ONLINE Application for GATE 2011

Instructions for the Candidate:

1. Your Login ID is LOGA3007. Remember your password and do not disclose it to anyone.
2. There are 5 Pages in this file. These pages should be printed on A4 sheets.
3. Page - 1: Instructions for the candidate to be retained by you carefully
4. Page - 2 : Application Form (GATE Copy)
a. Paste your recent color photo (3cm x 4cm) in designated place
b. Sign at designated places
5. Page - 3 : Application Form (CANDIDATE Copy) to be retained by you for your reference
6. Page - 5 : Bank challan in triplicate. Take it to any SBI branch and pay the fee. The Bank will retain a
copy with them and will return two copies to you. In those two copies, retain the Candidate's copy with
you and attach Institute's copy with Application Form

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

8. 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 by
Speed Post (preferably) or by Registered Post to Chairman, GATE, IIT Madras

List of Documents to be sent to GATE IIT Madras:

1. Application Form (GATE Copy)
2. Bank Challan (Institute's Copy)
3. Attested Copy of SC/ST/PD Certificate (if applicable)
4. Attested Copy of affidavit for change of name (if applicable)

Page - 1
 GATE IIT Madras COPY
APPLICATION FORM FOR GATE 2011
Application No: 7110183 Payment Mode: Bank Challan (State Bank of India)

Zone: IIT Madras Application Fee: Rs. 800/-

1. Name of the Candidate as in LOGANATHAN S 11. Address ANNAUNIVERSITY

the 10th Class Certificate
CGC

CHENNAI

2. Date of Birth (DD/MM/YYYY) 30/07/1995

PINCODE 600025
3. Gender MALE

4. Nationality INDIAN 14. Year of Degree 2009

15. Discipline Chemistry

5. Category OBC(Non-Creamy Layer)

6. Person with Disability (PD) No

Do You Require a Scribe? No 16. Name of Parent RAVI S

7. Qualifying Degree M.Sc./M.C.A./M.A. 17. State/Union Territory of Tamil Nadu

Permanent Residence

18. Phone / Mobile 09600434253

8. Choice of Examination City1 703 - Chennai South
Number
19. PINCODE of Address 600025
Choice of Examination City2 702 - Chennai North for Correspondence

9. Choice of GATE Paper CY - Chemistry

10. E-mail Address loguchem@gmail.com

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 of
suppression or distortion of any fact in my application form, I understand that I will be denied the opportunity to appear in GATE 2011.
Further, if any such suppression or distortion of facts is found after appearing in the exam, any admission/degree acquired on the basis of
GATE 2011 score is liable to be cancelled.

Place:
Date:
Full Signature of the Candidate
(do not sign in capital letters)

12. Photograph

Paste a front
facial high
contrast recent
13. Full Signature of the Candidate color photograph
7110183 using black ball point pen only 3cm x 4cm
(do not sign in capital letters) without any
signature or
attestation

Send this form along with the necessary documents to IIT Madras

Page - 2
 CANDIDATE COPY
APPLICATION FORM FOR GATE 2011
Application No: 7110183 Payment Mode: Bank Challan (State Bank of India)

Zone: IIT Madras Application Fee: Rs. 800/-

1. Name of the Candidate as in LOGANATHAN S 11. Address ANNAUNIVERSITY

the 10th Class Certificate
CGC

CHENNAI

2. Date of Birth (DD/MM/YYYY) 30/07/1995

PINCODE 600025
3. Gender MALE

4. Nationality INDIAN 14. Year of Degree 2009

15. Discipline Chemistry

5. Category OBC(Non-Creamy Layer)

6. Person with Disability (PD) No

Do You Require a Scribe? No 16. Name of Parent RAVI S

7. Qualifying Degree M.Sc./M.C.A./M.A. 17. State/Union Territory of Tamil Nadu

Permanent Residence

18. Phone / Mobile 09600434253

8. Choice of Examination City1 703 - Chennai South
Number
19. PINCODE of Address 600025
Choice of Examination City2 702 - Chennai North for Correspondence

9. Choice of GATE Paper CY - Chemistry

10. E-mail Address loguchem@gmail.com

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 of
suppression or distortion of any fact in my application form, I understand that I will be denied the opportunity to appear in GATE 2011.
Further, if any such suppression or distortion of facts is found after appearing in the exam, any admission/degree acquired on the basis of
GATE 2011 score is liable to be cancelled.

