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Zone/Scrutiny Code
6CP
To
GATE 2013
Chairman GATE Indian Institute of Technology Kharagpur Kharagpur, 721302
142 F 208 Q
81218 40206
(Mobile No.)
Cut Here
Note: Application ID - 142 F 208 Q. You should preserve this number for further correspondence.
Zone/Scrutiny Code
6CP
142 F 208 Q
(Full Name of Applicant)
4.5 cm x 3.5 cm
(Application ID)
20 Jun 1991
(D.O.B)
Male
(Name of Parent)
OBC-NC
Indian National
Communication Address
12-348/17 RAMALAXMI COLONY PEDANA PEDANA MANDAL Andhra Pradesh, 521366 India
Vijayawada, AP
(Exam City 1)
Hyderabad, AP
(Exam City 2) Scribe Assistance Required:
No
Qualification Details
B.Tech Civil/Environmental/Structural/Construction Engg. Graduated: No, Year of Graduation: 2013 SRI VASAVI INSTITUTE OF ENGINEERING AND PEDANA Andhra Pradesh, 521369
Enclosure Checklist
Stamped Bank Challan: GATE copy
Payment Details
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 Information Brochure 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 2013. Further, if any suppression or distortion of facts is found after appearing in the exam, any admission/degree acquired on the basis of GATE 2013 score is liable to be cancelled.
Date: ....../....../............
Principal Certificate
(For use as the eligibility certificate only for final year or backlog applicants)
This is to certify that Balla Bala Subrahmanyam is a student enrolled in SRI VASAVI INSTITUTE OF ENGINEERING AND TECHNOLOGY, PEDANA. He is a student of the final year of B.Tech. He appeared in the final semester/year exam of the above degree, but has a backlog to be cleared from an earlier semester/year, and therefore cannot produce a course completion certificate.
Date:
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