By Registered Post/Speed Post Only

Zone/Scrutiny Code

8MX
To

GATE 2013
Chairman GATE Indian Institute of Technology Roorkee Roorkee, 247667

From Ankush Kumar

V.P.O. - PUBOWAL, TEHSIL - HAROLI, DISTT.- UNA, UNA Himachal Pradesh, 174503

152 K 581 Z

98784 28953

(Mobile No.)

Cut Here

Instructions to the Applicant (GATE 2013)

1. This print out should contain the following pages. (a) This page: Address Slip and Instructions. (b) Application form, filled with the information you provided online. (c) Bank Challan in Triplicate (available as a separate file for download from the GATE Online Application Interface), if you have chosen Offline Challan Payment (Not applicable for female candidates). 2. On the GATE copy of the Application Form, paste a 4.5cm x 3.5cm printed copy of the SAME color photograph you uploaded online. (a) Use good quality glue to ensure that the photograph does not separate from the application. (b) Do not pin, stapple, sign, 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 year or you have a backlog 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 whole form to the Principals office without cutting it. 5. 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. 6. The bank teller will 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 send along with the printed application form and the other is for your reference. 7. Mailing Documents to GATE office. (a) Cut the Address Slip and paste it onto an A4 sized 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 (if you have uploaded the soft copy of the documents online, you need not send a hard 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) Send 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 - 152 K 581 Z. You should preserve this number for further correspondence.

Zone/Scrutiny Code

8MX
152 K 581 Z
(Full Name of Applicant)

GATE 2013 Application Form

Applicant's recent photograph

4.5 cm x 3.5 cm

(Application ID)

Ankush Kumar 152 K 581 Z

30 Sep 1990
(D.O.B)

Male
(Name of Parent)

SC

Do not Attest Do not sign on photo

Indian National

Subhash Chand

Communication Address
V.P.O. - PUBOWAL, TEHSIL - HAROLI, DISTT.- UNA, UNA Himachal Pradesh, 174503 India

GATE Exam Details

IN
(GATE Paper code)

Ludhiana, PB
(Exam City 1)

Patiala, PB
(Exam City 2) Scribe Assistance Required:

kumar.ankush59@gmail.com 98784 28953 (Mobile No.)

No

Qualification Details
B.E. Control and Instrumentation Graduated: No, Year of Graduation: 2013 Sant Longowal Institute of Engineering & Technology, Sangrur Punjab, 148106

Zonal GATE Office Contact

Chairman GATE Indian Institute of Technology Roorkee Roorkee, 247667

Payment Details

Online

Rs. 600.00
Docs Uploaded SC/ST Certificate

MPNB2812364647 19/09/2012

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 suppression or distortion of any fact in my application 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 liable to be cancelled.

Digital Fingerprint: 0612f46520f48f3bba0d010a746ed110

Date: ....../....../............

Applicants signature inside the box in black ink

Principal Certificate

(For use as the eligibility certificate only for final year or backlog applicants)

This is to certify that Ankush Kumar is a student enrolled in Sant Longowal Institute of Engineering & Technology, Longowal, Sangrur. He is a student of the final year of B.E.. 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