Professional Documents
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3. 4.
5. 6. 7.
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____________End of Instructions____________
GATE COPY
INDIAN General No
11. Address for Correspondence 5/201 ARAVALI VIHAR ALWAR RAJASTHAN 12. PINCODE of Address for 301001 Correspondence 13. Year of Degree 14. Discipline 15. Name of Parent 2012 Information Science / Information Technology NAND KUMAR Rajasthan
7. Qualifying Degree
09785948447
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
19. Photograph
Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS)
3.5 cm x 3.5 cm
302CS3056287
Send this form along with the necessary documents to IIT Delhi.
CANDIDATE COPY
INDIAN General No
11. Address for Correspondence 5/201 ARAVALI VIHAR ALWAR RAJASTHAN 12. PINCODE of Address for 301001 Correspondence 13. Year of Degree 14. Discipline 15. Name of Parent 2012 Information Science / Information Technology NAND KUMAR Rajasthan
7. Qualifying Degree
09785948447
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
19. Photograph
Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS)
3.5 cm x 3.5 cm
302CS3056287
BY SPEED / REGISTERED POST (Please do not Courier) GATE 2012 Application Form
To Chairman, GATE Indian Institute of Technology Delhi Hauz Khas, New Delhi - 110016
302CS3056287
Do not tamper with the bar code. For GATE official use.
From
SUMIT KUMAR (APPLNO : 3056287) 5/201 ARAVALI VIHAR ALWAR RAJASTHAN 301001
PAY IN SLIP
BANK COPY
PAY IN SLIP
CANDIDATE COPY
APPLICATION FEE PAYABLE AT ALL BRANCHES OF INDIAN BANK Paid into the credit of IIT DELHI GATE 2012 (Challan) A/C no 971937016 , HAUZ KHAS BRANCH NEW DELHI, BRANCH CODE : 1104
Name of the Candidate : SUMIT KUMAR
APPLICATION FEE PAYABLE AT ALL BRANCHES OF INDIAN BANK Paid into the credit of IIT DELHI GATE 2012 (Challan) A/C no 971937016, HAUZ KHAS BRANCH NEW DELHI, BRANCH CODE : 1104
Name of the Candidate : SUMIT KUMAR
APPLICATION FEE PAYABLE AT ALL BRANCHES OF INDIAN BANK Paid into the credit of IIT DELHI GATE 2012 (Challan) A/C no 971937016, HAUZ KHAS BRANCH NEW DELHI, BRANCH CODE : 1104
Name of the Candidate : SUMIT KUMAR
Head : Application Fees : Bank's Charges : Total * : Amount in words : Name of the Receiving Branch : Signature of the candidate : FOR BANKS USE MUP Ref. No: GATE Application Form No. : Branch Code : MU0003172455 Journal No: Signature of cashier : Date :
Amount Rs. 1000.00 Rs. 25.00 Rs. 1025.00 Rupees One thousand and Twenty Five Only. (*Inclusive of Bank Charges)
Head : Application Fees : Bank's Charges : Total * : Amount in words : Name of the Receiving Branch : Signature of the candidate : FOR BANKS USE MUP Ref. No: GATE Application Form No. : Branch Code : MU0003172455 Journal No: Signature of cashier : Date :
Amount Rs. 1000.00 Rs. 25.00 Rs. 1025.00 Rupees One thousand and Twenty Five Only. (*Inclusive of Bank Charges)
Rupees One thousand and Twenty Five Only. Amount in words : (*Inclusive of Bank Charges) Name of the Receiving Branch :
Signature of the candidate : FOR BANKS USE MUP Ref. No: GATE Application Form No. : Branch Code : MU0003172455 Journal No: Signature of cashier : Date :
3056287
3056287
3056287