ONLINE Application for GATE 2011

Instructions for the Candidate:

1. Your Login ID is PALL11035. Remember your password and do not disclose it to anyone.
2. There are 5 Pages in this file. These pages should be printed on A4 sheets.
3. Page - 1: Instructions for the candidate to be retained by you carefully
4. Page - 2 : Application Form (GATE Copy)
a. Paste your recent color photo (3cm x 4cm) in designated place
b. Sign at designated places
5. Page - 3 : Application Form (CANDIDATE Copy) to be retained by you for your reference
6. Page - 5 : Bank challan in triplicate. Take it to any SBI branch and pay the fee. The Bank will retain a
copy with them and will return two copies to you. In those two copies, retain the Candidate's copy with
you and attach Institute's copy with Application Form

7. Page - 4 : Address slip to be pasted on the A4 size envelope

8. Insert completed Application Form (GATE Copy) and attested copies of all applicable documents
(SC/ST/PD Certificate, Affidavit for change of name) into A4 size envelope, without folding and send by
Speed Post (preferably) or by Registered Post to Chairman, GATE, IIT Kharagpur

List of Documents to be sent to GATE IIT Kharagpur:

1. Application Form (GATE Copy)
2. Bank Challan (Institute's Copy)
3. Attested Copy of SC/ST/PD Certificate (if applicable)
4. Attested Copy of affidavit for change of name (if applicable)

Page - 1
 GATE IIT Kharagpur COPY
APPLICATION FORM FOR GATE 2011
Application No: 6141072 Payment Mode: Bank Challan (State Bank of India)

Zone: IIT Kharagpur Application Fee: Rs. 800/-

1. Name of the Candidate as in PALLAB KUNDU 11. Address SREENATHPUR ROAD,

the 10th Class Certificate COURTPARA,
RANAGHAT, NADIA,

WEST BENGAL-741201

2. Date of Birth (DD/MM/YYYY) 11/03/1989

PINCODE 741201
3. Gender MALE

4. Nationality INDIAN 14. Year of Degree 2010

15. Discipline Computer Science &

5. Category General Engg./Technology
6. Person with Disability (PD) No

Do You Require a Scribe? No 16. Name of Parent PANKAJ KUMAR KUNDU

7. Qualifying Degree B.E./B.Tech./ B.Sc. 17. State/Union Territory of West Bengal

(Engg.)/B.Sc.(Tech.)/B.Arch. Permanent Residence

18. Phone / Mobile 09477042729

8. Choice of Examination City1 611 - Kolkata
Number
19. PINCODE of Address 741201
Choice of Examination City2 610 - Kharagpur for Correspondence

9. Choice of GATE Paper CS - Computer Science and Information

Technology
10. E-mail Address pallabkundu@hotmail.com

I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. 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 2011.
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 2011 score is liable to be cancelled.

Place:
Date:
Full Signature of the Candidate
(do not sign in capital letters)

12. Photograph

Paste a front
facial high
contrast recent
13. Full Signature of the Candidate color photograph
6141072 using black ball point pen only 3cm x 4cm
(do not sign in capital letters) without any
signature or
attestation

Send this form along with the necessary documents to IIT Kharagpur

Page - 2
 CANDIDATE COPY
APPLICATION FORM FOR GATE 2011
Application No: 6141072 Payment Mode: Bank Challan (State Bank of India)

Zone: IIT Kharagpur Application Fee: Rs. 800/-

1. Name of the Candidate as in PALLAB KUNDU 11. Address SREENATHPUR ROAD,

the 10th Class Certificate COURTPARA,
RANAGHAT, NADIA,

WEST BENGAL-741201

2. Date of Birth (DD/MM/YYYY) 11/03/1989

PINCODE 741201
3. Gender MALE

4. Nationality INDIAN 14. Year of Degree 2010

15. Discipline Computer Science &

5. Category General Engg./Technology
6. Person with Disability (PD) No

Do You Require a Scribe? No 16. Name of Parent PANKAJ KUMAR KUNDU

7. Qualifying Degree B.E./B.Tech./ B.Sc. 17. State/Union Territory of West Bengal

(Engg.)/B.Sc.(Tech.)/B.Arch. Permanent Residence

18. Phone / Mobile 09477042729

8. Choice of Examination City1 611 - Kolkata
Number
19. PINCODE of Address 741201
Choice of Examination City2 610 - Kharagpur for Correspondence

9. Choice of GATE Paper CS - Computer Science and Information

Technology
10. E-mail Address pallabkundu@hotmail.com

I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. 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 2011.
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 2011 score is liable to be cancelled.

