gate2012_8002897
TRANSCRIPT
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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 KRIS0110. 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
Electrical EngineeringKRISHAN GOPAL SHAKYAName of the Candidate as inthe 10th Class Certificate
Choice of GATE Paper1. 9.
GATE COPYAPPLICATION NO. 8002897
GATE 2012 APPLICATION FORM
Zone: IIT Roorkee Payment Mode: Bank Challan (SBI) Fee: Rs. 1000
Date of Birth (DD/MM/YYYY)2. E-mail Address [email protected]/10/1989 10.
Gender3. MALE Address for Correspondence ASHOK NAGAR STREET NO. 311.
BEHIND LALWANI NURSINGHOMENIDHOLI ROAD ETAH U.P
Category
Person with Disability (PD)
Nationality
Year of Degree
Discipline
5.
6.
4.
13.
14.
OBC(Non-Creamy Layer)
No
INDIAN
2012
Electrical Engg/Electrical andElectronics Engg./Power Engg
PINCODE of Address forCorrespondence12. 207001
Qualifying Degree
Choice of Examination City1
Choice of Examination City2
Name of Parent
State/Union Territory ofPermanent Residence
7.
8.
15.
16.B.E./B.Tech./ B.Sc.(Engg.)/B.Sc.(Tech.)/B.Arch.
806 - Ghaziabad
818 - Noida
MADAN LAL SHAKYA
Uttar Pradesh
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. Inthe 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
Mobile / Landline No.17. 09958362122
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Electrical EngineeringKRISHAN GOPAL SHAKYAName of the Candidate as inthe 10th Class Certificate
Choice of GATE Paper1. 9.
CANDIDATE COPYAPPLICATION NO. 8002897
GATE 2012 APPLICATION FORM
Zone: IIT Roorkee Payment Mode: Bank Challan (SBI) Fee: Rs. 1000
Date of Birth (DD/MM/YYYY)2. E-mail Address [email protected]/10/1989 10.
Gender3. MALE Address for Correspondence ASHOK NAGAR STREET NO. 311.
BEHIND LALWANI NURSINGHOMENIDHOLI ROAD ETAH U.P
Category
Person with Disability (PD)
Nationality
Year of Degree
Discipline
5.
6.
4.
13.
14.
OBC(Non-Creamy Layer)
No
INDIAN
2012
Electrical Engg/Electrical andElectronics Engg./Power Engg
PINCODE of Address forCorrespondence12. 207001
Qualifying Degree
Choice of Examination City1
Choice of Examination City2
Name of Parent
State/Union Territory ofPermanent Residence
7.
8.
15.
16.B.E./B.Tech./ B.Sc.(Engg.)/B.Sc.(Tech.)/B.Arch.
806 - Ghaziabad
818 - Noida
MADAN LAL SHAKYA
Uttar Pradesh
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. Inthe 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
Mobile / Landline No.17. 09958362122
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To
BY SPEED / REGISTERED POST(Please do not Courier)
Chairman, GATE
GATE 2012 Application Form
Indian Institute of Technology Roorkee
From
KRISHAN GOPAL SHAKYA (APPLNO : 8002897)
ASHOK NAGAR STREET NO. 3
Roorkee - 247667
Do not tamper with the bar code. For GATE official use.
BEHIND LALWANI NURSING HOME
NIDHOLI ROAD ETAH U.P
207001
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OBC(Non-Creamy Layer)OBC(Non-Creamy Layer)OBC(Non-Creamy Layer)
[email protected]@[email protected]
099583621220995836212209958362122
ASHOK NAGAR STREET NO. 3 BEHIND
LALWANI NURSING HOME NIDHOLI ROAD
ETAH U.P - 207001
ASHOK NAGAR STREET NO. 3 BEHIND
LALWANI NURSING HOME NIDHOLI ROAD
ETAH U.P - 207001
ASHOK NAGAR STREET NO. 3 BEHIND
LALWANI NURSING HOME NIDHOLI ROAD
ETAH U.P - 207001
KRISHAN GOPAL SHAKYAKRISHAN GOPAL SHAKYAKRISHAN GOPAL SHAKYA
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 :
01/10/1989
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. : 8002897
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.1025/- *
Rupees One thousand and Twenty Five Only.(*Application Fees Including Bank Charges)
CASH CAN BE TENDERED AT ANY SBI BRANCH
Amount :
Amount in words :
Rs.1025/- *
Rupees One thousand and Twenty Five Only.(*Application Fees Including Bank Charges)
JOURNAL NUMBER
Name of the Candidate :
01/10/1989
Registration ID / Ref No. : 8002897
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.1025/- *
Rupees One thousand and Twenty Five Only.(*Application Fees Including Bank Charges)
Amount :
Amount in words :
Name of the Candidate :
01/10/1989
Registration ID / Ref No. : 8002897
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.