ONLINE Application for GATE 2011

Instructions for the Candidate:

1. Your Login ID is NAVA22051. Remember your password and do not disclose it to anyone.
2. There are 5 Pages in this file. These pages should be printed on A4 sheets.
3. Page - 1: Instructions for the candidate to be retained by you carefully
4. Page - 2 : Application Form (GATE Copy)
a. Paste your recent color photo (3cm x 4cm) in designated place
b. Sign at designated places
5. Page - 3 : Application Form (CANDIDATE Copy) to be retained by you for your reference
6. Page - 5 : Bank challan in triplicate. Take it to any Indian Bank branch and pay the fee. The Bank will
retain a copy with them and will return two copies to you. In those two copies, retain the Candidate's
copy with you and attach Institute's copy with Application Form

7. Page - 4 : Address slip to be pasted on the A4 size envelope

8. Insert completed Application Form (GATE Copy) and attested copies of all applicable documents
(SC/ST/PD Certificate, Affidavit for change of name) into A4 size envelope, without folding and send by
Speed Post (preferably) or by Registered Post to Chairman, GATE, IIT Madras

List of Documents to be sent to GATE IIT Madras:

1. Application Form (GATE Copy)
2. Bank Challan (Institute's Copy)
3. Attested Copy of SC/ST/PD Certificate (if applicable)
4. Attested Copy of affidavit for change of name (if applicable)

Page - 1
 GATE IIT Madras COPY
APPLICATION FORM FOR GATE 2011
Application No: 7169893 Payment Mode: Bank Challan (Indian Bank)

Zone: IIT Madras Application Fee: Rs. 800/-

1. Name of the Candidate as in NAVANEETHA KRISHNAN 11. Address 40 KAILASANATHAR KOIL STREET
the 10th Class Certificate
ATTUR(T.K)

SALEM(DT)

2. Date of Birth (DD/MM/YYYY) 22/05/1989

PINCODE 636102
3. Gender MALE

4. Nationality INDIAN 14. Year of Degree 2010

15. Discipline Mechanical Engg.

5. Category OBC(Non-Creamy Layer)

6. Person with Disability (PD) No

Do You Require a Scribe? No 16. Name of Parent ARUNACHALAM A

7. Qualifying Degree B.E./B.Tech./ B.Sc. 17. State/Union Territory of Tamil Nadu

(Engg.)/B.Sc.(Tech.)/B.Arch. Permanent Residence

18. Phone / Mobile 09751622359

8. Choice of Examination City1 703 - Chennai South
Number
19. PINCODE of Address 636102
Choice of Examination City2 702 - Chennai North for Correspondence

9. Choice of GATE Paper ME - Mechanical Engineering

10. E-mail Address navaneelavz@gmail.com

I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. 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 2011.
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 2011 score is liable to be cancelled.

Place:
Date:
Full Signature of the Candidate
(do not sign in capital letters)

12. Photograph

Paste a front
facial high
contrast recent
13. Full Signature of the Candidate color photograph
7169893 using black ball point pen only 3cm x 4cm
(do not sign in capital letters) without any
signature or
attestation

Send this form along with the necessary documents to IIT Madras

Page - 2
 CANDIDATE COPY
APPLICATION FORM FOR GATE 2011
Application No: 7169893 Payment Mode: Bank Challan (Indian Bank)

Zone: IIT Madras Application Fee: Rs. 800/-

1. Name of the Candidate as in NAVANEETHA KRISHNAN 11. Address 40 KAILASANATHAR KOIL STREET
the 10th Class Certificate
ATTUR(T.K)

SALEM(DT)

2. Date of Birth (DD/MM/YYYY) 22/05/1989

PINCODE 636102
3. Gender MALE

4. Nationality INDIAN 14. Year of Degree 2010

15. Discipline Mechanical Engg.

5. Category OBC(Non-Creamy Layer)

6. Person with Disability (PD) No

Do You Require a Scribe? No 16. Name of Parent ARUNACHALAM A

7. Qualifying Degree B.E./B.Tech./ B.Sc. 17. State/Union Territory of Tamil Nadu

(Engg.)/B.Sc.(Tech.)/B.Arch. Permanent Residence

18. Phone / Mobile 09751622359

8. Choice of Examination City1 703 - Chennai South
Number
19. PINCODE of Address 636102
Choice of Examination City2 702 - Chennai North for Correspondence

9. Choice of GATE Paper ME - Mechanical Engineering

10. E-mail Address navaneelavz@gmail.com

I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. 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 2011.
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 2011 score is liable to be cancelled.

