Professional Documents
Culture Documents
3. 4.
5. 6. 7.
8.
7.
____________End of Instructions____________
GATE COPY
11. Address for Correspondence S/O NAGANNA LALAGI POST;BALABATTI TQ;JEWARGI DIST;GULBARGA 12. PINCODE of Address for 585309 Correspondence 13. Year of Degree 14. Discipline 15. Name of Parent 2011 Mechanical Engineering NAGANNA LALAGI Karnataka
7. Qualifying Degree
09901495401
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
104ME1115918
Send this form along with the necessary documents to IISc Bangalore.
CANDIDATE COPY
11. Address for Correspondence S/O NAGANNA LALAGI POST;BALABATTI TQ;JEWARGI DIST;GULBARGA 12. PINCODE of Address for 585309 Correspondence 13. Year of Degree 14. Discipline 15. Name of Parent 2011 Mechanical Engineering NAGANNA LALAGI Karnataka
7. Qualifying Degree
09901495401
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
104ME1115918
BY SPEED / REGISTERED POST (Please do not Courier) GATE 2012 Application Form
104ME1115918
Do not tamper with the bar code. For GATE official use.
From
GURURAJ (APPLNO : 1115918) S/O NAGANNA LALAGI POST;BALABATTI TQ;JEWARGI DIST;GULBARGA 585309
CASH VOUCHER
CANDIDATE COPY
Challan can be deposited minimum one day after the generation of challan.
Name of the Candidate : GURURAJ Address for Correspondence :
Challan can be deposited minimum one day after the generation of challan.
Name of the Candidate : GURURAJ
Challan can be deposited minimum one day after the generation of challan.
Name of the Candidate : GURURAJ
S/O NAGANNA LALAGI POST;BALABATTI Address for Correspondence : TQ;JEWARGI DIST;GULBARGA - 585309
S/O NAGANNA LALAGI POST;BALABATTI Address for Correspondence : TQ;JEWARGI DIST;GULBARGA - 585309
09901495401 gururaj.lalgi@gmail.com
09901495401 gururaj.lalgi@gmail.com
09901495401 gururaj.lalgi@gmail.com
OBC(Non-Creamy Layer) Rs.1025/- * Rupees One thousand and Twenty Five Only. (*Application Fees Including Bank Charges)
OBC(Non-Creamy Layer) Rs.1025/- * Rupees One thousand and Twenty Five Only. (*Application Fees Including Bank Charges)
OBC(Non-Creamy Layer) Rs.1025/- * Rupees One thousand and Twenty Five Only. (*Application Fees Including Bank Charges)
JOURNAL NUMBER
JOURNAL NUMBER
JOURNAL NUMBER
Signature of the Candidate/Remitter For Receiving Branch use only 1. Please note to write the Journal Number in all the challans. 2. Please feed the Application No. in REG/ID/Ref No. Column.
Signature of the Candidate/Remitter For Receiving Branch use only 1. Please note to write the Journal Number in all the challans. 2. Please feed the Application No. in REG/ID/Ref No. Column.
Signature of the Candidate/Remitter For Receiving Branch use only 1. Please note to write the Journal Number in all the challans. 2. Please feed the Application No. in REG/ID/Ref No. Column.
SEAL / DATE
AUTHORISED SIGNATORY
SEAL / DATE
AUTHORISED SIGNATORY
SEAL / DATE
AUTHORISED SIGNATORY