Instructions and Application Form for GATE 2012

Instructions for the Candidate:

1.

Your Login ID is ATUL0804. Remember your password and do not disclose it to anyone.

2.

There are 5 pages in this pdf file. These pages should be printed on A4 size white sheets using a
laser/ink jet printer.

3.

Page - 1: Instructions for the candidate to be retained by the candidate.

4.

Page - 2 : Application Form (GATE Copy).

a. Paste your recent color photo (3.5cm x 3.5cm) in the designated place. Before pasting, please write
your name and application number on the backside of the photo with black ball point pen.
b. Sign at the designated place.

5.

Page - 3 : Application Form (Candidate copy) to be retained by the candidate.

6.

Page - 4 : Address page to be pasted on a 10 inch X 12 inch size laminated envelope.

7.

Page - 5 : Bank challan in triplicate. Take it to any SBI branch and pay the application fee plus the bank
service charge. The Bank will retain its copy and will return the remaining two copies to you. Out of
these two copies, retain the Candidate's copy with you and attach the GATE copy with the Application
Form.

8.

Without folding, insert the completed Application Form (GATE copy) and attested copies of all the
application documents (SC/ST/PD certificate, copy of degree certificate etc.) into a 10 inch X 12 inch
laminated envelope and send by Speed Post (preferably) or by Registered Post using the address
printed on page-4 so as to reach the respective Zonal GATE office on or before 24th October 2011.
Application sent through courier will not be accepted.

Put
List of Documents to be attached with the Application Form:
1.

Application Form (GATE Copy)

2.

Bank Challan (GATE Copy)

3.

Self Attested Copy of SC/ST/PD certificate (if applicable)

4.

Self Attested Copy of affidavit for change of name (if applicable)

5.

Self Attested Copy of the degree certificate if the year of qualifying

degree is 2011 or earlier.

6.

If the year of qualifying degree is 2012 or later, a certificate signed by

the principal of the college clearly indicating the year of qualifying
degree (format available on GATE website).

____________End of Instructions____________

GATE COPY

APPLICATION NO. 5010021

GATE 2012 APPLICATION FORM

Fee: Rs. 1000

Zone: IIT Kanpur

Payment Mode: Bank Challan (SBI)

1. Name of the Candidate as in

the 10th Class Certificate

ATUL KUMAR PANDEY

9. Choice of GATE Paper

Mechanical Engineering

2. Date of Birth (DD/MM/YYYY)

08/04/1991

10. E-mail Address

08atulpandey@gmail.com

3. Gender

MALE

4. Nationality

INDIAN

11. Address for Correspondence RB-3,304/4 CRWS COLONY,

rb-3,304/4 crws colony
12. PINCODE of Address for
462010
Correspondence

5. Category

General

13. Year of Degree

2012

6. Person with Disability (PD)

No

14. Discipline

Mechanical Engineering

15. Name of Parent

A L PANDEY

7. Qualifying Degree

B.E./B.Tech./ B.Sc.
(Engg.)/B.Sc.(Tech.)/B.Arch.

16. State/Union Territory of

Permanent Residence

Madhya Pradesh

8. Choice of Examination City1

505 - Bhopal

17. Mobile / Landline No.

07552746085

Choice of Examination City2

511 - Lucknow

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

Full Signature of the candidate using

BLACK INK PEN only
(do not sign in CAPITAL LETTERS)

19. Photograph

3.5 cm x 3.5 cm

505ME5010021

Send this form along with the necessary documents to IIT Kanpur.

CANDIDATE COPY

APPLICATION NO. 5010021

GATE 2012 APPLICATION FORM

Fee: Rs. 1000

Zone: IIT Kanpur

Payment Mode: Bank Challan (SBI)

1. Name of the Candidate as in

the 10th Class Certificate

ATUL KUMAR PANDEY

9. Choice of GATE Paper

Mechanical Engineering

2. Date of Birth (DD/MM/YYYY)

08/04/1991

10. E-mail Address

08atulpandey@gmail.com

3. Gender

MALE

4. Nationality

INDIAN

11. Address for Correspondence RB-3,304/4 CRWS COLONY,

rb-3,304/4 crws colony
12. PINCODE of Address for
462010
Correspondence

5. Category

General

13. Year of Degree

2012

6. Person with Disability (PD)

No

14. Discipline

Mechanical Engineering

15. Name of Parent

A L PANDEY

7. Qualifying Degree

B.E./B.Tech./ B.Sc.
(Engg.)/B.Sc.(Tech.)/B.Arch.

