Académique Documents
Professionnel Documents
Culture Documents
1. Your Login ID is DIWA2410. 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
Page - 1
GATE IIT Guwahati COPY
APPLICATION FORM FOR GATE 2011
Application No: 4111129 Payment Mode: Bank Challan (State Bank of India)
1. Name of the Candidate as in DIWAKAR KUMAR RANJAN 11. Address ROOM NO-111,NMH
the 10th Class Certificate
TEZPUR UNIVERSITY
NAPAM, TEZPUR
PINCODE 784028
3. Gender MALE
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
4111129 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 Guwahati
Page - 2
CANDIDATE COPY
APPLICATION FORM FOR GATE 2011
Application No: 4111129 Payment Mode: Bank Challan (State Bank of India)
1. Name of the Candidate as in DIWAKAR KUMAR RANJAN 11. Address ROOM NO-111,NMH
the 10th Class Certificate
TEZPUR UNIVERSITY
NAPAM, TEZPUR
PINCODE 784028
3. Gender MALE
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
4111129 using black ball point pen only 3cm x 4cm
(do not sign in capital letters) without any
signature or
attestation
Page - 3
BY SPEED POST / REGISTERED POST
GATE 2011
GATE PAPER CODE CS To
Guwahati
From
PINCODE 7 8 1 0 3 9
DIWAKAR KUMAR RANJAN
ROOM NO-111,NMH
APPLICATION NO
TEZPUR UNIVERSITY
NAPAM, TEZPUR
SONITPUR, ASSAM 4 1 1 1 1 2 9
PINCODE 7 8 4 0 2 8
Page - 4
CASH VOUCHER BANK'S COPY CASH VOUCHER INSTITUTE’S COPY CASH VOUCHER CANDIDATE'S COPY
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 DIWAKAR KUMAR RANJAN Name of the DIWAKAR KUMAR RANJAN Name of the DIWAKAR KUMAR RANJAN
Present Address Present Address Present Address
ROOM NO-111,NMH TEZPUR UNIVERSITY ROOM NO-111,NMH TEZPUR UNIVERSITY ROOM NO-111,NMH TEZPUR UNIVERSITY
NAPAM, TEZPUR SONITPUR, ASSAM - NAPAM, TEZPUR SONITPUR, ASSAM - NAPAM, TEZPUR SONITPUR, ASSAM -
784028 784028 784028
Mobile / Landline No: 09706440191 Mobile / Landline No: 09706440191 Mobile / Landline No: 09706440191
Application Fees Rs. 400.00 31372883605 Application Fees Rs.400.00 31372883605 Application Fees Rs. 400.00 31372883605
Bank's Charges Rs. 30.00 98353XXXXXX Bank's Charges Rs. 30.00 98353XXXXXX Bank's Charges Rs. 30.00 98353XXXXXX
Amount in words : Rupees four hundred and thirty only. Amount in words : Rupees four hundred and thirty only. Amount in words : Rupees four hundred and thirty only.
APPLICATION NUMBER JOURNAL NUMBER APPLICATION NUMBER JOURNAL NUMBER APPLICATION NUMBER JOURNAL NUMBER
1. Please credit Rs.30/- to your Branch Commission 1. Please credit Rs.30/- to your Branch Commission 1. Please credit Rs.30/- to your Branch Commission
A/c No.98353XXXXXX A/c No.98353XXXXXX A/c No.98353XXXXXX
2. Please note to write the Journal Number in all the challans. 2. Please note to write the Journal Number in all the challans. 2. Please note to write the Journal Number in all the challans.
3. Please feed the Application No. in REG/ID/Ref No. Column 3. Please feed the Application No. in REG/ID/Ref No. Column 3. Please feed the Application No. in REG/ID/Ref No. Column
and Name of the Candidate in the menu while posting. and Name of the Candidate in the menu while posting. and Name of the Candidate in the menu while posting.
SEAL / DATE AUTHORISED SIGNATORY SEAL / DATE AUTHORISED SIGNATORY SEAL / DATE AUTHORISED SIGNATORY