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.

SILAMBU HOTEL

NAMAKKAL(DT)SEETHARAMPALAYAM(PO),TIRUCHENGODE(TALUK)

Instructions to the Applicant (GATE 2013)

Zone/Scrutiny Code

7MXBy Registered Post/Speed Post Only

(Mobile No.)

Indian Institute of Technology Madras

GATE 2013

Tamil Nadu, 637211

To

Silambarasu M

Chairman GATE

98406 91910

181 H 211 F

Chennai, 600036

Cut Here

SANKAGIRI MAIN ROAD

From

Note: Application ID - 181 H 211 F. You should preserve this number for further correspondence.

(Application ID)181 H 211 F

GATE 2013Zone/Scrutiny Code

Payment DetailsRs. 600.00

7MX

(D.O.B)

Scribe Assistance Required:

Qualification Details

(Exam City 1)

Silambarasu M(Full Name of Applicant)

11 May 1991 Male

Indian National

SC

No

B.E.

Chennai, TN

Tiruchirapalli, TN

AE

Mozhiyarasu S(Name of Parent)

Tamil Nadu, 637211

Tamil Nadu, 603104

lovelysimbhu@gmail.com

SANKAGIRI MAIN ROAD

DHANALAKSHMI SRINIVASAN COLLEGE OF

(GATE Paper code)Communication Address

Graduated: No, Year of Graduation: 2013Aeronautical Engg.

98406 91910

I hereby declare that all the particulars stated in this application form are true to the best of my knowledgeand belief. I have read the Information Brochure and I shall abide by the terms and conditions therein. In theevent of suppression or distortion of any fact in my application form, I understand that I will be denied theopportunity to appear in GATE 2013. Further, if any suppression or distortion of facts is found after appearingin the exam, any admission/degree acquired on the basis of GATE 2013 score is liable to be cancelled.

Digital Fingerprint:

NAMAKKAL(DT)SEETHARAMPALAYAM(PO),TIRUCHENGODE(TALUK)

OnlineMIOB2817264240

He appeared in the final semester/year exam of the above degree, but has a backlog to be clearedfrom an earlier semester/year, and therefore cannot produce a course completion certificate.

Signature of Principal/ HOD

SILAMBU HOTEL

4.5 cm x 3.5 cm

Date: Seal

(For use as the eligibility certificate only for final year or backlog applicants)

Zonal GATE Office ContactChairman GATEIndian Institute of Technology MadrasChennai, 600036

b6c640638a15c95143d7c105c3613841

Applicant's recent photograph

181 H 211 F

GATE Exam Details

(Mobile No.)

(Exam City 2)

Principal CertificateThis is to certify that Silambarasu M is a student enrolled in

Applicants signature inside the box in black ink

27/09/2012

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

India

He is a student of the final year of B.E..

DHANALAKSHMI SRINIVASAN COLLEGE OF ENGINEERING AND TECHNOLOGY, CHENNAI.

CHENNAI

Application Form

Do not AttestDo not sign on photo

Docs Uploaded SC/ST Certificate