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2ND
To
GATE 2013
Chairman GATE Indian Institute of Technology Bombay Powai, Mumbai, 400076
132 F 880 K
98608 96994
(Mobile No.)
Cut Here
Note: Application ID - 132 F 880 K. You should preserve this number for further correspondence.
Zone/Scrutiny Code
2ND
132 F 880 K
(Full Name of Applicant)
4.5 cm x 3.5 cm
(Application ID)
19 Mar 1987
(D.O.B)
Male
(Name of Parent)
OBC-NC
Indian National
Mukundarao Palatkar
Communication Address
6, SHIVSHAKTI NAGAR-1 MANEWADA RING ROAD NAGPUR NAGPUR Maharashtra, 440034 India
Nagpur, MH
(Exam City 1)
Amravati, MH
(Exam City 2) Scribe Assistance Required:
No
Qualification Details
B.E. Mechanical Engg. Graduated: Yes, Year of Graduation: 2011 G.H. RAISONI COLLEGE OF ENGINEERING NAGPUR Maharashtra, 440016
Enclosure Checklist
Eligibility Certificate copy
Payment Details
Online
Rs. 1200.00
MSBI2818946873 29/09/2012
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 acquired on the basis of GATE 2013 score is liable to be cancelled.
Date: ....../....../............