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2MX
To
GATE 2013
Chairman GATE Indian Institute of Technology Bombay Powai, Mumbai, 400076
171 R 931 H
77090 74998
(Mobile No.)
Cut Here
Note: Application ID - 171 R 931 H. You should preserve this number for further correspondence.
Zone/Scrutiny Code
2MX
171 R 931 H
(Full Name of Applicant)
4.5 cm x 3.5 cm
(Application ID)
13 Jul 1986
(D.O.B)
Male
(Name of Parent)
OBC-NC
Indian National
Communication Address
CIo K B MUNDE NEAR S.B.H BANK HOUSING SOCIETY AMBAJOGAI Maharashtra, 431517 India
Pune (City), MH
(Exam City 1)
No
Qualification Details
B.E. Civil/Environmental/Structural/Construction Engg. Graduated: Yes, Year of Graduation: 2009 GOVERNMENT ENGINEERING COLLEGE AURANGABAD Maharashtra, 431003
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: ....../....../............