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3. 4.
5. 6. 7.
8.
7.
____________End of Instructions____________
GATE COPY
11. Address for Correspondence C/0-MD. FAWAZ K.A KARIYATT HOUSE,HMT COLONY P.O KALAMASSERY,COCHIN KERALA,PIN-683503 12. PINCODE of Address for 683503 Correspondence 13. Year of Degree 14. Discipline 2012 Civil/Civil & Environmental/Structural Engg./Construction Engg. MUNNI SAH Bihar
15. Name of Parent 7. Qualifying Degree B.E./B.Tech./ B.Sc. (Engg.)/B.Sc.(Tech.)/B.Arch. 16. State/Union Territory of Permanent Residence
09633808097
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 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 opportunity to appear in GATE 2012. 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 2012 score is liable to be cancelled. Place : Date :
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19. Photograph
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708CE7048869
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CANDIDATE COPY
11. Address for Correspondence C/0-MD. FAWAZ K.A KARIYATT HOUSE,HMT COLONY P.O KALAMASSERY,COCHIN KERALA,PIN-683503 12. PINCODE of Address for 683503 Correspondence 13. Year of Degree 14. Discipline 2012 Civil/Civil & Environmental/Structural Engg./Construction Engg. MUNNI SAH Bihar
15. Name of Parent 7. Qualifying Degree B.E./B.Tech./ B.Sc. (Engg.)/B.Sc.(Tech.)/B.Arch. 16. State/Union Territory of Permanent Residence
09633808097
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 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 opportunity to appear in GATE 2012. 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 2012 score is liable to be cancelled. Place : Date :
18. Signature
19. Photograph
Full Signature of the candidate using BLACK INK PEN only (do not sign in CAPITAL LETTERS)
3.5 cm x 3.5 cm
708CE7048869
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708CE7048869
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ANIL KUMAR GUPTA (APPLNO : 7048869) C/0-MD. FAWAZ K.A KARIYATT HOUSE,HMT COLONY P.O KALAMASSERY,COCHIN KERALA,PIN-683503 683503
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Name of the Candidate : ANIL KUMAR GUPTA Address for Correspondence :
Challan can be deposited minimum one day after the generation of challan.
Name of the Candidate : ANIL KUMAR GUPTA Address for Correspondence :
Challan can be deposited minimum one day after the generation of challan.
Name of the Candidate : ANIL KUMAR GUPTA
C/0-MD. FAWAZ K.A KARIYATT HOUSE,HMT COLONY P.O KALAMASSERY,COCHIN KERALA,PIN-683503 - 683503
C/0-MD. FAWAZ K.A KARIYATT HOUSE,HMT Address for Correspondence : COLONY P.O KALAMASSERY,COCHIN KERALA,PIN-683503 - 683503
C/0-MD. FAWAZ K.A KARIYATT HOUSE,HMT COLONY P.O KALAMASSERY,COCHIN KERALA,PIN-683503 - 683503
09633808097 cusatsoece@gmail.com
09633808097 cusatsoece@gmail.com
09633808097 cusatsoece@gmail.com
OBC(Non-Creamy Layer) Rs.1025/- * Rupees One thousand and Twenty Five Only. (*Application Fees Including Bank Charges)
OBC(Non-Creamy Layer) Rs.1025/- * Rupees One thousand and Twenty Five Only. (*Application Fees Including Bank Charges)
OBC(Non-Creamy Layer) Rs.1025/- * Rupees One thousand and Twenty Five Only. (*Application Fees Including Bank Charges)
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Signature of the Candidate/Remitter For Receiving Branch use only 1. Please note to write the Journal Number in all the challans. 2. Please feed the Application No. in REG/ID/Ref No. Column.
Signature of the Candidate/Remitter For Receiving Branch use only 1. Please note to write the Journal Number in all the challans. 2. Please feed the Application No. in REG/ID/Ref No. Column.
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