7/29/2019 A 105 k 99 Application

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1. This print out should contain the following pages.

(a) Page 1 : This page contains Instructions and Address Slip (cut and paste the Address Slip on A4 size envelope).(b) Page 2 : Application form that you have filled online.

2. Bank challan in Triplicate is available as a separate pdf file to be downloaded. This is available only if you have opted for OfflinePayment.

3. On the GATE 2014 Application Form, paste a 3.5cm x 4.5cm color photograph with plain background (this should be the samethat you have uploaded during application filling). The photograph should be taken in a studio.(a) Write your Enrolment ID. and Name on the reverse side of the photo.(b) Use good quality glue to ensure that the photograph does not separate from the application.(c) Do not pin, staple, sign or attest the photograph.

4. Read the declaration and put your full signature in the box next to it. Please note that signature should not be in capital letters.

5. If you are in the final year or you have a backlog after appearing for the final year examination, you must get your Principals orHODs Signature and Seal in the Certificate from Principal that is provided at the last portion of the application form. Submit the

whole form to the Principals office without cutting it.

6. If you have opted for challan payment, wait for 48 hours after your online submission to visit the banks branch. You can visit anybranch of the bank printed on your challan.

7. The bank teller will verify the details printed on the challan with the data available in their system and then accept the payment.The bank will retain one copy and give you the remaining two copies: one of which is the GATE Copy that you have to send alongwith the printed application form and the other is the Candidate Copy for your reference.

8. Keep a photo copy of the completed application form for your reference.

9. Mailing Documents to GATE office.(a) Cut the Address Slip and paste it onto an A4 size 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. Mark the enclosures in the

checklist 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 in the address slip. Theapplication packet should REACH the respective zonal GATE office on or before Thursday, 10 October 2013.

Instructions to the Applicant (GATE 2014)

A/106 SUKHSHANTI APARTMENTWYKES COMPOUND,B/H 7 SEAS MALLFATEHGUNJVADODARAGujarat 39000295748 08988 (Mobile Number)

Zone/Scrutiny

2CDBy Registered Post/Speed Post Only

Indian Institute of Technology Bombay

GATE 2014

ToChairperson GATE

A105K99

Powai, Mumbai 400076

Cut Here

Note: Enrolment ID - A105K99. You should preserve this number for further correspondence.

From

Maclin Roger Prakash

A105K99

7/29/2019 A 105 k 99 Application

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This space is intentionally left blank

(Enrolment ID)A105K99

Zone/Scrutiny

Payment Details

Rs. 1500.00

2CD

(D.O.B)

Qualification Details

(Exam City 1)

Maclin Roger Prakash(Full Name of the Applicant)

11 Jul 1991 Male

Indian National

OBC No

B.E.

Prakash

Gujarat 388306

SARDAR VALLABHBHAI PATEL INSTITUTE OF

Communication Address

Graduated: Yes; Year of Graduation: 2013

Mechanical Engg.

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. Theesponsibility of following the GATE 2014 website and meeting various deadlines lies with me. In the event of

suppression or distortion of any fact in my application form, I understand that I will be denied the opportunityo appear in GATE 2014. Further, if any suppression or distortion of facts is found after appearing in the

exam, any admission/degree/benefit acquired on the basis of GATE 2014 score/marks is liable to becancelled.

Digitalingerprint:

ChallanState Bank of India

A/106 SUKHSHANTI APARTMENTWYKES COMPOUND,B/H 7 SEAS MALLFATEHGUNJVADODARAGujarat 390002

95748 08988 (Mobile No.)roger.unique11@gmail.com

3.5 cm x 4.5 cm

Eligibility Certificate copy

Zonal GATE Office ContactChairperson GATE

Powai, Mumbai 400076

7eef4de38a31c4f88ba43c03325e4eba

Applicant's recent photograph

A105K99

GATE Exam Details

(Exam City 2)

Enclosure Checklist

Applicants signature inside the box in black inkDate: ....../....../.........

Stamped Bank Challan: GATE copy

VASAD

GATE 2014

Do not Attest

Do not sign on photo

(Exam City 3)

(Gender) (Category) (PD Status)

GATE Paper Code

9824114012

ME

Do not staple photo

Vadodara, GJ

Anand, GJ

Ahmedabad, GJ

Indian Institute of Technology Bombay

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

A105K99

A105K99