16. State/Union Territory of

Permanent Residence

Madhya Pradesh

8. Choice of Examination City1

505 - Bhopal

17. Mobile / Landline No.

07552746085

Choice of Examination City2

511 - Lucknow

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

Full Signature of the candidate using

BLACK INK PEN only
(do not sign in CAPITAL LETTERS)

505ME5010021

Retain this copy with you for future reference.

19. Photograph

3.5 cm x 3.5 cm

BY SPEED / REGISTERED POST

(Please do not Courier)
GATE 2012 Application Form

To
Chairman, GATE
Indian Institute of Technology Kanpur
Kanpur - 208016

Do not tamper with the bar code. For GATE official use.

From
ATUL KUMAR PANDEY (APPLNO : 5010021)
RB-3,304/4 CRWS COLONY,
rb-3,304/4 crws colony
462010

CASH VOUCHER

BANK COPY CASH VOUCHER

GATE COPY CASH VOUCHER

CANDIDATE COPY

Last date for acceptance

of challan in bank : 24 October 2011.

Last date for acceptance

of challan in bank : 24 October 2011.

Last date for acceptance

of challan in bank : 24 October 2011.

CASH CAN BE TENDERED AT ANY SBI BRANCH

GATE 2012 Application Fee Payment Challan

CASH CAN BE TENDERED AT ANY SBI BRANCH

GATE 2012 Application Fee Payment Challan

CASH CAN BE TENDERED AT ANY SBI BRANCH

GATE 2012 Application Fee Payment Challan

Use CBS Screen No. :

8888

FEE Type :

16

Registration ID / Ref No. :

5010021

Date of Birth :

08/04/1991

Use CBS Screen No. :

8888

FEE Type :

16

Registration ID / Ref No. :

5010021

Date of Birth :

08/04/1991

Use CBS Screen No. :

8888

FEE Type :

16

Registration ID / Ref No. :

5010021

Date of Birth :

08/04/1991

Challan can be deposited minimum one day after the

generation of challan.

Challan can be deposited minimum one day after the

generation of challan.

Challan can be deposited minimum one day after the

generation of challan.

Name of the Candidate : ATUL KUMAR PANDEY

Name of the Candidate : ATUL KUMAR PANDEY

Name of the Candidate : ATUL KUMAR PANDEY

Address for
Correspondence :

RB-3,304/4 CRWS COLONY, rb-3,304/4 crws Address for

Correspondence :
colony - 462010

RB-3,304/4 CRWS COLONY, rb-3,304/4 crws Address for

Correspondence :
colony - 462010

RB-3,304/4 CRWS COLONY, rb-3,304/4 crws

Mobile / Landline No:

07552746085

Mobile / Landline No:

07552746085

Mobile / Landline No:

07552746085

E Mail ID :

08atulpandey@gmail.com

E Mail ID :

08atulpandey@gmail.com

E Mail ID :

08atulpandey@gmail.com

Category :

General

Category :

General

Category :

General

Amount :

Rs.1025/- *

Amount :

Rs.1025/- *

Amount :

Rs.1025/- *

Amount in words :

Rupees One thousand and Twenty Five Only.

(*Application Fees Including Bank Charges)

Amount in words :

Rupees One thousand and Twenty Five Only.

(*Application Fees Including Bank Charges)

Amount in words :

Rupees One thousand and Twenty Five Only.

(*Application Fees Including Bank Charges)

JOURNAL NUMBER

JOURNAL NUMBER

Signature of the Candidate/Remitter

colony - 462010

JOURNAL NUMBER

Signature of the Candidate/Remitter

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.

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.

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

SEAL / DATE

SEAL / DATE

AUTHORISED SIGNATORY

AUTHORISED SIGNATORY

AUTHORISED SIGNATORY