ONLINE Application for GATE 2011 Instructions for the Candidate:

1. 2. 3. 4. Your Login ID is BHUV0403. Remember your password and do not disclose it to anyone. There are 5 Pages in this file. These pages should be printed on A4 sheets. Page - 1: Instructions for the candidate to be retained by you carefully Page - 2 : Application Form (GATE Copy) a. Paste your recent color photo (3cm x 4cm) in designated place b. Sign at designated places 5. 6. Page - 3 : Application Form (CANDIDATE Copy) to be retained by you for your reference Page - 5 : Bank challan in triplicate. Take it to any SBI branch and pay the fee. The Bank will retain a copy with them and will return two copies to you. In those two copies, retain the Candidate's copy with you and attach Institute's copy with Application Form Page - 4 : Address slip to be pasted on the A4 size envelope Insert completed Application Form (GATE Copy) and attested copies of all applicable documents (SC/ST/PD Certificate, Affidavit for change of name) into A4 size envelope, without folding and send by Speed Post (preferably) or by Registered Post to Chairman, GATE, IIT Madras

7. 8.

List of Documents to be sent to GATE IIT Madras:

1. 2. 3. 4. Application Form (GATE Copy) Bank Challan (Institute's Copy) Attested Copy of SC/ST/PD Certificate (if applicable) Attested Copy of affidavit for change of name (if applicable)

Page - 1

GATE IIT Madras COPY APPLICATION FORM FOR GATE 2011

Application No: Zone: IIT Madras 7144285 Payment Mode: Application Fee: BHUVANAGIRI SRAVANTHI Bank Challan (State Bank of India) Rs. 800/11. Address H.NO. 4-203/30, THRIPURARAM(VI THRIPURARAM(POST) NALGONDA (DIST) 2. Date of Birth (DD/MM/YYYY) 3. Gender 4. Nationality 5. Category 6. Person with Disability (PD) Do You Require a Scribe? 7. Qualifying Degree 04/03/1991 FEMALE INDIAN OBC(Non-Creamy Layer) No No B.E./B.Tech./ B.Sc. (Engg.)/B.Sc.(Tech.)/B.Arch. 16. Name of Parent 17. State/Union Territory of Permanent Residence 18. Phone / Mobile Number 19. PINCODE of Address for Correspondence 14. Year of Degree 15. Discipline ANDHRAPRADESH PINCODE 2012 Electronics & Comm./Electronics Engg./Comm. Engg./Telecommunication Engg. BHUVANAGIRI JANAIAH Andhra Pradesh 508358

1. Name of the Candidate as in the 10th Class Certificate

8. Choice of Examination City1 Choice of Examination City2 9. Choice of GATE Paper 10. E-mail Address

722 - Nalgonda 108 - Hyderabad EC - Electronics and Communication Engineering sravanthibhuvana@gmail.com

09849139161 508358

I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. 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 2011. 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 2011 score is liable to be cancelled.

Place: Date:
Full Signature of the Candidate (do not sign in capital letters)

12. Photograph

7144285

13.

Full Signature of the Candidate using black ball point pen only (do not sign in capital letters)

Paste a front facial high contrast recent color photograph 3cm x 4cm without any signature or attestation

Send this form along with the necessary documents to IIT Madras

Page - 2

CANDIDATE COPY APPLICATION FORM FOR GATE 2011

Application No: Zone: IIT Madras 7144285 Payment Mode: Application Fee: BHUVANAGIRI SRAVANTHI Bank Challan (State Bank of India) Rs. 800/11. Address H.NO. 4-203/30, THRIPURARAM(VI THRIPURARAM(POST) NALGONDA (DIST) 2. Date of Birth (DD/MM/YYYY) 3. Gender 4. Nationality 5. Category 6. Person with Disability (PD) Do You Require a Scribe? 7. Qualifying Degree 04/03/1991 FEMALE INDIAN OBC(Non-Creamy Layer) No No B.E./B.Tech./ B.Sc. (Engg.)/B.Sc.(Tech.)/B.Arch. 16. Name of Parent 17. State/Union Territory of Permanent Residence 18. Phone / Mobile Number 19. PINCODE of Address for Correspondence 14. Year of Degree 15. Discipline ANDHRAPRADESH PINCODE 2012 Electronics & Comm./Electronics Engg./Comm. Engg./Telecommunication Engg. BHUVANAGIRI JANAIAH Andhra Pradesh 508358

1. Name of the Candidate as in the 10th Class Certificate

8. Choice of Examination City1 Choice of Examination City2 9. Choice of GATE Paper 10. E-mail Address

722 - Nalgonda 108 - Hyderabad EC - Electronics and Communication Engineering sravanthibhuvana@gmail.com

09849139161 508358

I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. 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 2011. 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 2011 score is liable to be cancelled.

