Beruflich Dokumente
Kultur Dokumente
3. 4.
5. 6. 7.
8.
7.
____________End of Instructions____________
GATE COPY
INDIAN General No
11. Address for Correspondence C/O SULTAN MANSION ROOM NO:20 2ND GATE;M.C.ROAD THANJAVUR MEDICAL COLLEGE 12. PINCODE of Address for 613004 Correspondence 13. Year of Degree 14. Discipline 2012 Electronics & Comm./Electronics Engg./Communication Engg./Telecommunication Engg KAMAL KUMAR SINGH Jharkhand
15. Name of Parent 7. Qualifying Degree B.E./B.Tech./ B.Sc. (Engg.)/B.Sc.(Tech.)/B.Arch. 16. State/Union Territory of Permanent Residence
08122707050
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
19. Photograph
Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS)
3.5 cm x 3.5 cm
729EC7056227
Send this form along with the necessary documents to IIT Madras.
CANDIDATE COPY
INDIAN General No
11. Address for Correspondence C/O SULTAN MANSION ROOM NO:20 2ND GATE;M.C.ROAD THANJAVUR MEDICAL COLLEGE 12. PINCODE of Address for 613004 Correspondence 13. Year of Degree 14. Discipline 2012 Electronics & Comm./Electronics Engg./Communication Engg./Telecommunication Engg KAMAL KUMAR SINGH Jharkhand
15. Name of Parent 7. Qualifying Degree B.E./B.Tech./ B.Sc. (Engg.)/B.Sc.(Tech.)/B.Arch. 16. State/Union Territory of Permanent Residence
08122707050
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
19. Photograph
Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS)
3.5 cm x 3.5 cm
729EC7056227
BY SPEED / REGISTERED POST (Please do not Courier) GATE 2012 Application Form
729EC7056227
Do not tamper with the bar code. For GATE official use.
From
DHIRAJ ANAND (APPLNO : 7056227) C/O SULTAN MANSION ROOM NO:20 2ND GATE;M.C.ROAD THANJAVUR MEDICAL COLLEGE 613004
CASH VOUCHER
CANDIDATE COPY
Challan can be deposited minimum one day after the generation of challan.
Name of the Candidate : DHIRAJ ANAND Address for Correspondence :
Challan can be deposited minimum one day after the generation of challan.
Name of the Candidate : DHIRAJ ANAND Address for Correspondence :
Challan can be deposited minimum one day after the generation of challan.
Name of the Candidate : DHIRAJ ANAND
C/O SULTAN MANSION ROOM NO:20 2ND GATE;M.C.ROAD THANJAVUR MEDICAL COLLEGE - 613004
C/O SULTAN MANSION ROOM NO:20 2ND Address for Correspondence : GATE;M.C.ROAD THANJAVUR MEDICAL COLLEGE - 613004
C/O SULTAN MANSION ROOM NO:20 2ND GATE;M.C.ROAD THANJAVUR MEDICAL COLLEGE - 613004
08122707050 dhirajanandvicky@gmail.com
08122707050 dhirajanandvicky@gmail.com
08122707050 dhirajanandvicky@gmail.com
General Rs.1025/- * Rupees One thousand and Twenty Five Only. (*Application Fees Including Bank Charges)
General Rs.1025/- * Rupees One thousand and Twenty Five Only. (*Application Fees Including Bank Charges)
General Rs.1025/- * Rupees One thousand and Twenty Five Only. (*Application Fees Including Bank Charges)
JOURNAL NUMBER
JOURNAL NUMBER
JOURNAL NUMBER
Signature of the Candidate/Remitter 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.
Signature of the Candidate/Remitter 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.
Signature of the Candidate/Remitter 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
AUTHORISED SIGNATORY
SEAL / DATE
AUTHORISED SIGNATORY
SEAL / DATE
AUTHORISED SIGNATORY