R 288 Z 74 Applicationform

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Zone/Scrutiny GATE 2017

3GE R288Z74
R288Z74 (Enrollment ID)

Deepak Kumar
(Full Name of the Applicant)

05 May 1995 Male GEN No


(D.O.B) (Gender) (Category) (PD Status)

Indian National +918290324180 Parshuram Sharma


(Parent's Mobile Number) (Name of the Parent)

Communication Address GATE Exam Details


VILL-BANWARIYA GATE Paper Code
PO-BANWARIYA
PS-HULASGANJ
JEHANABAD
Bihar 824233
ME
(Mechanical Engineering)
+918290324180 (Mobile No.)
Jaipur, RJ
[email protected] (Exam City 1)

Qualification Details Ajmer, RJ


(Exam City 2)
B.Tech
Mechanical Engg. Kota, RJ
(Exam City 3)
Graduated: No; Year of Graduation: 2017
A C E I T JAIPUR Zonal GATE Office Contact
JAIPUR Chairperson GATE
Rajasthan 302028 Indian Institute of Technology Delhi
Hauz Khas, New Delhi 110016
Payment Details
Online Rs. 1500.00
Payment Ref. No.: CP60115662
03/10/2016

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. The
responsibility of following the GATE 2017 website and meeting various deadlines lies with me. 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 2017. Further, if any suppression or distortion of facts is found after appearing in the
exam, any admission/degree/benefit acquired on the basis of GATE 2017 score/marks is liable to be
cancelled.

Digital
Fingerprint: 048b273c52688db2dc84c28a05a08c4b

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