Instructions and Application Form For GATE 2012
Instructions and Application Form For GATE 2012
3. 4.
5. 6. 7.
8.
7.
____________End of Instructions____________
GATE COPY
11. Address for Correspondence JANGA PAVANKUMAR . S/O J VENKATESWARLU, LAKSHMIFANCYSTORES MAINROAD, BUCHIREDDYPALEM(M),NELLORE (D) 12. PINCODE of Address for 524305 Correspondence 13. Year of Degree 14. Discipline 15. Name of Parent 2012 Computer Science & Engineering/Technology JANGA VENKATESWARLU Andhra Pradesh
7. Qualifying Degree
09032601143
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
723CS7145440
Send this form along with the necessary documents to IIT Madras.
CANDIDATE COPY
11. Address for Correspondence JANGA PAVANKUMAR . S/O J VENKATESWARLU, LAKSHMIFANCYSTORES MAINROAD, BUCHIREDDYPALEM(M),NELLORE (D) 12. PINCODE of Address for 524305 Correspondence 13. Year of Degree 14. Discipline 15. Name of Parent 2012 Computer Science & Engineering/Technology JANGA VENKATESWARLU Andhra Pradesh
7. Qualifying Degree
09032601143
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
723CS7145440
BY SPEED / REGISTERED POST (Please do not Courier) GATE 2012 Application Form
723CS7145440
Do not tamper with the bar code. For GATE official use.
From
JANGA PAVAN KUMAR (APPLNO : 7145440) JANGA PAVANKUMAR . S/O J VENKATESWARLU, LAKSHMIFANCYSTORES MAINROAD, BUCHIREDDYPALEM(M),NELLORE(D) 524305
Date of Deposit : DD/MM/YY (to be treated by Applicant as fee receipt) Account to be Credited : 0036SLFEECOL
Date of Deposit : DD/MM/YY (to be treated by Applicant as fee receipt) Account to be Credited : 0036SLFEECOL
Account to be Credited :
0036SLFEECOL
1.Institution Name : 2.Student/Applicant Name : 3.Roll No/Application No : 4.Class/DOB : 5.Section/Category : 6.Amount : 7.Amount in words : 8.Cash Details : Denomination 1000 X 500 X 100 X
1.Institution Name : 2.Student/Applicant Name : 3.Roll No/Application ID : 4.Class/DOB : 5.Section/Category : 6.Amount : 7.Amount in words : 8.Cash Details : Denomination 1000 X 500 X 100 X
1.Institution Name : 2.Student/Applicant Name : 3.Roll No/Application ID : 4.Class/DOB : 5.Section/Category : 6.Amount : 7.Amount in words : 8.Cash Details : Denomination 1000 X 500 X 100 X
7145440
7145440
7145440
29/03/91 NA Rs.1025/- * Rupees One thousand and Twenty Five Only. (*Including Rs. 25 as Bank Charge)
29/03/91 NA Rs.1025/- * Rupees One thousand and Twenty Five Only. (*Including Rs. 25 as Bank Charge)
29/03/91 NA Rs.1025/- * Rupees One thousand and Twenty Five Only. (*Including Rs. 25 as Bank Charge)