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.

60

Bilari District MoradabadSuman Lal Ka Bagh

Instructions to the Applicant (GATE 2013)

Zone/Scrutiny Code

5CPBy Registered Post/Speed Post Only

(Mobile No.)

Indian Institute of Technology Kanpur

GATE 2013

Uttar Pradesh, 244411

To

Prateek Gupta

Chairman GATE

76693 38057

168 Q 061 Q

Kanpur, 208016

Cut Here

Chandravatika Colony

From

Note: Application ID - 168 Q 061 Q. You should preserve this number for further correspondence.

(Application ID)168 Q 061 Q

GATE 2013Zone/Scrutiny Code

Payment DetailsRs. 1200.00

5CP

(D.O.B)

Scribe Assistance Required:

Qualification Details

(Exam City 1)

Prateek Gupta(Full Name of Applicant)

12 Aug 1992 Male

Indian National

GEN

No

Dual Degree (after 10+2 or diploma)

Lucknow, UP

Bareilly, UP

CS

P Rastogi(Name of Parent)

Uttar Pradesh, 244411

Uttar Pradesh, 244001

prateek_gupta@live.in

Chandravatika Colony

College Of Engineering Teerthanker Mahaveer

(GATE Paper code)

Communication Address

Graduated: No, Year of Graduation: 2014Computer Science Engg./Technology

76693 38057

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:

Bilari District MoradabadSuman Lal Ka Bagh

ChallanState Bank of India

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

60

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 KanpurKanpur, 208016

5f6534e2a34eb4338ce5e8fb3fbd2f92

Applicant's recent photograph

168 Q 061 Q

GATE Exam Details

(Mobile No.)

(Exam City 2)

Enclosure Checklist

Principal CertificateThis is to certify that Prateek Gupta is a student enrolled in

Applicant’s signature inside the box in black inkDate: ....../....../............

Stamped Bank Challan: GATE copy

India

He is a student of the 4th/5th year of Dual Degree (after 10+2 or diploma).

College Of Engineering Teerthanker Mahaveer University, Moradabad.

Moradabad

Application Form

Do not AttestDo not sign on photo