application 5143723
TRANSCRIPT
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8/8/2019 Application 5143723
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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 MANI23094. 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 Kanpur
List of Documents to be sent to GATE IIT Kanpur:
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2 Bank Challan (Institute's Copy)
APPLICATION FORM FOR GATE 2011
Application No:
Zone:
5143723
IIT Kanpur
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 Examination City2
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
512 - Sultanpur
510 - Lucknow
EC - Electronics and CommunicationEngineering
2011
Electronics & Comm./ElectronicsEngg./Comm.Engg./Telecommunication Engg.
KRISHNA KUMAR TIWARI
Uttar Pradesh
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 VILLAGE AND POST BHAPTA
HANUMANGANJ SULTANPUR
U.P.
11.
PINCODE of Addressfor Correspondence
Phone / MobileNumber
18.
19. 228001
08004873669
GATE IIT Kanpur COPY
E-mail Address [email protected]
Do You Require a Scribe? No
MANISH KUMAR TIWARI
23/09/1987
10.
Payment Mode:
Application Fee: Rs. 800/-
228001PINCODE
Bank Challan (State Bank of India)
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APPLICATION FORM FOR GATE 2011
Application No:
Zone:
5143723
IIT Kanpur
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 Examination City2
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
512 - Sultanpur
510 - Lucknow
EC - Electronics and CommunicationEngineering
2011
Electronics & Comm./ElectronicsEngg./Comm.Engg./Telecommunication Engg.
KRISHNA KUMAR TIWARI
Uttar Pradesh
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 VILLAGE AND POST BHAPTA
HANUMANGANJ SULTANPUR
U.P.
11.
PINCODE of Addressfor Correspondence
Phone / MobileNumber
18.
19. 228001
08004873669
CANDIDATE COPY
E-mail Address [email protected]
Do You Require a Scribe? No
MANISH KUMAR TIWARI
23/09/1987
10.
Payment Mode:
Application Fee: Rs. 800/-
228001PINCODE
Bank Challan (State Bank of India)
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APPLICATION NO
GATE
From
PINCODE
To
PINCODE
BY SPEED POST / REGISTERED POST
2011
MANISH KUMAR TIWARI
VILLAGE AND POST BHAPTA
HANUMANGANJ SULTANPUR
U.P.
5 1 4 3 7 2 3
Chairman, GATE
Indian Institute of Technology Kanpur
Kanpur
512
GATE PAPER CODE
EXAM CITY OF FIRSTCHOICE
EC
2 2 8 0 0 1
Page - 4
2 0 8 0 1 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 AddressV I L L A G E A N D P O S T B H A P T A
HANUMANGANJ SULTANPUR U.P. - 228001
23/09/1987
08004873669
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
5143723
Rs. 800.00
Rs. 830.00
31372883605
98353XXXXXXBank's Charges
MANISH KUMAR TIWARI
GATE 2011 FEE COLLECTION A/C NO. 31372883605
APPLICATION NUMBER
5143723
CASH VOUCHER
)
JOURNAL NUMBER
For Receiving Branch use only
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
Signature of the Candidate/Remitter
E-mail Address:
Rs. 830.00
Head
Name of the
V I L L A G E A N D P O S T B H A P T A
HANUMANGANJ SULTANPUR U.P. - 228001
Amount in words :
Present Address
Total
Mobile / Landline No:
23/09/1987
Rupees eight hundred and thirty only.
Credit toAmount
Rs. 30.00
Date of Birth
Application Fees
08004873669
GATE 2011 Online Application Fee Payment
Rs.800.00 31372883605
98353XXXXXXBank's Charges
MANISH KUMAR TIWARI
GATE 2011 FEE COLLECTION A/C NO. 31372883605
APPLICATION NUMBER
5143723
CASH VOUCHER
)
JOURNAL NUMBER
For Receiving Branch use only
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
Signature of the Candidate/Remitter
E-mail Address:
Rs. 830.00
Head
Name of the
V I L L A G E A N D P O S T B H A P T A
HANUMANGANJ SULTANPUR U.P. - 228001
Amount in words :
Present Address
Total
Mobile / Landline No:
23/09/1987
Rupees eight hundred and thirty only.
Credit toAmount
Rs. 30.00
Date of Birth
Application Fees
08004873669
GATE 2011 Online Application Fee Payment
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
MANISH KUMAR TIWARI