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 write
your 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 a
laser/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
1. Application Form (GATE Copy)
2. Bank Challan (GATE Copy)
3. Self Attested Copy of SC/ST/PD certificate (if applicable)
4. Self Attested Copy of affidavit for change of name (if applicable)
Your Login ID is PATE18082. Remember your password and do not disclose it to anyone.
Without folding, insert the completed Application Form (GATE copy) and attested copies of all the
application 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
printed on page-4 so as to reach the respective Zonal GATE office on or before 24th October 2011.
List of Documents to be attached with the Application Form:
5. Self Attested Copy of the degree certificate if the year of qualifying
degree is 2011 or earlier.
6. If the year of qualifying degree is 2012 or later, a certificate signed by
the principal of the college clearly indicating the year of qualifying
degree (format available on GATE website).
____________End of Instructions____________
Application sent through courier will not be accepted.
Put
Page - 5 : Bank challan in triplicate. Take it to any SBI branch and pay the application fee plus the bank
service charge. The Bank will retain its copy and will return the remaining two copies to you. Out of
these two copies, retain the Candidate's copy with you and attach the GATE copy with the Application
Form.
b. Sign at the designated place.
7. Candiates with backlog: copy of final semester/year marks sheet or
course completion certificate or a letter from principal.
Mechanical Engineering PATEL SHAILESH BABULAL
Name of the Candidate as in
the 10th Class Certificate
Choice of GATE Paper 1. 9.
GATE COPY
APPLICATION NO.
2023054
GATE 2012 APPLICATION FORM
Zone:
IIT Bombay Payment Mode: Bank Challan (SBI)
Fee: Rs. 1000
Date of Birth (DD/MM/YYYY) 2. E-mail Address shailesh18889@gmail.com 18/08/1989 10.
Gender 3. MALE Address for Correspondence D/24 SAGUNAPARK PART-1 11.
NEAR, ADINATH NAGAR ODHAV
AHMEDABAD ,
GUJARAT
Category
Person with Disability (PD)
Nationality
Year of Degree
Discipline
5.
6.
4.
13.
14.
General
No
INDIAN
2011
Mechanical Engineering
PINCODE of Address for
Correspondence
12. 382415
Qualifying Degree
Choice of Examination City1
Choice of Examination City2
Name of Parent
State/Union Territory of
Permanent Residence
7.
8.
15.
16. B.E./B.Tech./ B.Sc.
(Engg.)/B.Sc.(Tech.)/B.Arch.
201 - Ahmedabad
230 - Vadodara
BABUBHAI GELABHAI PATEL
Gujarat
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 contents of GATE 2012 website 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 2012. Further, if any such suppression or distortion of facts is found after
appearing in the exam, any admission/degree acquired on the basis of GATE 2012 score is liable to be
cancelled.
Mobile / Landline No. 17. 09558015580
Place :
Date :
Full Signature of the candidate using
BLACK INK PEN only
(do not sign in CAPITAL LETTERS)
201ME2023054
19. Photograph 18. Signature
3.5 cm x 3.5 cm
Send this form along with the necessary documents to IIT Bombay.
Mechanical Engineering PATEL SHAILESH BABULAL
Name of the Candidate as in
the 10th Class Certificate
Choice of GATE Paper 1. 9.
CANDIDATE COPY
APPLICATION NO.
2023054
GATE 2012 APPLICATION FORM
Zone:
IIT Bombay Payment Mode: Bank Challan (SBI)
Fee: Rs. 1000
Date of Birth (DD/MM/YYYY) 2. E-mail Address shailesh18889@gmail.com 18/08/1989 10.
Gender 3. MALE Address for Correspondence D/24 SAGUNAPARK PART-1 11.
NEAR, ADINATH NAGAR ODHAV
AHMEDABAD ,
GUJARAT
Category
Person with Disability (PD)
Nationality
Year of Degree
Discipline
5.
6.
4.
13.
14.
General
No
INDIAN
2011
Mechanical Engineering
PINCODE of Address for
Correspondence
12. 382415
Qualifying Degree
Choice of Examination City1
Choice of Examination City2
Name of Parent
State/Union Territory of
Permanent Residence
7.
8.
15.
16. B.E./B.Tech./ B.Sc.
(Engg.)/B.Sc.(Tech.)/B.Arch.
201 - Ahmedabad
230 - Vadodara
BABUBHAI GELABHAI PATEL
Gujarat
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 contents of GATE 2012 website 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 2012. Further, if any such suppression or distortion of facts is found after
appearing in the exam, any admission/degree acquired on the basis of GATE 2012 score is liable to be
cancelled.
