Instructions and Application Form For GATE 2012

Instructions and Application Form for GATE 2012
Instructions for the Candidate:

1.
Your Login ID is ARUN17115. Remember your password and do not disclose it to anyone.
2.
There are 5 pages in this pdf file. These pages should be printed on A4 size white sheets using a
laser/ink jet printer.
3.
Page - 1: Instructions for the candidate to be retained by the candidate.
4.
Page - 2 : Application Form (GATE Copy).

a. Paste your recent color photo (3.5cm x 3.5cm) in the designated place. Before pasting, please write
your name and application number on the backside of the photo with black ball point pen.
5.
b. Sign at the designated place.

Page - 3 : Application Form (Candidate copy) to be retained by the candidate.
6.
Page - 4 : Address page to be pasted on a 10 inch X 12 inch size laminated envelope.
7.
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.
8.
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
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.
Application sent through courier will not be accepted.
Put
List of Documents to be attached with the Application Form:
1.
Application Form (GATE Copy)
2.
Bank Challan (GATE Copy)
3.
Self Attested Copy of SC/ST/PD certificate (if applicable)
4.
Self Attested Copy of affidavit for change of name (if applicable)
5.
Self Attested Copy of the degree certificate if the year of qualifying

degree is 2011 or earlier.
6.
If the year of qualifying degree is 2012 or later, a certificate signed by

the principal of the college clearly indicating the year of qualifying
degree (format available on GATE website).
7.
Candiates with backlog: copy of final semester/year marks sheet or

course completion certificate or a letter from principal.
____________End of Instructions____________
GATE COPY
APPLICATION NO. 7102913
GATE 2012 APPLICATION FORM

Fee: Rs. 1000
Zone: IIT Madras
Payment Mode: Bank Challan (SBI)
1. Name of the Candidate as in

the 10th Class Certificate
ARUN RAJAN CHOYYAN
9. Choice of GATE Paper
Electronics and Communication

Engineering
2. Date of Birth (DD/MM/YYYY)
17/11/1986
10. E-mail Address
[email protected]
3. Gender
MALE
4. Nationality
INDIAN
11. Address for Correspondence KRISHNA BAHAVAN

ELEYAVOOR SOUTH , P.O
MUNDAYAD
KANNUR , KERALA
INDIA
12. PINCODE of Address for
670597
Correspondence
5. Category
General
13. Year of Degree
2009
6. Person with Disability (PD)
No
14. Discipline
Electronics & Comm./Electronics

Engg./Communication
Engg./Telecommunication Engg
15. Name of Parent
THIRUMANGALATH PREMARAJAN
7. Qualifying Degree
B.E./B.Tech./ B.Sc.
(Engg.)/B.Sc.(Tech.)/B.Arch.
16. State/Union Territory of

Permanent Residence
Kerala
8. Choice of Examination City1
712 - Kannur (Kerala)
17. Mobile / Landline No.
09495115637
Choice of Examination City2
718 - Kozhikode
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
the 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
appearing in the exam, any admission/degree acquired on the basis of GATE 2012 score is liable to be
cancelled.
Place :
Date :
18. Signature
Full Signature of the candidate using

BLACK INK PEN only
(do not sign in CAPITAL LETTERS)
19. Photograph
3.5 cm x 3.5 cm
712EC7102913
Send this form along with the necessary documents to IIT Madras.
CANDIDATE COPY
APPLICATION NO. 7102913
GATE 2012 APPLICATION FORM

Fee: Rs. 1000
Zone: IIT Madras
Payment Mode: Bank Challan (SBI)
1. Name of the Candidate as in

the 10th Class Certificate
ARUN RAJAN CHOYYAN
9. Choice of GATE Paper
Electronics and Communication

Engineering
2. Date of Birth (DD/MM/YYYY)
17/11/1986
10. E-mail Address
[email protected]
3. Gender
MALE
4. Nationality
INDIAN
11. Address for Correspondence KRISHNA BAHAVAN

ELEYAVOOR SOUTH , P.O
MUNDAYAD
KANNUR , KERALA
INDIA
12. PINCODE of Address for
670597
Correspondence
5. Category
General
13. Year of Degree
2009
6. Person with Disability (PD)
No
14. Discipline
Electronics & Comm./Electronics

Engg./Communication
Engg./Telecommunication Engg
15. Name of Parent
THIRUMANGALATH PREMARAJAN
7. Qualifying Degree
B.E./B.Tech./ B.Sc.
(Engg.)/B.Sc.(Tech.)/B.Arch.
16. State/Union Territory of

Permanent Residence
Kerala
8. Choice of Examination City1
712 - Kannur (Kerala)
17. Mobile / Landline No.
09495115637
Choice of Examination City2
718 - Kozhikode
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
the 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
appearing in the exam, any admission/degree acquired on the basis of GATE 2012 score is liable to be
cancelled.
Place :
Date :
18. Signature
Full Signature of the candidate using

