Application 2102362

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8.

Page - 4 : Address slip to be pasted on the A4 size envelope7.

Instructions for the Candidate:

1.2.

Page - 1: Instructions for the candidate to be retained by you carefully3.

4.

5.

a. Paste your recent color photo (3cm x 4cm) in designated place

b. Sign at designated places

6.

There are 5 Pages in this file. These pages should be printed on A4 sheets.

Page - 2 : Application Form (GATE Copy)

Page - 3 : Application Form (CANDIDATE Copy) to be retained by you for your reference

Page - 5 : Bank challan in triplicate. Take it to any SBI branch and pay the fee. The Bank will retain acopy with them and will return two copies to you. In those two copies, retain the Candidate's copy withyou and attach Institute's copy with Application Form

ONLINE Application for GATE 2011

1. Application Form (GATE Copy)

2 Bank Challan (Institute's Copy)

Your Login ID is SURA0802. Remember your password and do not disclose it to anyone.

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 bySpeed Post (preferably) or by Registered Post to Chairman, GATE, IIT Bombay

List of Documents to be sent to GATE IIT Bombay:

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2 Bank Challan (Institute's Copy)

APPLICATION FORM FOR GATE 2011

Application No:

Zone:

2102362

IIT Bombay

Name of the Candidate as in

the 10th Class Certificate

Date of Birth (DD/MM/YYYY)

Gender

Category

Person with Disability (PD)

Qualifying Degree

Nationality

Choice of Examination City1


Choice of GATE Paper

Year of Degree

Discipline

Name of Parent

State/Union Territory ofPermanent Residence

1.

2.

3.

5.

6.

7.

4.

8.

9.

14.

15.

16.

17.

MALE

General

No

B.E./B.Tech./ B.Sc.(Engg.)/B.Sc.(Tech.)/B.Arch.

INDIAN

226 - Vadodara

301 - Ahmedabad

CH - Chemical Engineering

2011

Chemical Engg.

SUBHASHBHAI VACHHANI

Gujarat

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 ofsuppression or distortion of any fact in my application form I understand that I will be denied the opportunity to appear in GATE 2011

Address 2ND FLOOR,ASHIRWAD

APPARTMENT,NEAR GAYATRI DINNING HALL,

NANA BAZAR,VIDHYA NAGAR

ANAND

11.

PINCODE of Addressfor Correspondence

Phone / MobileNumber

18.

19. 388120

09824970540

GATE IIT Bombay COPY

E-mail Address [email protected]

Do You Require a Scribe? No

SURAJ SUBHASHBHAI VACHHANI

08/02/1989

10.

Payment Mode:

Application Fee: Rs. 800/-

388120PINCODE

Bank Challan (State Bank of India)

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APPLICATION FORM FOR GATE 2011

Application No:

Zone:

2102362

IIT Bombay

Name of the Candidate as in

the 10th Class Certificate

Date of Birth (DD/MM/YYYY)

Gender

Category

Person with Disability (PD)

Qualifying Degree

Nationality



Choice of GATE Paper

Year of Degree

Discipline

Name of Parent

State/Union Territory ofPermanent Residence

1.

2.

3.

5.

6.

7.

4.

8.

9.

14.

15.

16.

17.

MALE

General

No

B.E./B.Tech./ B.Sc.(Engg.)/B.Sc.(Tech.)/B.Arch.

INDIAN

226 - Vadodara

301 - Ahmedabad

CH - Chemical Engineering

2011

Chemical Engg.

SUBHASHBHAI VACHHANI

Gujarat

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 ofsuppression or distortion of any fact in my application form I understand that I will be denied the opportunity to appear in GATE 2011

Address 2ND FLOOR,ASHIRWAD

APPARTMENT,NEAR GAYATRI DINNING HALL,


ANAND

11.

PINCODE of Addressfor Correspondence

Phone / MobileNumber

18.

19. 388120

09824970540

CANDIDATE COPY

E-mail Address [email protected]

Do You Require a Scribe? No


08/02/1989

10.

Payment Mode:

Application Fee: Rs. 800/-

388120PINCODE

Bank Challan (State Bank of India)

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APPLICATION NO

GATE

From

PINCODE

To

PINCODE

BY SPEED POST / REGISTERED POST

2011


2ND FLOOR,ASHIRWAD APPARTMENT,

NEAR GAYATRI DINNING HALL,


ANAND 2 1 0 2 3 6 2

Chairman, GATE

Indian Institute of Technology Bombay

Powai, Mumbai

226

GATE PAPER CODE

EXAM CITY OF FIRSTCHOICE

CH

3 8 8 1 2 0

Page - 4

4 0 0 0 7 6

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[email protected]@gmail.com [email protected]

Head

Application Fees

Credit to

Bank's Charges

E-mail Address:

Amount in words : Rupees eight hundred and thirty only.

Present Address2ND FLOOR,ASHIRWAD APPARTMENT,

NEAR GAYATRI DINNING HALL, NANA

BAZAR,VIDHYA NAGAR ANAND - 388120

08/02/1989

09824970540

Date of Birth

Mobile / Landline No:

CASH VOUCHER

BRANCH (CODE NO. )

BANK'S COPY

GATE 2011 Online Application Fee Payment

GATE 2011 FEE COLLECTION A/C NO. 31372883605

Name of the Candidate

Amount

Total

31372883605

Rs. 30.00 98353XXXXXX

Signature of the Candidate/Remitter

For Receiving Branch use only

APPLICATION NUMBER JOURNAL NUMBER

1. Please credit Rs.30/- to your Branch CommissionA/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

2102362

Rs. 800.00

Rs. 830.00

31372883605

98353XXXXXXBank's Charges



APPLICATION NUMBER

2102362

CASH VOUCHER

)

JOURNAL NUMBER







E-mail Address:

Rs. 830.00

Head

Name of the




Amount in words :

Present Address

Total


08/02/1989

Rupees eight hundred and thirty only.

Credit toAmount

Rs. 30.00

Date of Birth

Application Fees

09824970540


Rs.800.00 31372883605

98353XXXXXXBank's Charges



APPLICATION NUMBER

2102362

CASH VOUCHER

)

JOURNAL NUMBER







E-mail Address:

Rs. 830.00

Head

Name of the




Amount in words :

Present Address

Total


08/02/1989

Rupees eight hundred and thirty only.

Credit toAmount

Rs. 30.00

Date of Birth

Application Fees

09824970540


Rs. 800.00

BRANCH (CODE NO. BRANCH (CODE NO.

INSTITUTES COPY CANDIDATE'S COPY

Category : General

Phys ica lly Disabled : No

Category : General

Physica lly Disabled : No

Category : General

Physica ll y Disabled : No