Place:
Date:
Full Signature of the Candidate
(do not sign in capital letters)

12. Photograph

Paste a front
facial high
contrast recent
13. Full Signature of the Candidate color photograph
6141072 using black ball point pen only 3cm x 4cm
(do not sign in capital letters) without any
signature or
attestation

Retain this page for your reference

Page - 3
 BY SPEED POST / REGISTERED POST

GATE 2011
GATE PAPER CODE CS To

EXAM CITY OF FIRST Chairman, GATE

CHOICE 611
Indian Institute of Technology Kharagpur

Kharagpur

From
PINCODE 7 2 1 3 0 2
PALLAB KUNDU

SREENATHPUR ROAD, COURTPARA,

APPLICATION NO
RANAGHAT, NADIA,

WEST BENGAL-741201
6 1 4 1 0 7 2
PINCODE 7 4 1 2 0 1

Page - 4
CASH VOUCHER BANK'S COPY CASH VOUCHER INSTITUTE’S COPY CASH VOUCHER CANDIDATE'S COPY

BRANCH (CODE NO. ) BRANCH (CODE NO. ) BRANCH (CODE NO. )

GATE 2011 – Online Application Fee Payment GATE 2011 – Online Application Fee Payment GATE 2011 – Online Application Fee Payment
GATE 2011 FEE COLLECTION A/C NO. 31372883605 GATE 2011 FEE COLLECTION A/C NO. 31372883605 GATE 2011 FEE COLLECTION A/C NO. 31372883605

Name of the Candidate PALLAB KUNDU Name of the PALLAB KUNDU Name of the PALLAB KUNDU
Present Address Present Address Present Address
SREENATHPUR ROAD, COURTPARA, SREENATHPUR ROAD, COURTPARA, SREENATHPUR ROAD, COURTPARA,
RANAGHAT, NADIA, WEST BENGAL-741201 RANAGHAT, NADIA, WEST BENGAL-741201 RANAGHAT, NADIA, WEST BENGAL-741201
- 741201 - 741201 - 741201

Date of Birth 11/03/1989 Date of Birth 11/03/1989 Date of Birth 11/03/1989

Mobile / Landline No: 09477042729 Mobile / Landline No: 09477042729 Mobile / Landline No: 09477042729

E-mail Address: pallabkundu@hotmail.com E-mail Address: pallabkundu@hotmail.com E-mail Address: pallabkundu@hotmail.com

Category : General Category : General Category : General

Physically Disabled : No Physically Disabled : No Physically Disabled : No

Head Amount Credit to Head Amount Credit to Head Amount Credit to

Application Fees Rs. 800.00 31372883605 Application Fees Rs.800.00 31372883605 Application Fees Rs. 800.00 31372883605

Bank's Charges Rs. 30.00 98353XXXXXX Bank's Charges Rs. 30.00 98353XXXXXX Bank's Charges Rs. 30.00 98353XXXXXX

Total Rs. 830.00 Total Rs. 830.00 Total Rs. 830.00

Amount in words : Rupees eight hundred and thirty only. Amount in words : Rupees eight hundred and thirty only. Amount in words : Rupees eight hundred and thirty only.

Signature of the Candidate/Remitter Signature of the Candidate/Remitter Signature of the Candidate/Remitter

For Receiving Branch use only For Receiving Branch use only For Receiving Branch use only

APPLICATION NUMBER JOURNAL NUMBER APPLICATION NUMBER JOURNAL NUMBER APPLICATION NUMBER JOURNAL NUMBER

6141072 6141072 6141072

1. Please credit Rs.30/- to your Branch Commission
A/c No.98353XXXXXX
2. Please note to write the Journal Number in all the challans.
3. Please feed the Application No. in REG/ID/Ref No. Column
and Name of the Candidate in the menu while posting.
1. Please credit Rs.30/- to your Branch Commission
A/c No.98353XXXXXX
2. Please note to write the Journal Number in all the challans.
3. Please feed the Application No. in REG/ID/Ref No. Column
and Name of the Candidate in the menu while posting.
1. Please credit Rs.30/- to your Branch Commission
A/c No.98353XXXXXX
2. Please note to write the Journal Number in all the challans.
3. Please feed the Application No. in REG/ID/Ref No. Column
and Name of the Candidate in the menu while posting.

SEAL / DATE AUTHORISED SIGNATORY SEAL / DATE AUTHORISED SIGNATORY SEAL / DATE AUTHORISED SIGNATORY