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By Registered Post/Speed Post Only

Zone/Scrutiny Code

2AL

GATE 2013
To
Chairman GATE
Indian Institute of Technology Bombay
Powai, Mumbai, 400076

From
Aayush Anand
187 Mig

107 E 486 H

Hanuman Nagar
Patna
Bihar, 800020

94298 97175

(Mobile No.)

Cut Here

Instructions to the Applicant (GATE 2013)


1. This print out should contain the following pages.
(a) This page: Address Slip and Instructions.
(b) Application form, filled with the information you provided online.
(c) Bank Challan in Triplicate (available as a separate file for download from the
GATE Online Application Interface), if you have chosen Offline Challan Payment (Not applicable for female candidates).
2. On the GATE copy of the Application Form, paste a 4.5cm x 3.5cm printed copy of the SAME color
photograph you uploaded online.
(a) Use good quality glue to ensure that the photograph does not separate from the application.
(b) Do not pin, stapple, sign, or attest the photograph.
3. Read the declaration and put your signature in the box next to it.
4. If you are in the final year or you have a backlog after appearing for the final year exam, you must get your
Principals or HODs sign and seal in the last portion of the application form. Submit the whole form
to the Principals office without cutting it.
5. If you have opted for Challan payment, wait for 48 hours after your online submission to visit the banks
branch. You can visit any branch of the bank printed on your challan.
6. The bank teller will verify the details printed on the challan with the data available on their computer and
then accept the payment. The bank will retain one copy and give you back the remaining copies: one of
which you have to send along with the printed application form and the other is for your reference.
7. Mailing Documents to GATE office.
(a) Cut the Address Slip and paste it onto an A4 sized envelope (Do not fill address by hand or tamper the
address slip).
(b) Collect the supporting documents shown under Enclosure Checklist in the application form (if you
have uploaded the soft copy of the documents online, you need not send a hard copy). Mark the check
list boxes.
(c) Do NOT FOLD the application form and Do NOT STAPLE or pin the documents to the form.
(d) Send the packet by Speed Post (preferably) or by Registered Post to the address mentioned. The
application packet should REACH the respective GATE office on or before Monday, 8 October 2012.

Note: Application ID - 107 E 486 H. You should preserve this number for further correspondence.

GATE 2013
Application Form

Zone/Scrutiny Code

2AL
107 E 486 H

Applicant's recent photograph

4.5 cm x 3.5 cm

(Application ID)

Aayush Anand
(Full Name of Applicant)

107 E 486 H

15 Feb 1987

Male

Do not Attest
Do not sign on photo

GEN

(D.O.B)

Indian National

Yagya Narayan Pathak


(Name of Parent)

Communication Address

GATE Exam Details

187 Mig

EE

Hanuman Nagar
Patna
Bihar, 800020
India

Ahmedabad, GJ

(GATE Paper code)

(Exam City 1)

Rajkot, GJ
(Exam City 2)

aayushchill@gmail.com
94298 97175 (Mobile No.)

Scribe Assistance Required:

No

Zonal GATE Office Contact

Qualification Details
B.E.
Electrical Engg./Electrical and Electronics Engg./Power
2009
Manipal Institute Of Technology
Manipal
Karnataka, 576104

Chairman GATE
Indian Institute of Technology Bombay
Powai, Mumbai, 400076

Payment Details

Online

Rs. 1200.00

MICI2804308587
06/09/2012
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. 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 2013. Further, if any suppression or distortion of facts is
found after appearing in the exam, any admission/degree acquired on the basis of GATE 2013 score is
liable to be cancelled.

Digital Fingerprint: 0a8800b717ea2bb63600433df73f9699

Date: ....../....../............

This space is intentionally left blank

Applicants signature inside the box in black ink

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