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8.

Page - 4 : Address page to be pasted on a 10 inch X 12 inch size laminated envelope.

7.

Instructions for the Candidate:

1.

2.

Page - 1: Instructions for the candidate to be retained by the candidate.3.

4.

5.

a. Paste your recent color photo (3.5cm x 3.5cm) in the designated place. Before pasting, please writeyour name and application number on the backside of the photo with black ball point pen.

6.

There are 5 pages in this pdf file. These pages should be printed on A4 size white sheets using alaser/ink jet printer.

Page - 2 : Application Form (GATE Copy).

Page - 3 : Application Form (Candidate copy) to be retained by the candidate.

Instructions and Application Form for GATE 2012

Your Login ID is GARI24031. Remember your password and do not disclose it to anyone.

Without folding, insert the completed Application Form (GATE copy) and attested copies of all theapplication documents (SC/ST/PD certificate, copy of degree certificate etc.) into a 10 inch X 12 inch

laminated envelope and send by Speed Post (preferably) or by Registered Post using the address

Page - 5 : Bank challan in triplicate. Take it to any SBI branch and pay the application fee plus the bankservice charge. The Bank will retain its copy and will return the remaining two copies to you. Out ofthese two copies, retain the Candidate's copy with you and attach the GATE copy with the ApplicationForm.

b. Sign at the designated place.

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laminated envelope and send by Speed Post (preferably) or by Registered Post using the address

BiotechnologyG A R I M AName of the Candidate as inthe 10th Class Certificate

Choice of GATE Paper1. 9.

GATE COPYAPPLICATION NO. 8049487

GATE 2012 APPLICATION FORM

Zone: IIT Roorkee Payment Mode: Bank Challan (SBI) Fee: Rs. 1000

Date of Birth (DD/MM/YYYY)2. E-mail Address [email protected]/03/1990 10.

Gender3. FEMALE Address for Correspondence GARIMA ,D/O ANIL GAUR11.

H.NO. - 329-A ,WARD NO. 11

ADARSH NAGAR, BEHIND BAWAHALL

SONEPAT, HARYANA

Category

Person with Disability (PD)

Nationality

Year of Degree

Discipline

5.

6.

4.

13.

14.

General

No

INDIAN

2011

Biotechnology

PINCODE of Address forCorrespondence

12. 131001

Qualifying Degree

Choice of Examination City1


Name of Parent

State/Union Territory of

Permanent Residence

7.

8.

15.

16.B.E./B.Tech./ B.Sc.

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

820 - Rohtak

308 - Delhi West

A N I L G A U R

Haryana

I hereby declare that all the particulars stated in this application form are true to the best of my knowledge andbelief. 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

Mobile / Landline No.17. 01302233216

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BiotechnologyG A R I M AName of the Candidate as inthe 10th Class Certificate

Choice of GATE Paper1. 9.

CANDIDATE COPYAPPLICATION NO. 8049487

GATE 2012 APPLICATION FORM

Zone: IIT Roorkee Payment Mode: Bank Challan (SBI) Fee: Rs. 1000

Date of Birth (DD/MM/YYYY)2. E-mail Address [email protected]/03/1990 10.

Gender3. FEMALE Address for Correspondence GARIMA ,D/O ANIL GAUR11.

H.NO. - 329-A ,WARD NO. 11

ADARSH NAGAR, BEHIND BAWAHALL

SONEPAT, HARYANA

Category

Person with Disability (PD)

Nationality

Year of Degree

Discipline

5.

6.

4.

13.

14.

General

No

INDIAN

2011

Biotechnology

PINCODE of Address forCorrespondence

12. 131001

Qualifying Degree



Name of Parent

State/Union Territory of

Permanent Residence

7.

8.

15.

16.B.E./B.Tech./ B.Sc.

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

820 - Rohtak

308 - Delhi West

A N I L G A U R

Haryana

I hereby declare that all the particulars stated in this application form are true to the best of my knowledge andbelief. 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

Mobile / Landline No.17. 01302233216

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To

BY SPEED / REGISTERED POST(Please do not Courier)

Chairman, GATE

GATE 2012 Application Form

Indian Institute of Technology Roorkee

From

G A R I M A (APPLNO : 8049487)

GARIMA ,D/O ANIL GAUR

Roorkee - 247667

Do not tamper with the bar code. For GATE official use.

820BT8049487

H.NO. - 329-A ,WARD NO. 11

ADARSH NAGAR, BEHIND BAWA HALL

SONEPAT, HARYANA

131001

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GeneralGeneralGeneral

[email protected][email protected][email protected]

013022332160130223321601302233216

GARIMA ,D/O ANIL GAUR H.NO. - 329-A

,WARD NO. 11 ADARSH NAGAR, BEHIND

BAWA HALL SONEPAT, HARYANA - 131001







G A R I M AG A R I M AG A R I M A

1. Please note to write the Journal Number in all the challans.2. Please feed the Application No. in REG/ID/Ref No. Column.

SEAL / DATE AUTHORISED SIGNATORY

E Mail ID :

Category :

Address forCorrespondence :

24/03/1990

Mobile / Landline No:

CASH VOUCHER BANK COPY

GATE 2012 Application Fee Payment Challan

Name of the Candidate :

Signature of the Candidate/Remitter

For Receiving Branch use only

Registration ID / Ref No. : 8049487

Category :

CASH VOUCHER

JOURNAL NUMBER



E Mail ID :




Category :

CASH VOUCHER



E Mail ID :




GATE COPY CANDIDATE COPY

CASH CAN BE TENDERED AT ANY SBI BRANCH

Use CBS Screen No. :

FEE Type :

Date of Birth :

16

8888

Amount :

Amount in words :

Rs.1025/- *

Rupees One thousand and Twenty Five Only.(*Application Fees Including Bank Charges)


Amount :

Amount in words :

Rs.1025/- *


JOURNAL NUMBER


24/03/1990



FEE Type :

Date of Birth :

16

8888





JOURNAL NUMBER

Rs.1025/- *


Amount :

Amount in words :


24/03/1990



FEE Type :

Date of Birth :

16

8888


Challan can be deposited minimum one day after thegeneration of challan.



Last date for acceptanceof challan in bank : 24 October 2011.



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