Zone/Scrutiny GATE 2016

4GE B196Y12
B196Y12 (Enrolment ID)

Kaushik Sengupta
(Full Name of the Applicant)

10 Jan 1982 Male GEN No

(D.O.B) (Gender) (Category) (PD Status)

Indian National 9832201548 Manju Sengupta

(Parent's Mobile Number) (Name of the Parent)

Communication Address GATE Exam Details

HOUSE NO- 30, NEAR H/O DR OMIYO MUKHEREE GATE Paper Code
DHARMARAJ MANDIR ROAD
ISMAIL
ASANSOL
West Bengal 713301
ME
(Mechanical Engineering)
97045 41045 (Mobile No.)
Asansol-Durgapur, WB
kaushiksen10@yahoo.com (Exam City 1)

Qualification Details Dhanbad , JH

(Exam City 2)
B.E.
Mechanical Engg. Kolkata, WB
(Exam City 3)
Graduated: Yes; Year of Graduation: 2013
INSTITUTION OF ENGINEERS Zonal GATE Office Contact
KOLKATA Chairperson GATE
West Bengal 700020 Indian Institute of Technology Guwahati
Guwahati 781039
Payment Details
Online Rs. 1500.00
Payment Ref. No.: IG0ASUDTC6
24/09/2015

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. The
responsibility of following the GATE 2016 website and meeting various deadlines lies with me. 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 2016. Further, if any suppression or distortion of facts is found after appearing in the
exam, any admission/degree/benefit acquired on the basis of GATE 2016 score/marks is liable to be
cancelled.

Digital
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