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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 ATHI05093. 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

Electrical EngineeringATHISHA U SName of the Candidate as inthe 10th Class Certificate

Choice of GATE Paper1. 9.

GATE COPYAPPLICATION NO. 7183913

GATE 2012 APPLICATION FORM

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

Date of Birth (DD/MM/YYYY)2. E-mail Address athishau@yahoo.com05/09/1987 10.

Gender3. FEMALE Address for Correspondence KRISHNA VILASAM VEEDU11.

K.V.ROAD

EVRA 264

JAGATHY,THYCAUD.P.O

Category

Person with Disability (PD)

Nationality

Year of Degree

Discipline

5.

6.

4.

13.

14.

General

No

INDIAN

2010

Electrical Engg/Electrical andElectronics Engg./Power Engg

PINCODE of Address forCorrespondence

12. 695014

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.

730 - Thiruvananthapuram

715 - Kollam

M V SANKARAN KUTTY

Kerala

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 after

Mobile / Landline No.17. 09995325711

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Electrical EngineeringATHISHA U SName of the Candidate as inthe 10th Class Certificate

Choice of GATE Paper1. 9.

CANDIDATE COPYAPPLICATION NO. 7183913

GATE 2012 APPLICATION FORM

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

Date of Birth (DD/MM/YYYY)2. E-mail Address athishau@yahoo.com05/09/1987 10.

Gender3. FEMALE Address for Correspondence KRISHNA VILASAM VEEDU11.

K.V.ROAD

EVRA 264

JAGATHY,THYCAUD.P.O

Category

Person with Disability (PD)

Nationality

Year of Degree

Discipline

5.

6.

4.

13.

14.

General

No

INDIAN

2010

Electrical Engg/Electrical andElectronics Engg./Power Engg

PINCODE of Address forCorrespondence

12. 695014

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.

730 - Thiruvananthapuram

715 - Kollam

M V SANKARAN KUTTY

Kerala

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 after

Mobile / Landline No.17. 09995325711

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To

BY SPEED / REGISTERED POST(Please do not Courier)

Chairman, GATE

GATE 2012 Application Form

Indian Institute of Technology Madras

FromATHISHA U S (APPLNO : 7183913)

KRISHNA VILASAM VEEDU

Chennai - 600036

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

730EE7183913

K.V.ROAD

EVRA 264

JAGATHY,THYCAUD.P.O

695014

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