A 562 S 80 Application

By Registered Post/Speed Post Only
Zone/Scrutiny
6ND
GATE 2014
Chairperson GATE
Indian Institute of Technology Kharagpur
Kharagpur 721302
A562S80
To
From
Seethini Ratnakar
30-19-4
VADLAPUDI POST OFFICE LINE
VISAKHAPATNAM
Andhra Pradesh 530046
97003 73959 (Mobile Number)
A562S80
Cut Here
Instructions to the Applicant (GATE 2014)

1. This print out should contain the following pages.
(a) Page 1 : This page contains Instructions and Address Slip (cut and paste the Address Slip on A4 size envelope).
(b) Page 2 : Application form that you have filled online.
2. Bank challan in Triplicate is available as a separate pdf file to be downloaded. This is available only if you have opted for Offline
Payment.
3. On the GATE 2014 Application Form, paste a 3.5cm x 4.5cm color photograph with plain background (this should be the same
that you have uploaded during application filling). The photograph should be taken in a studio.
(a) Write your Enrolment ID. and Name on the reverse side of the photo.
(b) Use good quality glue to ensure that the photograph does not separate from the application.
(c) Do not pin, staple, sign or attest the photograph.
4. Read the declaration and put your full signature in the box next to it. Please note that signature should not be in capital letters.
5. If you are in the final year or you have a backlog after appearing for the final year examination, you must get your Principals or
HODs Signature and Seal in the Certificate from Principal that is provided at the last portion of the application form. Submit the
whole form to the Principals office without cutting it.
6. If you have opted for challan payment, wait for 48 hours after your online submission to visit the banks branch. You can visit any
branch of the bank printed on your challan.
7. The bank teller will verify the details printed on the challan with the data available in their system and then accept the payment.
The bank will retain one copy and give you the remaining two copies: one of which is the GATE Copy that you have to send along
with the printed application form and the other is the Candidate Copy for your reference.
8. Keep a photo copy of the completed application form for your reference.
9. Mailing Documents to GATE office.
(a) Cut the Address Slip and paste it onto an A4 size envelope (Do not fill address by hand or tamper the address slip).
(b) Collect the supporting documents shown under Enclosure Checklist in the application form. Mark the enclosures in the
checklist boxes.
(c) Do NOT FOLD the application form and Do NOT STAPLE or pin the documents to the form.
(d) Send the packet by Speed Post (preferably) or by Registered Post to the address mentioned in the address slip. The
application packet should REACH the respective zonal GATE office on or before Thursday, 10 October 2013.
Note: Enrolment ID - A562S80. You should preserve this number for further correspondence.
Zone/Scrutiny
GATE 2014
6ND
A562S80
A562S80
A562S80
Applicant's recent photograph
(Enrolment ID)
Seethini Ratnakar
(Full Name of the Applicant)
3.5 cm x 4.5 cm
A562S80
01 Jul 1988
Male
OBC
No
(D.O.B)
(Gender)
(Category)
(PD Status)
Indian National
Do not Attest
Do not sign on photo
Do not staple photo
9701348139
Mohana Rao
(Parent's Mobile Number)
(Name of the Parent)
Communication Address
GATE Exam Details
30-19-4
VADLAPUDI POST OFFICE LINE
VISAKHAPATNAM
GATE Paper Code
97003 73959 (Mobile No.)

[email protected]
EE
Visakhapatnam, AP
(Exam City 1)
Srikakulam-Vizianagaram, AP
Qualification Details
(Exam City 2)
B.Tech
Electrical Engg./Electrical and Electronics Engg.
Graduated: Yes; Year of Graduation: 2009
AVANTHI INST OF ENGG JNTUK
VISAKHAPATNAM
Payment Details
(Exam City 3)
Zonal GATE Office Contact

Chairperson GATE
Indian Institute of Technology Kharagpur
Kharagpur 721302
Enclosure Checklist
Rs. 1500.00
Online
Vijayawada, AP
Eligibility Certificate copy
Payment Ref. No.: MSBI3118708180

28/09/2013
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 Information Brochure and I shall abide by the terms and conditions therein. The
responsibility of following the GATE 2014 website and meeting various deadlines lies with me. 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 2014. Further, if any suppression or distortion of facts is found after appearing in the
exam, any admission/degree/benefit acquired on the basis of GATE 2014 score/marks is liable to be
cancelled.
Digital
Fingerprint:
6acde9670e41506291fcab673a63053d
Date: ....../....../.........
This space is intentionally left blank
Applicants signature inside the box in black ink

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By Registered Post/Speed Post Only

Instructions to the Applicant (GATE 2014)

Applicant's recent photograph

(Parent's Mobile Number)

(Name of the Parent)

GATE Exam Details

GATE Paper Code

97003 73959 (Mobile No.)

Zonal GATE Office Contact

Eligibility Certificate copy

Payment Ref. No.: MSBI3118708180

This space is intentionally left blank

Applicants signature inside the box in black ink

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