GATE2012_1037959
5
8. Page - 4 : Address page to be pasted on a 10 inch X 12 inch size laminated envelope. 7. Instructions for the Candidate: 1. 2. Page - 1: Instructions for the candidate to be retained by the candidate. 3. 4. 5. a. Paste yo ur recen t color pho to (3.5c m x 3.5cm) in the des igna ted pla ce. Befo re pasti ng, plea se write your name and application number on the backside of the photo with black ball point pen. 6. There are 5 pages in this pdf file. These pages should be printed on A4 size white sheets using a laser/ink jet printer. Page - 2 : Application Form (GATE Copy). Page - 3 : Application Form (Candidate copy) to be retained by the candidate. Instructions and Application Form for GATE 2012 1. Appl ic at ion For m ( GATE Co py ) 2. Ba nk Ch al la n (GATE C op y) 3. Self Attested Copy of SC/ST/ PD c ertif icate (if applicable) 4. Self Attested C opy o f affidavit for chan ge of name (if a ppli cabl e) Your Login ID is ABHI14044. Remember your password and do not disclose it to anyone. Without folding, insert the completed Application Form (GATE copy) and attested copies of all the application docume nts (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. List of Documents to be attached with the Application Form: 5. Self Attest ed Co py of t he de gree certi ficate if th e yea r of qu alif ying degree is 2011 or earlier. 6. If the year o f qua lifyi ng de gree is 201 2 or l ater, a cert ifica te sig ned b y the principal of the college clearly indicating the year of qualifying degree (format available on GATE website). ____________End of Instructions____________ Application sent through courier will not be accepted. Put Page - 5 : Bank challan in triplicate. Take it to any SBI branch and pay the application fee plus the bank service charge. The Bank will retain its copy and will return the remaining two copies to you. Out of these two copies, retain the Candidate's copy with you and attach the GATE copy with the Application Form. b. Sign at the de si gnated place. 7. Cand iate s wit h ba cklog : cop y of final seme ster/ year mark s she et or course completion certificate or a letter from principal.
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8.
Page - 4 : Address page to be pasted on a 10 inch X 12 inch size laminated envelope.
7.
Instructions for the Candidate:
1.
2.
Page - 1: Instructions for the candidate to be retained by the candidate.3.
4.
5.
a. Paste your recent color photo (3.5cm x 3.5cm) in the designated place. Before pasting, please writeyour name and application number on the backside of the photo with black ball point pen.
6.
There are 5 pages in this pdf file. These pages should be printed on A4 size white sheets using alaser/ink jet printer.
Page - 2 : Application Form (GATE Copy).
Page - 3 : Application Form (Candidate copy) to be retained by the candidate.
Instructions and Application Form for GATE 2012
Your Login ID is ABHI14044. Remember your password and do not disclose it to anyone.
Without folding, insert the completed Application Form (GATE copy) and attested copies of all theapplication 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
Page - 5 : Bank challan in triplicate. Take it to any SBI branch and pay the application fee plus the bankservice charge. The Bank will retain its copy and will return the remaining two copies to you. Out ofthese two copies, retain the Candidate's copy with you and attach the GATE copy with the ApplicationForm.
b. Sign at the designated place.
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laminated envelope and send by Speed Post (preferably) or by Registered Post using the address
Civil EngineeringABHILASH DEVANOORName of the Candidate as inthe 10th Class Certificate
Choice of GATE Paper1. 9.
GATE COPYAPPLICATION NO. 1037959
GATE 2012 APPLICATION FORM
Zone: IISc Bangalore Payment Mode: Bank Challan (SBI) Fee: Rs. 500
Date of Birth (DD/MM/YYYY)2. E-mail Address [email protected]/04/1990 10.
Gender3. MALE Address for Correspondence #29,PRAKRUTHI11.
RAMAKRISHNA NAGAR
J BLOCK
MYSORE
Category
Person with Disability (PD)
Nationality
Year of Degree
Discipline
5.
6.
4.
13.
14.
Scheduled Caste
No
INDIAN
2012
Civil/Civil &Environmental/StructuralEngg./Construction Engg.
PINCODE of Address forCorrespondence
12. 570022
Qualifying Degree
Choice of Examination City1
Choice of Examination City2
Name of Parent
State/Union Territory of
Permanent Residence
7.
8.
15.
16.B.E./B.Tech./ B.Sc.
(Engg.)/B.Sc.(Tech.)/B.Arch.
112 - Mysore
104 - Bengaluru
BASAVARAJA DEVANURA
Karnataka
I hereby declare that all the particulars stated in this application form are true to the best of my knowledge andbelief. 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
Mobile / Landline No.17. 09611414139
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Civil EngineeringABHILASH DEVANOORName of the Candidate as inthe 10th Class Certificate
Choice of GATE Paper1. 9.
