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8.

Page - 4 : Address slip to be pasted on the A4 size envelope7.

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 5 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

Page - 5 : Bank challan in triplicate. Take it to any SBI branch and pay the fee. The Bank will retain acopy with them and will return two copies to you. In those two copies, retain the Candidate's copy withyou and attach Institute's copy with Application Form

ONLINE Application for GATE 2011

1. Application Form (GATE Copy)

2 Bank Challan (Institute's Copy)

Your Login ID is SOUR02102. 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 send bySpeed 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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2 Bank Challan (Institute's Copy)

APPLICATION FORM FOR GATE 2011

Application No:

Zone:

6123730

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

604 - Bhubaneswar

616 - Rourkela

ME - Mechanical Engineering

2011

Mechanical Engg.

GANGADHAR PATEL

Orissa

I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. In the event ofsuppression or distortion of any fact in my application form I understand that I will be denied the opportunity to appear in GATE 2011

Address C/O: MR. GANGADHAR PATEL

AT/PO: SURUGUDA

DIST: SUNDARGARH

ODISHA

11.

PINCODE of Addressfor Correspondence

Phone / MobileNumber

18.

19. 770012

09861699289

GATE IIT Kharagpur COPY

E-mail Address sourajpatel@gmail.com

Do You Require a Scribe? No

SOURAJ RANJAN PATEL

02/10/1990

10.

Payment Mode:

Application Fee: Rs. 800/-

770012PINCODE

Bank Challan (State Bank of India)

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APPLICATION FORM FOR GATE 2011

Application No:

Zone:

6123730

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

604 - Bhubaneswar

616 - Rourkela

ME - Mechanical Engineering

2011

Mechanical Engg.

GANGADHAR PATEL

Orissa

I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. In the event ofsuppression or distortion of any fact in my application form I understand that I will be denied the opportunity to appear in GATE 2011

Address C/O: MR. GANGADHAR PATEL

AT/PO: SURUGUDA

DIST: SUNDARGARH

ODISHA

11.

PINCODE of Addressfor Correspondence

Phone / MobileNumber

18.

19. 770012

09861699289

CANDIDATE COPY

E-mail Address sourajpatel@gmail.com

Do You Require a Scribe? No

SOURAJ RANJAN PATEL

02/10/1990

10.

Payment Mode:

Application Fee: Rs. 800/-

770012PINCODE

Bank Challan (State Bank of India)

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APPLICATION NO

GATE

From

PINCODE

To

PINCODE

BY SPEED POST / REGISTERED POST

2011

SOURAJ RANJAN PATEL

C/O: MR. GANGADHAR PATEL

AT/PO: SURUGUDA

DIST: SUNDARGARH

ODISHA 6 1 2 3 7 3 0

Chairman, GATE

Indian Institute of Technology Kharagpur

Kharagpur

604

GATE PAPER CODE

EXAM CITY OF FIRSTCHOICE

ME

7 7 0 0 1 2

Page - 4

7 2 1 3 0 2

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sourajpatel@gmail.comsourajpatel@gmail.com sourajpatel@gmail.com

Head

Application Fees

Credit to

Bank's Charges

E-mail Address:

Amount in words : Rupees eight hundred and thirty only.

Present AddressC/O: MR. GANGADHAR PATEL AT/PO:

SURUGUDA DIST: SUNDARGARH ODISHA -

770012

02/10/1990

09861699289

Date of Birth

Mobile / Landline No:

CASH VOUCHER

BRANCH (CODE NO. )

BANK'S COPY

GATE 2011 Online Application Fee Payment

GATE 2011 FEE COLLECTION A/C NO. 31372883605

Name of the Candidate

Amount

Total

31372883605

Rs. 30.00 98353XXXXXX

Signature of the Candidate/Remitter

For Receiving Branch use only

APPLICATION NUMBER JOURNAL NUMBER

1. Please credit Rs.30/- to your Branch CommissionA/c No.98353XXXXXX

2. Please note to write the Journal Number in all the challans.3. Please feed the Application No. in REG/ID/Ref No. Column

and Name of the Candidate in the menu while posting.

SEAL / DATE AUTHORISED SIGNATORY

6123730

Rs. 800.00

Rs. 830.00

31372883605

98353XXXXXXBank's Charges

SOURAJ RANJAN PATEL

GATE 2011 FEE COLLECTION A/C NO. 31372883605

APPLICATION NUMBER

6123730

CASH VOUCHER

)

JOURNAL NUMBER

For Receiving Branch use only

1. Please credit Rs.30/- to your Branch CommissionA/c No.98353XXXXXX

2. Please note to write the Journal Number in all the challans.3. Please feed the Application No. in REG/ID/Ref No. Column

and Name of the Candidate in the menu while posting.

SEAL / DATE AUTHORISED SIGNATORY

Signature of the Candidate/Remitter

E-mail Address:

Rs. 830.00

Head

Name of the

C/O: MR. GANGADHAR PATEL AT/PO:

SURUGUDA DIST: SUNDARGARH ODISHA -

770012

Amount in words :

Present Address

Total

Mobile / Landline No:

02/10/1990

Rupees eight hundred and thirty only.

Credit toAmount

Rs. 30.00

Date of Birth

Application Fees

09861699289

GATE 2011 Online Application Fee Payment

Rs.800.00 31372883605

98353XXXXXXBank's Charges

SOURAJ RANJAN PATEL

GATE 2011 FEE COLLECTION A/C NO. 31372883605

APPLICATION NUMBER

6123730

CASH VOUCHER

)

JOURNAL NUMBER

For Receiving Branch use only

1. Please credit Rs.30/- to your Branch CommissionA/c No.98353XXXXXX

2. Please note to write the Journal Number in all the challans.3. Please feed the Application No. in REG/ID/Ref No. Column

and Name of the Candidate in the menu while posting.

SEAL / DATE AUTHORISED SIGNATORY

Signature of the Candidate/Remitter

E-mail Address:

Rs. 830.00

Head

Name of the

C/O: MR. GANGADHAR PATEL AT/PO:

SURUGUDA DIST: SUNDARGARH ODISHA -

770012

Amount in words :

Present Address

Total

Mobile / Landline No:

02/10/1990

Rupees eight hundred and thirty only.

Credit toAmount

Rs. 30.00

Date of Birth

Application Fees

09861699289

GATE 2011 Online Application Fee Payment

Rs. 800.00

BRANCH (CODE NO. BRANCH (CODE NO.

INSTITUTES COPY CANDIDATE'S COPY

Category : General

Phys ica lly Disabled : No

Category : General

Physica lly Disabled : No

Category : General

Physica ll y Disabled : No

SOURAJ RANJAN PATEL