Place: Date:
Full Signature of the Candidate (do not sign in capital letters)

12. Photograph

7144285

13.

Full Signature of the Candidate using black ball point pen only (do not sign in capital letters)

Paste a front facial high contrast recent color photograph 3cm x 4cm without any signature or attestation

Retain this page for your reference

Page - 3

BY SPEED POST / REGISTERED POST

GATE 2011
GATE PAPER CODE EXAM CITY OF FIRST CHOICE

EC 722

To Chairman, GATE Indian Institute of Technology Madras Chennai

From BHUVANAGIRI SRAVANTHI H.NO. 4-203/30, THRIPURARAM(VI THRIPURARAM(POST) NALGONDA (DIST) ANDHRAPRADESH PINCODE

PINCODE 6

APPLICATION NO

7 1 4 4 2
5 0 8 3 5 8

8 5

Page - 4

CASH VOUCHER

BANK'S COPY CASH VOUCHER

INSTITUTES COPY CASH VOUCHER

CANDIDATE'S COPY

BRANCH (CODE NO. GATE 2011 Online Application Fee Payment

BRANCH (CODE NO.

BRANCH (CODE NO. GATE 2011 Online Application Fee Payment GATE 2011 FEE COLLECTION A/C NO. 31372883605
Name of the Present Address BHUVANAGIRI SRAVANTHI

GATE 2011 FEE COLLECTION A/C NO. 31372883605

Name of the Candidate Present Address BHUVANAGIRI SRAVANTHI H.NO. 4-203/30, THRIPURARAM(VI THRIPURARAM(POST) NALGONDA (DIST) ANDHRAPRADESH - 508358

GATE 2011 Online Application Fee Payment GATE 2011 FEE COLLECTION A/C NO. 31372883605
Name of the Present Address BHUVANAGIRI SRAVANTHI H.NO. 4-203/30, THRIPURARAM(VI THRIPURARAM(POST) NALGONDA (DIST) ANDHRAPRADESH - 508358

H.NO. 4-203/30, THRIPURARAM(VI THRIPURARAM(POST) NALGONDA (DIST) ANDHRAPRADESH - 508358

Date of Birth Mobile / Landline No: E-mail Address: Category : Physically Disabled : Head Application Fees Bank's Charges Total Amount in words :

04/03/1991 09849139161 sravanthibhuvana@gmail.com OBC(Non-Creamy Layer) No Amount Rs. 800.00 Rs. 30.00 Rs. 830.00 Rupees eight hundred and thirty only. Credit to 31372883605 98353XXXXXX

Date of Birth Mobile / Landline No: E-mail Address: Category : Physically Disabled : Head Application Fees Bank's Charges Total Amount in words :

04/03/1991 09849139161 sravanthibhuvana@gmail.com OBC(Non-Creamy Layer) No Amount Rs.800.00 Rs. 30.00 Rs. 830.00 Rupees eight hundred and thirty only. Credit to 31372883605 98353XXXXXX

Date of Birth Mobile / Landline No: E-mail Address: Category : Physically Disabled : Head Application Fees Bank's Charges Total Amount in words :

04/03/1991 09849139161 sravanthibhuvana@gmail.com OBC(Non-Creamy Layer) No Amount Rs. 800.00 Rs. 30.00 Rs. 830.00 Rupees eight hundred and thirty only. Credit to 31372883605 98353XXXXXX

Signature of the Candidate/Remitter For Receiving Branch use only APPLICATION NUMBER 7144285 1. Please credit Rs.30/- to your Branch Commission A/c No.98353XXXXXX 2. Please note to write the Journal Number in all the challans. 3. Please feed the Application No. in REG/ID/Ref No. Column and Name of the Candidate in the menu while posting. JOURNAL NUMBER APPLICATION NUMBER 7144285

Signature of the Candidate/Remitter For Receiving Branch use only JOURNAL NUMBER

Signature of the Candidate/Remitter For Receiving Branch use only APPLICATION NUMBER 7144285 1. Please credit Rs.30/- to your Branch Commission A/c No.98353XXXXXX 2. Please note to write the Journal Number in all the challans. 3. Please feed the Application No. in REG/ID/Ref No. Column and Name of the Candidate in the menu while posting. JOURNAL NUMBER

1. Please credit Rs.30/- to your Branch Commission A/c No.98353XXXXXX 2. Please note to write the Journal Number in all the challans. 3. Please feed the Application No. in REG/ID/Ref No. Column and Name of the Candidate in the menu while posting.

SEAL / DATE

AUTHORISED SIGNATORY

SEAL / DATE

AUTHORISED SIGNATORY

SEAL / DATE

AUTHORISED SIGNATORY