smita gate

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7.

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

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 4 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 SMIT26111. 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 inchlaminated envelope and send by Speed Post (preferably) or by Registered Post using the addressprinted on page-4 so as to reach the respective Zonal GATE office on or before 28th October 2011.

List of Documents to be attached with the Application Form

Application sent through courier will not be accepted.

Put

b. Sign at the designated place.

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

Computer Science and InformationTechnology

SMITA SINGHName of the Candidate as inthe 10th Class Certificate

Choice of GATE Paper1. 9.

GATE COPYAPPLICATION NO. 3115301

GATE 2012 APPLICATION FORM

Zone: IIT Delhi Payment Mode: Payment GatewayPayment Reference No: MSBI1007280381

Fee: Rs. 1000

Date of Birth (DD/MM/YYYY)2. E-mail Address [email protected]/11/1984 10.

Gender3. FEMALE Address for Correspondence SMITA SINGH11.

C/O H.P MASHEWARI

FINE CARE GIRLSHOSTELOPP.MITS

LAXMANGARH, SIKARRAJSHTHAN

Category

Person with Disability (PD)

Nationality

Year of Degree

Discipline

5.

6.

4.

13.

14.

General

No

INDIAN

2008

Computer Science &Engineering/Technology

PINCODE of Address forCorrespondence

12. 332311

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.

315 - Sikar

304 - Delhi Central

SHIVA CHANDRA SINGH

Uttar Pradesh

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 Inth t f i di t ti f f t i li ti f I d t d th t I ill b d i d th

Mobile / Landline No.17. 09799864463

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To

BY SPEED / REGISTERED POST(Please do not Courier)

Chairman, GATE

GATE 2012 Application Form

Indian Institute of Technology Delhi

FromSMITA SINGH (APPLNO : 3115301)

SMITA SINGH

Hauz Khas, New Delhi - 110016

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

315CS3115301

C/O H.P MASHEWARI

FINE CARE GIRLS HOSTELOPP.MITS

LAXMANGARH, SIKAR RAJSHTHAN

332311