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Page - 4 : Address slip to be pasted on the A4 size envelope

7.

Instructions for the Candidate:

1.2.

Page - 1: Instructions for the candidate to be retained by you carefully3.

4.

5.

a. Paste your recent color photo (3cm x 4cm) in designated place

b. Sign at designated places

6.

There are 4 Pages in this file. These pages should be printed on A4 sheets.

Page - 2 : Application Form (GATE Copy)

Page - 3 : Application Form (CANDIDATE Copy) to be retained by you for your reference

ONLINE Application for GATE 2011

Your Login ID is DEBI1106. Remember your password and do not disclose it to anyone.

Insert completed Application Form (GATE Copy) and attested copies of all applicable documents(SC/ST/PD Certificate, Affidavit for change of name) into A4 size envelope, without folding and sendSpeed Post (preferably) or by Registered Post to Chairman, GATE, IIT Kharagpur

List of Documents to be sent to GATE IIT Kharagpur:

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List of Documents to be sent to GATE IIT Kharagpur:

APPLICATION FORM FOR GATE 2011

Application No:

Zone:

6107626

IIT Kharagpur

Name of the Candidate as in

the 10th Class Certificate

Date of Birth (DD/MM/YYYY)

Gender

Category

Person with Disability (PD)

Qualifying Degree

Nationality

Choice of Examination City1

Choice of Examination City2

Choice of GATE Paper

Year of Degree

Discipline

Name of Parent

State/Union Territory ofPermanent Residence

1.

2.

3.

5.

6.

7.

4.

8.

9.

14.

15.

16.

17.

MALE

General

No

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

INDIAN

606 - Cuttack

604 - Bhubaneswar

EC - Electronics and CommunicationEngineering

2011

Electronics & Comm./ElectronEngg./Comm.Engg./Telecommunication Eng

LAXMIDHAR PATTANAIK

Orissa

Address C/O LAXMIDHAR PATTANAIK

LAXMINAGAR,(NEAR TBW PR

BIDANASI

CUTTACK

11.

PINCODE of Addressfor Correspondence

Phone / MobileNumber

18.

19. 753014

09861076051

GATE IIT Kharagpur

Do You Require a Scribe? No

DEBIDUTTA PATTANAIK

11/06/1990

Payment Mode:

Application Fee: Rs. 800/-

753014PINCODE

BillDesk Gateway

MIDB0098099Payment Reference No:

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APPLICATION FORM FOR GATE 2011

Application No:

Zone:

6107626

IIT Kharagpur

Name of the Candidate as in

the 10th Class Certificate

Date of Birth (DD/MM/YYYY)

Gender

Category

Person with Disability (PD)

Qualifying Degree

Nationality

Choice of Examination City1

Choice of Examination City2

Choice of GATE Paper

Year of Degree

Discipline

Name of Parent

State/Union Territory ofPermanent Residence

1.

2.

3.

5.

6.

7.

4.

8.

9.

14.

15.

16.

17.

MALE

General

No

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

INDIAN

606 - Cuttack

604 - Bhubaneswar

EC - Electronics and CommunicationEngineering

2011

Electronics & Comm./ElectronEngg./Comm.Engg./Telecommunication Eng

LAXMIDHAR PATTANAIK

Orissa

Address C/O LAXMIDHAR PATTANAIK

LAXMINAGAR,(NEAR TBW PR

BIDANASI

CUTTACK

11.

PINCODE of Addressfor Correspondence

Phone / MobileNumber

18.

19. 753014

09861076051

CANDIDATE C

Do You Require a Scribe? No

DEBIDUTTA PATTANAIK

11/06/1990

Payment Mode:

Application Fee: Rs. 800/-

753014PINCODE

BillDesk Gateway

MIDB0098099Payment Reference No:

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APPLICATION NO

GATE

From

PINCODE

To

PINCODE

BY SPEED POST / REGISTERED POST

2011

DEBIDUTTA PATTANAIK

C/O LAXMIDHAR PATTANAIK

LAXMINAGAR,(NEAR TBW PRESS)

BIDANASI

CUTTACK 6 1 0 7 6 2 6

Chairman, GATE

Indian Institute of Technology Kharagpur

Kharagpur

606

GATE PAPER CODE

EXAM CITY OF FIRSTCHOICE

EC

7 5 3 0 1 4

Page

7 2 1 3 0 2