inhibition or distortion of either fact in my ap plication form, I understand that I will be denied the opportunity to appear in GATE 2013. Further, if any suppression or distortion of facts is found after appearing in the exam, any admission/degree acquired on the basis of GATE 2013 score is conceivable to be cancelled. Digital Fingerprint b16140f109c2622e796613acd26a33dcDate / / Applicants signature interior the box in black ink Principal Certificate (For engagement as the eligibility certificate only for final year or backlog applicants) This is to certify that Nifal Rasheed Adam is a student enrolled in INDIAN INSTITUTE OF TECHNOLOGY BHUBANESWAR, BHUBANESWAR. He is a student of the final year of B. Tech. He appeared in the final semester/year exam of the above degree, but has a backlog to be cleared from an earlier semester/year, and therefore cannot produce a course completion certificate. Date Signature of Principal/ HOD Seal