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Instructions and Application Form for GATE 2012 Instructions for the Candidate: 1.

Your Login ID is ASHU2202. Remember your password and do not disclose it to anyone.

2.

There are 5 pages in this pdf file. These pages should be printed on A4 size white sheets using a laser/ink jet printer.

3.

Page - 1: Instructions for the candidate to be retained by the candidate.

4.

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.

5.

Page - 3 : Application Form (Candidate copy) to be retained by the candidate.

6.

Page - 4 : Address page to be pasted on a 10 inch X 12 inch size laminated envelope.

7.

Page - 5 : Bank challan in triplicate. Take it to any ICICI 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.

8.

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.

Put List of Documents to be attached with the Application Form: 1.

Application Form (GATE Copy)

2.

Bank Challan (GATE Copy)

3.

Self Attested Copy of SC/ST/PD certificate (if applicable)

4.

Self Attested Copy of affidavit for change of name (if applicable)

5.

Self Attested Copy of the degree certificate if the year of qualifying degree is 2011 or earlier.

6.

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).

____________End of Instructions____________


GATE COPY

APPLICATION NO. 8002703

GATE 2012 APPLICATION FORM Fee: Rs. 1000

Zone: IIT Roorkee

Payment Mode: Bank Challan (ICICI Bank)

1. Name of the Candidate as in the 10th Class Certificate

ASHUTOSH KUMAR

9. Choice of GATE Paper

Computer Science and Information Technology

2. Date of Birth (DD/MM/YYYY)

22/02/1990

10. E-mail Address

ashu22feb@gmail.com

3. Gender

MALE

4. Nationality

INDIAN

11. Address for Correspondence VILL.PANAPUR SILAUTHAR,PO.KALA PAHAR,PS.JANDAHA DISTT.VAISHALI STATE.BIHAR 12. PINCODE of Address for 844505 Correspondence

5. Category

OBC(Non-Creamy Layer)

13. Year of Degree

2012

6. Person with Disability (PD)

No

14. Discipline

Information Science / Information Technology

15. Name of Parent

VIJAY KUMAR PANDIT

7. Qualifying Degree

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

16. State/Union Territory of Permanent Residence

Bihar

8. Choice of Examination City1

804 - Chandigarh

17. Mobile / Landline No.

09646233165

Choice of Examination City2

814 - Ludhiana

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

Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS)

19. Photograph

3.5 cm x 3.5 cm

804CS8002703

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


CANDIDATE COPY

APPLICATION NO. 8002703

GATE 2012 APPLICATION FORM Fee: Rs. 1000

Zone: IIT Roorkee

Payment Mode: Bank Challan (ICICI Bank)

1. Name of the Candidate as in the 10th Class Certificate

ASHUTOSH KUMAR

9. Choice of GATE Paper

Computer Science and Information Technology

2. Date of Birth (DD/MM/YYYY)

22/02/1990

10. E-mail Address

ashu22feb@gmail.com

3. Gender

MALE

4. Nationality

INDIAN

11. Address for Correspondence VILL.PANAPUR SILAUTHAR,PO.KALA PAHAR,PS.JANDAHA DISTT.VAISHALI STATE.BIHAR 12. PINCODE of Address for 844505 Correspondence

5. Category

OBC(Non-Creamy Layer)

13. Year of Degree

2012

6. Person with Disability (PD)

No

14. Discipline

Information Science / Information Technology

15. Name of Parent

VIJAY KUMAR PANDIT

7. Qualifying Degree

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

16. State/Union Territory of Permanent Residence

Bihar

8. Choice of Examination City1

804 - Chandigarh

17. Mobile / Landline No.

09646233165

Choice of Examination City2

814 - Ludhiana

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

Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS)

804CS8002703

Retain this copy with you for future reference.

19. Photograph

3.5 cm x 3.5 cm


BY SPEED / REGISTERED POST (Please do not Courier) GATE 2012 Application Form

To Chairman, GATE Indian Institute of Technology Roorkee Roorkee - 247667

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

From ASHUTOSH KUMAR (APPLNO : 8002703) VILL.PANAPUR SILAUTHAR,PO.KALA PAHAR,PS.JANDAHA DISTT.VAISHALI STATE.BIHAR 844505


BANK COPY GATE 2012 Organizing Institute -IIT Delhi

GATE COPY GATE 2012 Organizing Institute -IIT Delhi

CANDIDATE COPY GATE 2012 Organizing Institute -IIT Delhi

The PAN No. of IIT Delhi : AAATI0303L

The PAN No. of IIT Delhi : AAATI0303L

The PAN No. of IIT Delhi : AAATI0303L

Name of Branch :

Name of Branch :

Name of Branch :

Date of Deposit :

Date of Deposit :

Date of Deposit :

DD/MM/YY

DD/MM/YY (to be treated by Applicant as fee receipt)

DD/MM/YY (to be treated by Applicant as fee receipt)

Account to be Credited :

0036SLFEECOL

Account to be Credited :

0036SLFEECOL

Account to be Credited :

0036SLFEECOL

1.Institution Name :

FCGATE

1.Institution Name :

FCGATE

1.Institution Name :

FCGATE

2.Student/Applicant Name :

ASHUTOSH KUMAR

2.Student/Applicant Name :

ASHUTOSH KUMAR

2.Student/Applicant Name :

ASHUTOSH KUMAR

3.Roll No/Application No :

8002703

3.Roll No/Application ID :

8002703

3.Roll No/Application ID :

8002703

4.Class/DOB :

22/02/90

4.Class/DOB :

22/02/90

4.Class/DOB :

22/02/90

5.Section/Category :

NA

5.Section/Category :

NA

5.Section/Category :

NA

6.Amount :

Rs.1025/- *

6.Amount :

Rs.1025/- *

6.Amount :

Rs.1025/- *

7.Amount in words :

Rupees One thousand and Twenty Five Only. (*Including Rs. 25 as Bank Charge)

7.Amount in words :

Rupees One thousand and Twenty Five Only. (*Including Rs. 25 as Bank Charge)

7.Amount in words :

Rupees One thousand and Twenty Five Only. (*Including Rs. 25 as Bank Charge)

8.Cash Details :

8.Cash Details :

8.Cash Details :

Denomination

Denomination

Denomination

1000 X

1000 X

1000 X

500 X 100 X

500 X 100 X

500 X 100 X

50 X Branch Transaction ID (To be mandatory writen by the Branch)

Signature/Stamp ICICI Bank Ltd

50 X Branch Transaction ID (To be mandatory writen by the Branch)

Signature of Depositor Phone No : 09646233165

Signature/Stamp ICICI Bank Ltd

50 X Branch Transaction ID (To be mandatory writen by the Branch)

Signature of Depositor Phone No : 09646233165

Signature/Stamp ICICI Bank Ltd

Signature of Depositor Phone No : 09646233165


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