ONLINE Application for GATE 2011

Instructions for the Candidate:

1. Your Login ID is JITE1005. Remember your password and do not disclose it to anyone.
2. There are 4 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 - 4 : Address slip to be pasted on the A4 size envelope
7. 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 Roorkee

List of Documents to be sent to GATE IIT Roorkee:

1. Application Form (GATE Copy)
2. Attested Copy of SC/ST/PD Certificate (if applicable)
3. Attested Copy of affidavit for change of name (if applicable)

Page - 1
 GATE IIT Roorkee COPY
APPLICATION FORM FOR GATE 2011
Application No: 8102759 Payment Mode: BillDesk Gateway

Zone: IIT Roorkee Application Fee: Rs. 800/- Payment Reference No: MPNB0097389194

1. Name of the Candidate as in JITENDRA GUPTA 11. Address RAJ KUMAR GOEL INSTITUE OF
the 10th Class Certificate
TECHNOLOGY , 5TH KM STONE,

DELHI MEERUT ROAD ,GHAZIABAD

2. Date of Birth (DD/MM/YYYY) 10/05/1988 U.P.

PINCODE 201003
3. Gender MALE

4. Nationality INDIAN 14. Year of Degree 2011

15. Discipline Computer Science &

5. Category OBC(Non-Creamy Layer) Engg./Technology
6. Person with Disability (PD) No

Do You Require a Scribe? No 16. Name of Parent RAMASHRYA GUPTA

7. Qualifying Degree B.E./B.Tech./ B.Sc. 17. State/Union Territory of Uttar Pradesh

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

18. Phone / Mobile 09990650419

8. Choice of Examination City1 806 - Ghaziabad
Number
19. PINCODE of Address 201003
Choice of Examination City2 819 - Noida for Correspondence

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

Technology
10. E-mail Address gupta.jkumar@gmail.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
8102759 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 Roorkee

Page - 2
 CANDIDATE COPY
APPLICATION FORM FOR GATE 2011
Application No: 8102759 Payment Mode: BillDesk Gateway

Zone: IIT Roorkee Application Fee: Rs. 800/- Payment Reference No: MPNB0097389194

1. Name of the Candidate as in JITENDRA GUPTA 11. Address RAJ KUMAR GOEL INSTITUE OF
the 10th Class Certificate
TECHNOLOGY , 5TH KM STONE,

DELHI MEERUT ROAD ,GHAZIABAD

2. Date of Birth (DD/MM/YYYY) 10/05/1988 U.P.

PINCODE 201003
3. Gender MALE

4. Nationality INDIAN 14. Year of Degree 2011

15. Discipline Computer Science &

5. Category OBC(Non-Creamy Layer) Engg./Technology
6. Person with Disability (PD) No

Do You Require a Scribe? No 16. Name of Parent RAMASHRYA GUPTA

7. Qualifying Degree B.E./B.Tech./ B.Sc. 17. State/Union Territory of Uttar Pradesh

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

18. Phone / Mobile 09990650419

8. Choice of Examination City1 806 - Ghaziabad
Number
19. PINCODE of Address 201003
Choice of Examination City2 819 - Noida for Correspondence

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

Technology
10. E-mail Address gupta.jkumar@gmail.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
8102759 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 806
Indian Institute of Technology Roorkee

Roorkee

From
PINCODE 2 4 7 6 6 7
JITENDRA GUPTA

RAJ KUMAR GOEL INSTITUE OF

APPLICATION NO
TECHNOLOGY , 5TH KM STONE,

DELHI MEERUT ROAD ,GHAZIABAD

U.P. 8 1 0 2 7 5 9
PINCODE 2 0 1 0 0 3

Page - 4