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8.

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

7.

Instructions for the Candidate:

1.

2.

Page - 1: Instructions for the candidate to be retained by the candidate.3.

4.

5.

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

6.

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

Page - 2 : Application Form (GATE Copy).

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

Instructions and Application Form for GATE 2012

Your Login ID is DEEP19114. Remember your password and do not disclose it to anyone.

Without folding, insert the completed Application Form (GATE copy) and attested copies of all theapplication 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

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

b. Sign at the designated place.

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laminated envelope and send by Speed Post (preferably) or by Registered Post using the address

Mechanical EngineeringDEEPAK KALAName of the Candidate as inthe 10th Class Certificate

Choice of GATE Paper1. 9.

GATE COPYAPPLICATION NO. 8012557

GATE 2012 APPLICATION FORM

Zone: IIT Roorkee Payment Mode: Bank Challan (SBI) Fee: Rs. 1000

Date of Birth (DD/MM/YYYY)2. E-mail Address deepakkala@hotmail.com19/11/1990 10.

Gender3. MALE Address for Correspondence 78/57, OLD DALANWALA11.

DEHRADUN

UTTARAKHAND

Category

Person with Disability (PD)

Nationality

Year of Degree

Discipline

5.

6.

4.

13.

14.

General

No

INDIAN

2012

Production & IndustrialEngineering

PINCODE of Address for

Correspondence

12. 248001

Qualifying Degree

Choice of Examination City1

Choice of Examination City2

Name of Parent

State/Union Territory ofPermanent Residence

7.

8.

15.

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

805 - Dehradun

821 - Roorkee

HARISH CHANDRA

Uttarakhand

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 contents of GATE 2012 website and I shall abide by the terms and conditions therein. Inthe event of suppression or distortion of any fact in my application form, I understand that I will be denied theopportunity to appear in GATE 2012. Further, if any such suppression or distortion of facts is found afterappearing in the exam any admission/degree acquired on the basis of GATE 2012 score is liable to be

Mobile / Landline No.17. 09634414807

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Mechanical EngineeringDEEPAK KALAName of the Candidate as inthe 10th Class Certificate

Choice of GATE Paper1. 9.

CANDIDATE COPYAPPLICATION NO. 8012557

GATE 2012 APPLICATION FORM

Zone: IIT Roorkee Payment Mode: Bank Challan (SBI) Fee: Rs. 1000

Date of Birth (DD/MM/YYYY)2. E-mail Address deepakkala@hotmail.com19/11/1990 10.

Gender3. MALE Address for Correspondence 78/57, OLD DALANWALA11.

DEHRADUN

UTTARAKHAND

Category

Person with Disability (PD)

Nationality

Year of Degree

Discipline

5.

6.

4.

13.

14.

General

No

INDIAN

2012

Production & IndustrialEngineering

PINCODE of Address for

Correspondence

12. 248001

Qualifying Degree

Choice of Examination City1

Choice of Examination City2

Name of Parent

State/Union Territory ofPermanent Residence

7.

8.

15.

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

805 - Dehradun

821 - Roorkee

HARISH CHANDRA

Uttarakhand

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 contents of GATE 2012 website and I shall abide by the terms and conditions therein. Inthe event of suppression or distortion of any fact in my application form, I understand that I will be denied theopportunity to appear in GATE 2012. Further, if any such suppression or distortion of facts is found afterappearing in the exam any admission/degree acquired on the basis of GATE 2012 score is liable to be

Mobile / Landline No.17. 09634414807

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To

BY SPEED / REGISTERED POST(Please do not Courier)

Chairman, GATE

GATE 2012 Application Form

Indian Institute of Technology Roorkee

From

DEEPAK KALA (APPLNO : 8012557)

78/57, OLD DALANWALA

Roorkee - 247667

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

805ME8012557

DEHRADUN

UTTARAKHAND

248001

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GeneralGeneralGeneral

deepakkala@hotmail.comdeepakkala@hotmail.comdeepakkala@hotmail.com

096344148070963441480709634414807

78/57, OLD DALANWALA DEHRADUN

UTTARAKHAND - 248001

78/57, OLD DALANWALA DEHRADUN

UTTARAKHAND - 248001

78/57, OLD DALANWALA DEHRADUN

UTTARAKHAND - 248001

DEEPAK KALADEEPAK KALADEEPAK KALA

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 AUTHORISED SIGNATORY

E Mail ID :

Category :

Address forCorrespondence :

19/11/1990

Mobile / Landline No:

CASH VOUCHER BANK COPY

GATE 2012 Application Fee Payment Challan

Name of the Candidate :

Signature of the Candidate/Remitter

For Receiving Branch use only

Registration ID / Ref No. : 8012557

Category :

CASH VOUCHER

JOURNAL NUMBER

For Receiving Branch use only

Signature of the Candidate/Remitter

E Mail ID :

Address forCorrespondence :

Mobile / Landline No:

GATE 2012 Application Fee Payment Challan

Category :

CASH VOUCHER

For Receiving Branch use only

Signature of the Candidate/Remitter

E Mail ID :

Address forCorrespondence :

Mobile / Landline No:

GATE 2012 Application Fee Payment Challan

GATE COPY CANDIDATE COPY

CASH CAN BE TENDERED AT ANY SBI BRANCH

Use CBS Screen No. :

FEE Type :

Date of Birth :

16

8888

Amount :

Amount in words :

Rs.1025/- *

Rupees One thousand and Twenty Five Only.(*Application Fees Including Bank Charges)

CASH CAN BE TENDERED AT ANY SBI BRANCH

Amount :

Amount in words :

Rs.1025/- *

Rupees One thousand and Twenty Five Only.(*Application Fees Including Bank Charges)

JOURNAL NUMBER

Name of the Candidate :

19/11/1990

Registration ID / Ref No. : 8012557

Use CBS Screen No. :

FEE Type :

Date of Birth :

16

8888

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 AUTHORISED SIGNATORY

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 AUTHORISED SIGNATORY

JOURNAL NUMBER

Rs.1025/- *

Rupees One thousand and Twenty Five Only.(*Application Fees Including Bank Charges)

Amount :

Amount in words :

Name of the Candidate :

19/11/1990

Registration ID / Ref No. : 8012557

Use CBS Screen No. :

FEE Type :

Date of Birth :

16

8888

CASH CAN BE TENDERED AT ANY SBI BRANCH

Challan can be deposited minimum one day after thegeneration of challan.

Challan can be deposited minimum one day after thegeneration of challan.

Challan can be deposited minimum one day after thegeneration of challan.

Last date for acceptanceof challan in bank : 24 October 2011.

Last date for acceptanceof challan in bank : 24 October 2011.

Last date for acceptanceof challan in bank : 24 October 2011.