Professional Documents
Culture Documents
3. 4.
8.
____________End of Instructions____________
GATE COPY
11. Address for Correspondence H.NO 10-2-246,VIDYANAGAR KARIMNAGAR ANDHRA PRADESH 505001 12. PINCODE of Address for 505001 Correspondence 13. Year of Degree 14. Discipline 15. Name of Parent 2012 Mechanical Engineering SHANAGONDA LAXMIPATHI Andhra Pradesh
7. Qualifying Degree
09885221791
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. Place : Date :
18. Signature
19. Photograph
Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS)
3.5 cm x 3.5 cm
108ME1004995
Send this form along with the necessary documents to IISc Bangalore.
CANDIDATE COPY
11. Address for Correspondence H.NO 10-2-246,VIDYANAGAR KARIMNAGAR ANDHRA PRADESH 505001 12. PINCODE of Address for 505001 Correspondence 13. Year of Degree 14. Discipline 15. Name of Parent 2012 Mechanical Engineering SHANAGONDA LAXMIPATHI Andhra Pradesh
7. Qualifying Degree
09885221791
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. Place : Date :
18. Signature
19. Photograph
Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS)
3.5 cm x 3.5 cm
108ME1004995
BY SPEED / REGISTERED POST (Please do not Courier) GATE 2012 Application Form
Do not tamper with the bar code. For GATE official use.
From
SHANAGONDACHANDRASHEKHARACHARY (APPLNO : 1004995) H.NO 10-2-246,VIDYANAGAR KARIMNAGAR ANDHRA PRADESH 505001 505001
Date of Deposit : DD/MM/YY (to be treated by Applicant as fee receipt) Account to be Credited : 0036SLFEECOL
Date of Deposit : DD/MM/YY (to be treated by Applicant as fee receipt) Account to be Credited : 0036SLFEECOL
Account to be Credited :
0036SLFEECOL
1.Institution Name : 2.Student/Applicant Name : 3.Roll No/Application No : 4.Class/DOB : 5.Section/Category : 6.Amount : 7.Amount in words : 8.Cash Details : Denomination 1000 X 500 X 100 X
FCGATE SHANAGONDACHANDRASHEKHARACHA
1.Institution Name : 2.Student/Applicant Name : 3.Roll No/Application ID : 4.Class/DOB : 5.Section/Category : 6.Amount : 7.Amount in words : 8.Cash Details : Denomination 1000 X 500 X 100 X
FCGATE
1.Institution Name :
FCGATE SHANAGONDACHANDRASHEKHARACHAR
SHANAGONDACHANDRASHEKHARACHAR 2.Student/Applicant Name : 1004995 3.Roll No/Application ID : 4.Class/DOB : 5.Section/Category : 6.Amount : 7.Amount in words : 8.Cash Details : Denomination 1000 X 500 X 100 X
1004995
1004995
01/12/90 NA Rs.1025/- * Rupees One thousand and Twenty Five Only. (*Including Rs. 25 as Bank Charge)
01/12/90 NA Rs.1025/- * Rupees One thousand and Twenty Five Only. (*Including Rs. 25 as Bank Charge)
01/12/90 NA Rs.1025/- * Rupees One thousand and Twenty Five Only. (*Including Rs. 25 as Bank Charge)