Place:
Date:
Full Signature of the Candidate
(do not sign in capital letters)

12. Photograph

Paste a front
facial high
contrast recent
13. Full Signature of the Candidate color photograph
7169893 using black ball point pen only 3cm x 4cm
(do not sign in capital letters) without any
signature or
attestation

Retain this page for your reference

Page - 3
 BY SPEED POST / REGISTERED POST

GATE 2011
GATE PAPER CODE ME To

EXAM CITY OF FIRST Chairman, GATE

CHOICE 703
Indian Institute of Technology Madras

Chennai

From
PINCODE 6 0 0 0 3 6
NAVANEETHA KRISHNAN

40 KAILASANATHAR KOIL STREET

APPLICATION NO
ATTUR(T.K)

SALEM(DT)
7 1 6 9 8 9 3
PINCODE 6 3 6 1 0 2

Page - 4
 CANDIDATE’S COPY
PAY IN SLIP BANK'S COPY PAY IN SLIP INSTITUTE’S COPY PAY IN SLIP

PAYABLE AT ALL BRANCHES OF PAYABLE AT ALL BRANCHES OF PAYABLE AT ALL BRANCHES OF

INDIAN BANK INDIAN BANK INDIAN BANK
Paid in to the credit of IIT MADRAS GATE 2011 Paid in to the credit of IIT MADRAS GATE 2011 Paid in to the credit of IIT MADRAS GATE 2011
A/C no 899746136 , ADYAR BRANCH CHENNAI, A/C no 899746136 , ADYAR BRANCH CHENNAI, A/C no 899746136 , ADYAR BRANCH CHENNAI,
BRANCH CODE : 79 BRANCH CODE : 79 BRANCH CODE : 79
Name of the Candidate NAVANEETHA KRISHNAN Name of the Candidate NAVANEETHA KRISHNAN Name of the Candidate NAVANEETHA KRISHNAN

Present Address 4 0 K A I L A S A N A T H A R K O I L S T R E E T Present Address 40 KAILASANATHAR KOIL STREET Present Address

40 KAILASANATHAR KOIL STREET
in CAPITAL LETTERS ATTUR(T.K) SALEM(DT) - 6 3 6 1 0 2 in CAPITAL LETTERS ATTUR(T.K) SALEM(DT) - 636102 in CAPITAL LETTERS ATTUR(T.K) SALEM(DT) - 636102
with Pin Code with Pin Code with Pin Code

Date of Birth 22/05/1989 Date of Birth 22/05/1989 Date of Birth 22/05/1989

Mobile / Landline No: 09751622359 Mobile / Landline No: 09751622359 Mobile / Landline No: 09751622359

E-mail Address navaneelavz@gmail.com E-mail Address navaneelavz@gmail.com E-mail Address navaneelavz@gmail.com

Category : OBC(Non-Creamy Layer) Category : OBC(Non-Creamy Layer) Category : OBC(Non-Creamy Layer)
Physically Disabled : No Physically Disabled : No Physically Disabled : No
Amount : Rs.830/- Amount : Rs.830/- Amount : Rs.830/-

Amount in words : Rupees eight hundred and thirty only. Amount in words : Rupees eight hundred and thirty only. Amount in words : Rupees eight hundred and thirty only.
(*Inclusive of Bank Charge) (*Inclusive of Bank Charge) (*Inclusive of Bank Charge)
Name of the Name of the Name of the
Receiving Branch Receiving Branch Receiving Branch

Signature of the candidate Signature of the candidate Signature of the candidate

FOR BANK’S USE FOR BANK’S USE FOR BANK’S USE

Journal No: Branch Journal No: Branch Journal No: Branch

Code Code Code

Application 7169893 Signature Application 7169893 Signature Application 7169893 Signature

Number : of Number : of Number : of
cashier cashier cashier

Branch Date Branch Date Branch Date

Name Name Name