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1CP
To
GATE 2014
A471J90 Chairperson GATE Indian Institute of Science Bangalore Bengaluru 560012
A471J90
Note: Enrolment ID - A471J90. You should preserve this number for further correspondence.
Zone/Scrutiny
GATE 2014
1CP
A471J90
(Enrolment ID) (Full Name of the Applicant)
A471J90
A471J90
3.5 cm x 4.5 cm
A471J90
04 Sep 1989
(D.O.B)
Female
(Gender)
GEN
(Category)
No
(PD Status)
Indian National
9611339893
(Parent's Mobile Number)
Mahananda P Kohalli
(Name of the Parent)
Communication Address
PRAKASH I HALAGOND A/p- ADAHALLI TAL-ATHANI Dist- BELGAUM BELGAUM Karnataka 591248
EC
Belgaum, KA
(Exam City 1)
Hubli, KA
(Exam City 2)
Qualification Details
B.E. Electronics/Comm./Telecomm Engg. Graduated: No; Year of Graduation: 2014 KLEMSSCET BELGAUM BELGAUM Karnataka 590008
Bengaluru, KA
(Exam City 3)
Payment Details
Enclosure Checklist
Stamped Bank Challan: GATE copy
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 Information Brochure and I shall abide by the terms and conditions therein. The responsibility of following the GATE 2014 website and meeting various deadlines lies with me. 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 2014. Further, if any suppression or distortion of facts is found after appearing in the exam, any admission/degree/benefit acquired on the basis of GATE 2014 score/marks is liable to be cancelled.
Digital Fingerprint:
c5671e5d05613734355678cbe545417c
Date: ....../....../.........
(For use as the eligibility certificate only for final year or backlog applicants)
She appeared in the final semester/year exam of the above degree, but has a backlog to be cleared from an earlier semester/year, and therefore cannot produce a course completion certificate.
Date:
Seal