gate2012 8066815
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7.
Page - 4 : Address page to be pasted on a 10 inch X 12 inch size laminated envelope.
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 4 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
1. Application Form (GATE Copy)
2. Self Attested Copy of SC/ST/PD certificate (if applicable)
3. Self Attested Copy of affidavit for change of name (if applicable)
Your Login ID is SACH200815. 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 inchlaminated envelope and send by Speed Post (preferably) or by Registered Post using the addressprinted 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:
4. Self Attested Copy of the degree certificate if the year of qualifyingdegree is 2011 or earlier.
5. If the year of qualifying degree is 2012 or later, a certificate signed bythe principal of the college clearly indicating the year of qualifyingdegree (format available on GATE website).
____________End of Instructions____________
Application sent through courier will not be accepted.
Put
b. Sign at the designated place.
7. Candiates with backlog: copy of final semester /year marks sheet orcourse completion certificate or a letter from principal.
Computer Science and InformationTechnology
SACHCHIDA NAND SINGHName of the Candidate as inthe 10th Class Certificate
Choice of GATE Paper1. 9.
GATE COPYAPPLICATION NO. 8066815
GATE 2012 APPLICATION FORM
Zone: IIT Roorkee Payment Mode: Payment GatewayPayment Reference No: MSBI1005445686
Fee: Rs. 1000
Date of Birth (DD/MM/YYYY)2. E-mail Address sssach05@gmail.com20/08/1989 10.
Gender3. MALE Address for Correspondence VILL.-DOBHIYARA11.POST-DOBHIYARADIST.-SULTANPUR
Category
Person with Disability (PD)
Nationality
Year of Degree
Discipline
5.
6.
4.
13.
14.
General
No
INDIAN
2012
Computer Science &Engineering/Technology
PINCODE of Address forCorrespondence
12. 227815
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.
815 - Mathura
501 - Agra
JAG JIWAN SINGH
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 theopportunity to appear in GATE 2012. Further, if any such suppression or distortion of facts is found afterappearing in the exam, any admission/degree acquired on the basis of GATE 2012 score is liable to becancelled.
Mobile / Landline No.17. 09897068420
Place :
Date :
Full Signature of the candidate usingBLACK INK PEN only
(do not sign in CAPITAL LETTERS)
815CS8066815
19. Photograph18. Signature
3.5 cm x 3.5 cm
Send this form along with the necessary documents to IIT Roorkee.
Computer Science and InformationTechnology
SACHCHIDA NAND SINGHName of the Candidate as inthe 10th Class Certificate
Choice of GATE Paper1. 9.
CANDIDATE COPYAPPLICATION NO. 8066815
GATE 2012 APPLICATION FORM
Zone: IIT Roorkee Payment Mode: Payment GatewayPayment Reference No: MSBI1005445686
Fee: Rs. 1000
Date of Birth (DD/MM/YYYY)2. E-mail Address sssach05@gmail.com20/08/1989 10.
Gender3. MALE Address for Correspondence VILL.-DOBHIYARA11.POST-DOBHIYARADIST.-SULTANPUR
Category
Person with Disability (PD)
Nationality
Year of Degree
Discipline
5.
6.
4.
13.
14.
General
No
INDIAN
2012
Computer Science &Engineering/Technology
PINCODE of Address forCorrespondence
12. 227815
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.
815 - Mathura
501 - Agra
JAG JIWAN SINGH
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 theopportunity to appear in GATE 2012. Further, if any such suppression or distortion of facts is found afterappearing in the exam, any admission/degree acquired on the basis of GATE 2012 score is liable to becancelled.
Mobile / Landline No.17. 09897068420
Place :
Date :
Full Signature of the candidate usingBLACK INK PEN only
(do not sign in CAPITAL LETTERS)
815CS8066815
19. Photograph18. Signature
3.5 cm x 3.5 cm
Retain this copy with you for future reference.
To
BY SPEED / REGISTERED POST(Please do not Courier)
Chairman, GATE
GATE 2012 Application Form
Indian Institute of Technology Roorkee
FromSACHCHIDA NAND SINGH (APPLNO : 8066815)
VILL.-DOBHIYARA
Roorkee - 247667
Do not tamper with the bar code. For GATE official use.
815CS8066815
POST-DOBHIYARA
DIST.-SULTANPUR
227815
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