BLACK INK PEN only
(do not sign in CAPITAL LETTERS)
712EC7102913
Retain this copy with you for future reference.
19. Photograph
3.5 cm x 3.5 cm
BY SPEED / REGISTERED POST

(Please do not Courier)
GATE 2012 Application Form
To
Chairman, GATE
Indian Institute of Technology Madras
Chennai - 600036
712EC7102913
Do not tamper with the bar code. For GATE official use.
From
ARUN RAJAN CHOYYAN (APPLNO : 7102913)
KRISHNA BAHAVAN
ELEYAVOOR SOUTH , P.O MUNDAYAD
KANNUR , KERALA
INDIA
670597
CASH VOUCHER
BANK COPY CASH VOUCHER
GATE COPY CASH VOUCHER
CANDIDATE COPY
Last date for acceptance

of challan in bank : 24 October 2011.


CASH CAN BE TENDERED AT ANY SBI BRANCH

GATE 2012 Application Fee Payment Challan


Use CBS Screen No. :
8888
FEE Type :
16
Registration ID / Ref No. :
7102913
Date of Birth :
17/11/1986
8888
FEE Type :
16
7102913
Date of Birth :
17/11/1986
8888
FEE Type :
16
7102913
Date of Birth :
17/11/1986
Challan can be deposited minimum one day after the

generation of challan.


Name of the Candidate : ARUN RAJAN CHOYYAN
Address for
Correspondence :
KRISHNA BAHAVAN ELEYAVOOR SOUTH , Address for

Correspondence :
P.O MUNDAYAD KANNUR , KERALA INDIA -
KRISHNA BAHAVAN ELEYAVOOR SOUTH , Address for

Correspondence :
KRISHNA BAHAVAN ELEYAVOOR SOUTH ,
670597
670597
670597
Mobile / Landline No:
09495115637
09495115637
09495115637
E Mail ID :
[email protected]
E Mail ID :
[email protected]
E Mail ID :
[email protected]
Category :
General
Category :
General
Category :
General
Amount :
Rs.1025/- *
Amount :
Rs.1025/- *
Amount :
Rs.1025/- *
Amount in words :
Rupees One thousand and Twenty Five Only.

(*Application Fees Including Bank Charges)
Amount in words :

Amount in words :

JOURNAL NUMBER
JOURNAL NUMBER
Signature of the Candidate/Remitter
JOURNAL NUMBER
For Receiving Branch use only

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
SEAL / DATE
SEAL / DATE
AUTHORISED SIGNATORY

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Instructions and Application Form for GATE 2012

Instructions for the Candidate:

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

Page - 2 : Application Form (GATE Copy).

b. Sign at the designated place.

Page - 4 : Address page to be pasted on a 10 inch X 12 inch size laminated envelope.

Application Form (GATE Copy)

Bank Challan (GATE Copy)

Self Attested Copy of SC/ST/PD certificate (if applicable)

Self Attested Copy of affidavit for change of name (if applicable)

Self Attested Copy of the degree certificate if the year of qualifying

If the year of qualifying degree is 2012 or later, a certificate signed by

Candiates with backlog: copy of final semester/year marks sheet or

APPLICATION NO. 7102913

GATE 2012 APPLICATION FORM

Zone: IIT Madras

Payment Mode: Bank Challan (SBI)

1. Name of the Candidate as in

ARUN RAJAN CHOYYAN

9. Choice of GATE Paper

Electronics and Communication

2. Date of Birth (DD/MM/YYYY)

10. E-mail Address

11. Address for Correspondence KRISHNA BAHAVAN

13. Year of Degree

6. Person with Disability (PD)

Electronics & Comm./Electronics

15. Name of Parent

16. State/Union Territory of

8. Choice of Examination City1

712 - Kannur (Kerala)

17. Mobile / Landline No.

Choice of Examination City2

Full Signature of the candidate using

APPLICATION NO. 7102913

GATE 2012 APPLICATION FORM

Zone: IIT Madras

Payment Mode: Bank Challan (SBI)

1. Name of the Candidate as in

ARUN RAJAN CHOYYAN

9. Choice of GATE Paper

Electronics and Communication

2. Date of Birth (DD/MM/YYYY)

10. E-mail Address

11. Address for Correspondence KRISHNA BAHAVAN

13. Year of Degree

6. Person with Disability (PD)

Electronics & Comm./Electronics

15. Name of Parent

16. State/Union Territory of

8. Choice of Examination City1

712 - Kannur (Kerala)

17. Mobile / Landline No.

Choice of Examination City2

Full Signature of the candidate using

Retain this copy with you for future reference.

BY SPEED / REGISTERED POST

BANK COPY CASH VOUCHER