Instructions and Application Form for GATE 2012

Instructions for the Candidate:

1. 2. Your Login ID is AMRI01019. Remember your password and do not disclose it to anyone. There are 4 pages in this pdf file. These pages should be printed on A4 size white sheets using a laser/ink jet printer. Page - 1: Instructions for the candidate to be retained by the candidate. Page - 2 : Application Form (GATE Copy). a. Paste your recent color photo (3.5cm x 3.5cm) in the designated place. Before pasting, please write your name and application number on the backside of the photo with black ball point pen. b. Sign at the designated place. 5. 6. 7. Page - 3 : Application Form (Candidate copy) to be retained by the candidate. Page - 4 : Address page to be pasted on a 10 inch X 12 inch size laminated envelope. Without folding, insert the completed Application Form (GATE copy) and attested copies of all the application documents (SC/ST/PD certificate, copy of degree certificate etc.) into a 10 inch X 12 inch laminated envelope and send by Speed Post (preferably) or by Registered Post using the address printed on page-4 so as to reach the respective Zonal GATE office on or before 24th October 2011. Application sent through courier will not be accepted.

3. 4.

List of Documents to be attached with the Application Form:

1. 2. 3. 4. 5. Application Form (GATE Copy) Self Attested Copy of SC/ST/PD certificate (if applicable) Self Attested Copy of affidavit for change of name (if applicable) Self Attested Copy of the degree certificate if the year of qualifying degree is 2011 or earlier. If the year of qualifying degree is 2012 or later, a certificate signed by the principal of the college clearly indicating the year of qualifying degree (format available on GATE website). Candiates with backlog: copy of final semester /year marks sheet or course completion certificate or a letter from principal.

Put

7.

____________End of Instructions____________

APPLICATION NO. 5079884

GATE COPY

GATE 2012 APPLICATION FORM

Zone: IIT Kanpur
1. Name of the Candidate as in the 10th Class Certificate 2. Date of Birth (DD/MM/YYYY) 3. Gender

Payment Mode: Payment Gateway

Payment Reference No: MSBI1006123824 AMRITA SHUKLA 01/01/1990 FEMALE 9. Choice of GATE Paper 10. E-mail Address

Fee: Rs. 1000

Computer Science and Information Technology eramritashuklacs@gmail.com

4. Nationality 5. Category 6. Person with Disability (PD)

INDIAN General No

11. Address for Correspondence NEW CONVENT HIGH SCHOOL VILLAGE AND POST AJAGAKAHA REWA MP 12. PINCODE of Address for 486001 Correspondence 13. Year of Degree 14. Discipline 15. Name of Parent 2011 Computer Science & Engineering/Technology ARUNESH KUMAR SHUKLA Madhya Pradesh

7. Qualifying Degree

B.E./B.Tech./ B.Sc. (Engg.)/B.Sc.(Tech.)/B.Arch.

16. State/Union Territory of Permanent Residence

8. Choice of Examination City1 Choice of Examination City2

505 - Bhopal 508 - Jabalpur

17. Mobile / Landline No.

09229670971

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

505CS5079884

Send this form along with the necessary documents to IIT Kanpur.

APPLICATION NO. 5079884

CANDIDATE COPY

GATE 2012 APPLICATION FORM

Zone: IIT Kanpur
1. Name of the Candidate as in the 10th Class Certificate 2. Date of Birth (DD/MM/YYYY) 3. Gender

Payment Mode: Payment Gateway

Payment Reference No: MSBI1006123824 AMRITA SHUKLA 01/01/1990 FEMALE 9. Choice of GATE Paper 10. E-mail Address

Fee: Rs. 1000

Computer Science and Information Technology eramritashuklacs@gmail.com

4. Nationality 5. Category 6. Person with Disability (PD)

INDIAN General No

11. Address for Correspondence NEW CONVENT HIGH SCHOOL VILLAGE AND POST AJAGAKAHA REWA MP 12. PINCODE of Address for 486001 Correspondence 13. Year of Degree 14. Discipline 15. Name of Parent 2011 Computer Science & Engineering/Technology ARUNESH KUMAR SHUKLA Madhya Pradesh

7. Qualifying Degree

B.E./B.Tech./ B.Sc. (Engg.)/B.Sc.(Tech.)/B.Arch.

16. State/Union Territory of Permanent Residence

8. Choice of Examination City1 Choice of Examination City2

505 - Bhopal 508 - Jabalpur

17. Mobile / Landline No.

09229670971

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

505CS5079884

Retain this copy with you for future reference.

BY SPEED / REGISTERED POST (Please do not Courier) GATE 2012 Application Form

To Chairman, GATE Indian Institute of Technology Kanpur Kanpur - 208016

505CS5079884
Do not tamper with the bar code. For GATE official use.

From
AMRITA SHUKLA (APPLNO : 5079884) NEW CONVENT HIGH SCHOOL VILLAGE AND POST - AJAGAKAHA REWA MP 486001