SUBMITTED ON : gate.iitd.ac.

in ORGANISING INSTITUTE: INDIAN INSTITUTE OF TECHNOLOGY DELHI

ONLINE APPLICATION FORM FOR JMET 2011

COMPLETE MAILING ADDRESS INCLUDING NAME PHOTOGRAPH
NAME: GADDAM NEERAJ
ADDRESS:
2-2-47/5
RAJAJI NAGAR
HANAMKONDA
WARANGAL
PIN CODE: 506001
138741

NOTE: Congratulations! Your application is successfully submitted. No need to mail this to GATE Office, IIT Delhi.

APPLICATION NUMBER : 138741

NAME OF THE CANDIDATE : GADDAM NEERAJ
EXAMINATION CITY (1st Choice) : Hyderabad
EXAMINATION CITY (2nd Choice) : Vijayawada
DATE OF ONLINE SUBMISSION (dd/mm/yy) : 07/10/10 AMOUNT : Rs. 775 Only
QUALIFYING DEGREE : B.E./B.Tech./ B.Sc. (Engg.)
QUALIFYING YEAR : 2011
OTHER DETAILS : MOBILE No. : 9000364541
Email Id : g.neeraj.tinku@gmail.com
NAME OF PARENT : GADDAM KUMARASWAMY
DATE OF BIRTH (dd/mm/yy) : 22/08/1990
GENDER :M
NATIONALITY : Indian
PERSON WITH DISABILITY :N
CATEGORY : GEN
STATE/UT OF PERMANENT ADDRESS : Andhra Pradesh :

DECLARATION BY THE CANDIDATE :

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 online information on JMET 2011 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
JMET 2011. Further, if any such suppression or distortion of facts is discovered after appearing in JMET 2011, any
admission/degree acquired on the basis of JMET 2011 score is liable for cancellation.

FULL SIGNATURE OF THE CANDIDATE