Professional Documents
Culture Documents
3. 4.
Put
7.
____________End of Instructions____________
GATE COPY
INDIAN General No
11. Address for Correspondence 221, B-4 PARYATAN VIHAR SOCIETY VASUNDHRA ENCLAVE DELHI 12. PINCODE of Address for 110096 Correspondence 13. Year of Degree 14. Discipline 2012 Electronics & Comm./Electronics Engg./Communication Engg./Telecommunication Engg KAMAL NAIN KHANNA Delhi
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
09013281455
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
305EC3073982
Send this form along with the necessary documents to IIT Delhi.
CANDIDATE COPY
INDIAN General No
11. Address for Correspondence 221, B-4 PARYATAN VIHAR SOCIETY VASUNDHRA ENCLAVE DELHI 12. PINCODE of Address for 110096 Correspondence 13. Year of Degree 14. Discipline 2012 Electronics & Comm./Electronics Engg./Communication Engg./Telecommunication Engg KAMAL NAIN KHANNA Delhi
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
09013281455
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
305EC3073982
BY SPEED / REGISTERED POST (Please do not Courier) GATE 2012 Application Form
To Chairman, GATE Indian Institute of Technology Delhi Hauz Khas, New Delhi - 110016
305EC3073982
Do not tamper with the bar code. For GATE official use.
From
PARUL KHANNA (APPLNO : 3073982) 221, B-4 PARYATAN VIHAR SOCIETY VASUNDHRA ENCLAVE DELHI 110096