(Enrolment ID)B117M57

Zone/Scrutiny

Payment DetailsRs. 1500.00

6GE

(D.O.B)

Qualification Details (Exam City 1)

Angshuman Gaine(Full Name of the Applicant)

28 Apr 1994 Male

Indian National

GEN No

B.Tech

Amitava Gaine

West Bengal 700124

Adamas Institute of Technology

Communication Address

Graduated: No; Year of Graduation: 2016Electrical Engg./Electrical and Electronics Engg.

I hereby declare that all the particulars stated in this application form are true to the best of my knowledge andbelief. I have read the Information Brochure and I shall abide by the terms and conditions therein. Theresponsibility of following the GATE 2016 website and meeting various deadlines lies with me. In the event ofsuppression or distortion of any fact in my application form, I understand that I will be denied the opportunityto appear in GATE 2016. Further, if any suppression or distortion of facts is found after appearing in theexam, any admission/degree/benefit acquired on the basis of GATE 2016 score/marks is liable to becancelled.

DigitalFingerprint:

OnlinePayment Ref. No.: CP29049735

12/5,Harinath Sen Road,DakshinparaBarasat,KolkataKolkataWest Bengal 70012480136 76906 (Mobile No.)

angshuman94@gmail.com

Zonal GATE Office ContactChairperson GATE

Kharagpur 721302

e32bdd9f7b50b65e21748b7f2fc16c82

GATE Exam Details

(Exam City 2)

19/09/2015

Kolkata

GATE 2016

(Exam City 3)

(Gender) (Category) (PD Status)

GATE Paper Code

9748919718

EEKolkata , WB

Hooghly, WB

Bhubaneswar , OR

Indian Institute of Technology Kharagpur

(Parent's Mobile Number) (Name of the Parent)

B117M57

(Electrical Engineering)