ONLINE Application for GATE 2011

Instructions for the Candidate:

1. Your Login ID is ADIT16085. Remember your password and do not disclose it to anyone.
2. There are 4 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 - 4 : Address slip to be pasted on the A4 size envelope
7. 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 Delhi

List of Documents to be sent to GATE IIT Delhi:

1. Application Form (GATE Copy)
2. Attested Copy of SC/ST/PD Certificate (if applicable)
3. Attested Copy of affidavit for change of name (if applicable)

Page - 1
 GATE IIT Delhi COPY
APPLICATION FORM FOR GATE 2011
Application No: 3132048 Payment Mode: BillDesk Gateway

Zone: IIT Delhi Application Fee: Rs. 800/- Payment Reference No: MCIT0102937339

1. Name of the Candidate as in ADITI GUPTA 11. Address 295 J/2

the 10th Class Certificate
DURGA NAGAR

TALAB TILLO BOHRI

2. Date of Birth (DD/MM/YYYY) 16/08/1986 JAMMU

PINCODE 180002
3. Gender FEMALE

4. Nationality INDIAN 14. Year of Degree 2008

15. Discipline Electronics & Comm./Electronics

5. Category General Engg./Comm.
Engg./Telecommunication Engg.
6. Person with Disability (PD) No

Do You Require a Scribe? No 16. Name of Parent AGYA PAUL GUPTA

7. Qualifying Degree B.E./B.Tech./ B.Sc. 17. State/Union Territory of Jammu & Kashmir
(Engg.)/B.Sc.(Tech.)/B.Arch. Permanent Residence

18. Phone / Mobile 09419108294

8. Choice of Examination City1 315 - Jammu
Number
19. PINCODE of Address 180002
Choice of Examination City2 804 - Chandigarh for Correspondence

9. Choice of GATE Paper EC - Electronics and Communication

Engineering
10. E-mail Address aditi0016@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
3132048 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 Delhi

Page - 2
 CANDIDATE COPY
APPLICATION FORM FOR GATE 2011
Application No: 3132048 Payment Mode: BillDesk Gateway

Zone: IIT Delhi Application Fee: Rs. 800/- Payment Reference No: MCIT0102937339

1. Name of the Candidate as in ADITI GUPTA 11. Address 295 J/2

the 10th Class Certificate
DURGA NAGAR

TALAB TILLO BOHRI

2. Date of Birth (DD/MM/YYYY) 16/08/1986 JAMMU

PINCODE 180002
3. Gender FEMALE

4. Nationality INDIAN 14. Year of Degree 2008

15. Discipline Electronics & Comm./Electronics

5. Category General Engg./Comm.
Engg./Telecommunication Engg.
6. Person with Disability (PD) No

Do You Require a Scribe? No 16. Name of Parent AGYA PAUL GUPTA

7. Qualifying Degree B.E./B.Tech./ B.Sc. 17. State/Union Territory of Jammu & Kashmir
(Engg.)/B.Sc.(Tech.)/B.Arch. Permanent Residence

18. Phone / Mobile 09419108294

8. Choice of Examination City1 315 - Jammu
Number
19. PINCODE of Address 180002
Choice of Examination City2 804 - Chandigarh for Correspondence

9. Choice of GATE Paper EC - Electronics and Communication

Engineering
10. E-mail Address aditi0016@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
3132048 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 EC To

EXAM CITY OF FIRST Chairman, GATE

CHOICE 315
Indian Institute of Technology Delhi

Hauz Khas, New Delhi

From
PINCODE 1 1 0 0 1 6
ADITI GUPTA

295 J/2
APPLICATION NO
DURGA NAGAR

TALAB TILLO BOHRI

JAMMU 3 1 3 2 0 4 8
PINCODE 1 8 0 0 0 2

Page - 4