Place:
Date:
Full Signature of the Candidate
(do not sign in capital letters)

12. Photograph

Paste a front
facial high
contrast recent
13. Full Signature of the Candidate color photograph
7110183 using black ball point pen only 3cm x 4cm
(do not sign in capital letters) without any
signature or
attestation

Retain this page for your reference

Page - 3
 BY SPEED POST / REGISTERED POST

GATE 2011
GATE PAPER CODE CY To

EXAM CITY OF FIRST Chairman, GATE

CHOICE 703
Indian Institute of Technology Madras

Chennai

From
PINCODE 6 0 0 0 3 6
LOGANATHAN S

ANNAUNIVERSITY
APPLICATION NO
CGC

CHENNAI
7 1 1 0 1 8 3
PINCODE 6 0 0 0 2 5

Page - 4
CASH VOUCHER BANK'S COPY CASH VOUCHER INSTITUTE’S COPY CASH VOUCHER CANDIDATE'S COPY

BRANCH (CODE NO. ) BRANCH (CODE NO. ) BRANCH (CODE NO. )

GATE 2011 – Online Application Fee Payment GATE 2011 – Online Application Fee Payment GATE 2011 – Online Application Fee Payment
GATE 2011 FEE COLLECTION A/C NO. 31372883605 GATE 2011 FEE COLLECTION A/C NO. 31372883605 GATE 2011 FEE COLLECTION A/C NO. 31372883605

Name of the Candidate LOGANATHAN S Name of the LOGANATHAN S Name of the LOGANATHAN S
Present Address Present Address Present Address
ANNAUNIVERSITY CGC CHENNAI - 600025 ANNAUNIVERSITY CGC CHENNAI - 600025 ANNAUNIVERSITY CGC CHENNAI - 600025

Date of Birth 30/07/1995 Date of Birth 30/07/1995 Date of Birth 30/07/1995

Mobile / Landline No: 09600434253 Mobile / Landline No: 09600434253 Mobile / Landline No: 09600434253

E-mail Address: loguchem@gmail.com E-mail Address: loguchem@gmail.com E-mail Address: loguchem@gmail.com

Category : OBC(Non-Creamy Layer) Category : OBC(Non-Creamy Layer) Category : OBC(Non-Creamy Layer)

Physically Disabled : No Physically Disabled : No Physically Disabled : No

Head Amount Credit to Head Amount Credit to Head Amount Credit to

Application Fees Rs. 800.00 31372883605 Application Fees Rs.800.00 31372883605 Application Fees Rs. 800.00 31372883605

Bank's Charges Rs. 30.00 98353XXXXXX Bank's Charges Rs. 30.00 98353XXXXXX Bank's Charges Rs. 30.00 98353XXXXXX

Total Rs. 830.00 Total Rs. 830.00 Total Rs. 830.00

Amount in words : Rupees eight hundred and thirty only. Amount in words : Rupees eight hundred and thirty only. Amount in words : Rupees eight hundred and thirty only.

Signature of the Candidate/Remitter Signature of the Candidate/Remitter Signature of the Candidate/Remitter

For Receiving Branch use only For Receiving Branch use only For Receiving Branch use only

APPLICATION NUMBER JOURNAL NUMBER APPLICATION NUMBER JOURNAL NUMBER APPLICATION NUMBER JOURNAL NUMBER

7110183 7110183 7110183

1. Please credit Rs.30/- to your Branch Commission
A/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.
1. Please credit Rs.30/- to your Branch Commission
A/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.
1. Please credit Rs.30/- to your Branch Commission
A/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 SEAL / DATE AUTHORISED SIGNATORY SEAL / DATE AUTHORISED SIGNATORY