Mobile / Landline No. 17. 09558015580
Place :
Date :
Full Signature of the candidate using
BLACK INK PEN only
(do not sign in CAPITAL LETTERS)
201ME2023054
19. Photograph 18. Signature
3.5 cm x 3.5 cm
Retain this copy with you for future reference.
To
BY SPEED / REGISTERED POST
(Please do not Courier)
Chairman, GATE
GATE 2012 Application Form
Indian Institute of Technology Bombay
From
PATEL SHAILESH BABULAL (APPLNO : 2023054)
D/24 SAGUNAPARK PART-1
Powai, Mumbai - 400076
Do not tamper with the bar code. For GATE official use.
201ME2023054
NEAR, ADINATH NAGAR ODHAV
AHMEDABAD ,
GUJARAT
382415
General General General
shailesh18889@gmail.com shailesh18889@gmail.com shailesh18889@gmail.com
09558015580 09558015580 09558015580
D/24 SAGUNAPARK PART-1 NEAR, ADINATH
NAGAR ODHAV AHMEDABAD , GUJARAT -
382415
D/24 SAGUNAPARK PART-1 NEAR, ADINATH
NAGAR ODHAV AHMEDABAD , GUJARAT -
382415
D/24 SAGUNAPARK PART-1 NEAR, ADINATH
NAGAR ODHAV AHMEDABAD , GUJARAT -
382415
PATEL SHAILESH BABULAL PATEL SHAILESH BABULAL PATEL SHAILESH BABULAL
1. Please note to write the Journal Number in all the challans.
2. Please feed the Application No. in REG/ID/Ref No. Column.
SEAL / DATE AUTHORISED SIGNATORY
E Mail ID :
Category :
Address for
Correspondence :
18/08/1989
Mobile / Landline No:
CASH VOUCHER BANK COPY
GATE 2012 Application Fee Payment Challan
Name of the Candidate :
Signature of the Candidate/Remitter
For Receiving Branch use only
Registration ID / Ref No. : 2023054
Category :
CASH VOUCHER
JOURNAL NUMBER
For Receiving Branch use only
Signature of the Candidate/Remitter
E Mail ID :
Address for
Correspondence :
Mobile / Landline No:
GATE 2012 Application Fee Payment Challan
Category :
CASH VOUCHER
For Receiving Branch use only
Signature of the Candidate/Remitter
E Mail ID :
Address for
Correspondence :
Mobile / Landline No:
GATE 2012 Application Fee Payment Challan
GATE COPY CANDIDATE COPY
CASH CAN BE TENDERED AT ANY SBI BRANCH
Use CBS Screen No. :
FEE Type :
Date of Birth :
16
8888
Amount :
Amount in words :
Rs.1025/- *
Rupees One thousand and Twenty Five Only.
(*Application Fees Including Bank Charges)
CASH CAN BE TENDERED AT ANY SBI BRANCH
Amount :
Amount in words :
Rs.1025/- *
Rupees One thousand and Twenty Five Only.
(*Application Fees Including Bank Charges)
JOURNAL NUMBER
Name of the Candidate :
18/08/1989
Registration ID / Ref No. : 2023054
Use CBS Screen No. :
FEE Type :
Date of Birth :
16
8888
1. Please note to write the Journal Number in all the challans.
2. Please feed the Application No. in REG/ID/Ref No. Column.
SEAL / DATE AUTHORISED SIGNATORY
1. Please note to write the Journal Number in all the challans.
2. Please feed the Application No. in REG/ID/Ref No. Column.
SEAL / DATE AUTHORISED SIGNATORY
JOURNAL NUMBER
Rs.1025/- *
Rupees One thousand and Twenty Five Only.
(*Application Fees Including Bank Charges)
Amount :
Amount in words :
Name of the Candidate :
18/08/1989
Registration ID / Ref No. : 2023054
Use CBS Screen No. :
FEE Type :
Date of Birth :
16
8888
CASH CAN BE TENDERED AT ANY SBI BRANCH
Challan can be deposited minimum one day after the
generation of challan.
Challan can be deposited minimum one day after the
generation of challan.
Challan can be deposited minimum one day after the
generation of challan.
Last date for acceptance
of challan in bank : 24 October 2011.
Last date for acceptance
of challan in bank : 24 October 2011.
Last date for acceptance
of challan in bank : 24 October 2011.