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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 DIPE0502. 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 documents (SC/ST/PD certificate copy of degree certificate etc ) into a 10 inch X 12 inch

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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application documents (SC/ST/PD certificate copy of degree certificate etc ) into a 10 inch X 12 inch

Computer Science and InformationTechnology

DIPESH KUMARName of the Candidate as inthe 10th Class Certificate

Choice of GATE Paper1. 9.

GATE COPYAPPLICATION NO. 2009540

GATE 2012 APPLICATION FORM

Zone: IIT Bombay Payment Mode: Bank Challan (SBI) Fee: Rs. 1000

Date of Birth (DD/MM/YYYY)2. E-mail Address [email protected]/02/1986 10.

Gender3. MALE Address for Correspondence DIPESH KUMAR , EMP ID - 08730C11.

IBM INDIA PVT. LTD,ETZ,

RAJIV GANDHI INFOTECH PARK,

PLOT-3,HINJEWADI,PHASE-2,PUNE,

Category

Person with Disability (PD)

Nationality

Year of Degree

Discipline

5.

6.

4.

13.

14.

OBC(Non-Creamy Layer)

No

INDIAN

2011

Computer Science &Engineering/Technology

PINCODE of Address forCorrespondence

12. 411057

Qualifying Degree

Choice of Examination City1


Name of Parent

State/Union Territory ofPermanent Residence

7.

8.

15.

16.M.Sc./M.C.A./M.A.

222 - Pune

217 - Nagpur

NAWAL KISHORE SHARMA

Jharkhand

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

Mobile / Landline No.17. 08600309539

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Computer Science and InformationTechnology

DIPESH KUMARName of the Candidate as inthe 10th Class Certificate

Choice of GATE Paper1. 9.

CANDIDATE COPYAPPLICATION NO. 2009540

GATE 2012 APPLICATION FORM

Zone: IIT Bombay Payment Mode: Bank Challan (SBI) Fee: Rs. 1000

Date of Birth (DD/MM/YYYY)2. E-mail Address [email protected]/02/1986 10.

Gender3. MALE Address for Correspondence DIPESH KUMAR , EMP ID - 08730C11.




Category

Person with Disability (PD)

Nationality

Year of Degree

Discipline

5.

6.

4.

13.

14.

OBC(Non-Creamy Layer)

No

INDIAN

2011

Computer Science &Engineering/Technology

PINCODE of Address forCorrespondence

12. 411057

Qualifying Degree



Name of Parent

State/Union Territory ofPermanent Residence

7.

8.

15.

16.M.Sc./M.C.A./M.A.

222 - Pune

217 - Nagpur

NAWAL KISHORE SHARMA

Jharkhand

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

Mobile / Landline No.17. 08600309539

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To

BY SPEED / REGISTERED POST(Please do not Courier)

Chairman, GATE

GATE 2012 Application Form

Indian Institute of Technology Bombay

From

DIPESH KUMAR (APPLNO : 2009540)

DIPESH KUMAR , EMP ID - 08730C

Powai, Mumbai - 400076

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




411057

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OBC(Non-Creamy Layer)OBC(Non-Creamy Layer)OBC(Non-Creamy Layer)

[email protected]@[email protected]

086003095390860030953908600309539

DIPESH KUMAR , EMP ID - 08730C IBM INDIA

PVT. LTD,ETZ, RAJIV GANDHI INFOTECH

PARK, PLOT-3,HINJEWADI,PHASE-2,PUNE, -

411057




411057




411057

DIPESH KUMARDIPESH KUMARDIPESH KUMAR

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 :

05/02/1986

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. : 2009540

Category :

CASH VOUCHER

JOURNAL NUMBER



E Mail ID :




Category :

CASH VOUCHER



E Mail ID :




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.1025/- *

Rupees One thousand and Twenty Five Only.(*Application Fees Including Bank Charges)


Amount :

Amount in words :

Rs.1025/- *


JOURNAL NUMBER


05/02/1986



FEE Type :

Date of Birth :

16

8888





JOURNAL NUMBER

Rs.1025/- *


Amount :

Amount in words :


05/02/1986



FEE Type :

Date of Birth :

16

8888


Challan can be deposited minimum one day after thegeneration of challan.



Last date for acceptanceof challan in bank : 24 October 2011.



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