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By Registered Post/Speed Post Only Zone/Scrutiny Code 3MX GATE 2013 To Chairman GATE Indian Institute of Technology Delhi Hauz Khas, New Delhi, 110016 From Manil Kumar Jha 85-A Dudhichak Po- Kasba Dudhichak Meharma Godda Jharkhand, 814160 80100 48457 114 S 687 G (Mobile No.) Cut Here Instructions to the Applicant (GATE 2013) 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 Principal s or HOD s sign and seal in the last portion of the application form. Submit the whole form to the Principal s office without cutting it. 5. If you have opted for Challan payment, wait for 48 hours after your online submission to visit the bank s 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. Note: Application ID - 114 S 687 G. You should preserve this number for further correspondence. Zone/Scrutiny Code 3MX 114 S 687 G GATE 2013 Application Form Applicant's recent photograph 4.5 cm x 3.5 cm (Application ID) Manil Kumar Jha (Full Name of Applicant) 114 S 687 G 05 May 1985 Male Do not Attest Do not sign on photo GEN (D.O.B) Indian National Chandrakant Jha (Name of Parent) Communication Address GATE Exam Details 85-A Dudhichak Po- Kasba Dudhichak Meharma Godda Jharkhand, 814160 India CS (GATE Paper code) Delhi East, DL (Exam City 1) Delhi North, DL (Exam City 2) manil.05may@hotmail.com 80100 48457 (Mobile No.) Scribe Assistance Required: No Zonal GATE Office Contact Qualification Details Chairman GATE Indian Institute of Technology Delhi Hauz Khas, New Delhi, 110016 M.Sc/M.A./MCA Computer Applications Graduated: Yes, Year of Graduation: 2012 Institute Of Management Education Ghaziabad Ghaziabad Uttar Pradesh, 201005 Enclosure Checklist Stamped Bank Challan: GATE copy Payment Details Challan Rs. 1200.00 State Bank of India Docs Uploaded Eligibility Certificate 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 Information Brochure and I shall abide by the terms and conditions therein. In the event of suppression or distortion of any fact in my application form, I understand that I will be denied the opportunity to appear in GATE 2013. Further, if any suppression or distortion of facts is found after appearing in the exam, any admission/degree Digital Fingerprint: ee15b6dce674c9598f47f8760430c6a1 Date: ....../....../............ This space is intentionally left blank Applicant s signature inside the box in black ink

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