CANDIDATE COPYAPPLICATION NO. 1037959
GATE 2012 APPLICATION FORM
Zone: IISc Bangalore Payment Mode: Bank Challan (SBI) Fee: Rs. 500
Date of Birth (DD/MM/YYYY)2. E-mail Address [email protected]/04/1990 10.
Gender3. MALE Address for Correspondence #29,PRAKRUTHI11.
RAMAKRISHNA NAGAR
J BLOCK
MYSORE
Category
Person with Disability (PD)
Nationality
Year of Degree
Discipline
5.
6.
4.
13.
14.
Scheduled Caste
No
INDIAN
2012
Civil/Civil &Environmental/StructuralEngg./Construction Engg.
PINCODE of Address forCorrespondence
12. 570022
Qualifying Degree
Choice of Examination City1
Choice of Examination City2
Name of Parent
State/Union Territory of
Permanent Residence
7.
8.
15.
16.B.E./B.Tech./ B.Sc.
(Engg.)/B.Sc.(Tech.)/B.Arch.
112 - Mysore
104 - Bengaluru
BASAVARAJA DEVANURA
Karnataka
I hereby declare that all the particulars stated in this application form are true to the best of my knowledge andbelief. 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
Mobile / Landline No.17. 09611414139
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To
BY SPEED / REGISTERED POST(Please do not Courier)
Chairman, GATE
GATE 2012 Application Form
Indian Institute of Science
FromABHILASH DEVANOOR (APPLNO : 1037959)
#29,PRAKRUTHI
Bangalore - 560012
Do not tamper with the bar code. For GATE official use.
112CE1037959
RAMAKRISHNA NAGAR
J BLOCK
MYSORE
570022
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Scheduled CasteScheduled CasteScheduled Caste
[email protected]@[email protected]
096114141390961141413909611414139
#29,PRAKRUTHI RAMAKRISHNA NAGAR J
BLOCK MYSORE - 570022
#29,PRAKRUTHI RAMAKRISHNA NAGAR J
BLOCK MYSORE - 570022
#29,PRAKRUTHI RAMAKRISHNA NAGAR J
BLOCK MYSORE - 570022
ABHILASH DEVANOORABHILASH DEVANOORABHILASH DEVANOOR
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
E Mail ID :
Category :
Address forCorrespondence :
14/04/1990
Mobile / Landline No:
CASH VOUCHER BANK COPY
GATE 2012 – Application Fee Payment Challan
Name of the Candidate :
Signature of the Candidate/Remitter
For Receiving Branch use only
Registration ID / Ref No. : 1037959
Category :
CASH VOUCHER
JOURNAL NUMBER
For Receiving Branch use only
Signature of the Candidate/Remitter
E Mail ID :
Address forCorrespondence :
Mobile / Landline No:
GATE 2012 – Application Fee Payment Challan
Category :
CASH VOUCHER
For Receiving Branch use only
Signature of the Candidate/Remitter
E Mail ID :
Address forCorrespondence :
Mobile / Landline No:
GATE 2012 – Application Fee Payment Challan
GATE COPY CANDIDATE COPY
CASH CAN BE TENDERED AT ANY SBI BRANCH
Use CBS Screen No. :
FEE Type :
Date of Birth :
16
8888
Amount :
Amount in words :
Rs.525/- *
Rupees Five Hundred and Twenty Five Only.(*Application Fees Including Bank Charges)
CASH CAN BE TENDERED AT ANY SBI BRANCH
Amount :
Amount in words :
Rs.525/- *
Rupees Five Hundred and Twenty Five Only.(*Application Fees Including Bank Charges)
JOURNAL NUMBER
Name of the Candidate :
14/04/1990
Registration ID / Ref No. : 1037959
Use CBS Screen No. :
FEE Type :
Date of Birth :
16
8888
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
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
JOURNAL NUMBER
Rs.525/- *
Rupees Five Hundred and Twenty Five Only.(*Application Fees Including Bank Charges)
Amount :
Amount in words :
Name of the Candidate :
14/04/1990
Registration ID / Ref No. : 1037959
Use CBS Screen No. :
FEE Type :
Date of Birth :
16
8888
CASH CAN BE TENDERED AT ANY SBI BRANCH
Challan can be deposited minimum one day after thegeneration of challan.
Challan can be deposited minimum one day after thegeneration of challan.
Challan can be deposited minimum one day after thegeneration of challan.
Last date for acceptanceof challan in bank : 24 October 2011.
Last date for acceptanceof challan in bank : 24 October 2011.
Last date for acceptanceof challan in bank : 24 October 2011.
