1. This print out should contain the following pages.

(a) This page: Address Slip and Instructions.

(b) Application form, filled with the information you provided online.
(c) Bank Challan in Triplicate (available as a separate file for download from the
GATE Online Application Interface), if you have chosen Offline Challan Payment (Not applicable for female candidates).
2. On the GATE copy of the Application Form, paste a 4.5cm x 3.5cm printed copy of the SAME color
photograph you uploaded online.
(a) Use good quality glue to ensure that the photograph does not separate from the application.
(b) Do not pin, stapple, sign, or attest the photograph.
3. Read the declaration and put your signature in the box next to it.
4. If you are in the final year or you have a backlog after appearing for the final year exam, you must get your
Principals or HODs sign and seal in the last portion of the application form. Submit the whole form
to the Principals office without cutting it.
5. If you have opted for Challan payment, wait for 48 hours after your online submission to visit the banks
branch. You can visit any branch of the bank printed on your challan.
6. The bank teller will verify the details printed on the challan with the data available on their computer and
then accept the payment. The bank will retain one copy and give you back the remaining copies: one of
which you have to send along with the printed application form and the other is for your reference.
7. Mailing Documents to GATE office.
(a) Cut the Address Slip and paste it onto an A4 sized envelope (Do not fill address by hand or tamper the
address slip).
(b) Collect the supporting documents shown under Enclosure Checklist in the application form (if you
have uploaded the soft copy of the documents online, you need not send a hard copy). Mark the check
list boxes.
(c) Do NOT FOLD the application form and Do NOT STAPLE or pin the documents to the form.
(d) Send the packet by Speed Post (preferably) or by Registered Post to the address mentioned. The
application packet should REACH the respective GATE office on or before Monday, 8 October 2012.
ROOM NO 39
TIRUCHIRAPPALLI
NATIONAL INSTITUTE OF TECHNOLOGY,
Instructions to the Applicant (GATE 2013)
Zone/Scrutiny Code
7NP
By Registered Post/Speed Post Only
(Mobile No.)
Indian Institute of Technology Madras
GATE 2013
Tamil Nadu, 620015
To
Gautam Kunal
Chairman GATE
90423 42934
135 G 636 H
Chennai, 600036
Cut Here
HOSTEL- GARNET A
From
Note: Application ID - 135 G 636 H. You should preserve this number for further correspondence.
(Application ID) 135 G 636 H
GATE 2013
Zone/Scrutiny Code
Payment Details
Rs. 1200.00
7NP
(D.O.B)
Scribe Assistance Required:
Qualification Details
(Exam City 1)
Gautam Kunal
(Full Name of Applicant)
25 Dec 1988 Male
Indian National
OBC-NC
No
B.Tech
Tiruchirapalli, TN
Thanjavur, TN
EC
Ashok Kumar Varma
(Name of Parent)
Tamil Nadu, 620015
Tamil Nadu, 620015
gautinitt@gmail.com
HOSTEL- GARNET A
NATIONAL INSTITUTE OF TECHNOLOGY,
(GATE Paper code)
Communication Address
Graduated: No, Year of Graduation: 2013
Electronics/Comm./Telecomm Engg.
90423 42934
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.
Digital Fingerprint:
TIRUCHIRAPPALLI
NATIONAL INSTITUTE OF TECHNOLOGY,
Online
MSBI2811961161
He appeared in the final semester/year exam of the above degree, but has a backlog to be cleared
from an earlier semester/year, and therefore cannot produce a course completion certificate.
Signature of Principal/ HOD
ROOM NO 39
4.5 cm x 3.5 cm
Date: Seal
(For use as the eligibility certificate only for final year or backlog applicants)
Zonal GATE Office Contact
Chairman GATE
Indian Institute of Technology Madras
Chennai, 600036
0716c50ba736c32b45568bc9921d213d
Applicant's recent photograph
135 G 636 H
GATE Exam Details
(Mobile No.)
(Exam City 2)
Principal Certificate
This is to certify that Gautam Kunal is a student enrolled in
Applicants signature inside the box in black ink
19/09/2012
Date: ....../....../............
India
He is a student of the final year of B.Tech.
NATIONAL INSTITUTE OF TECHNOLOGY,TIRUCHIRAPPALLI, TIRUCHIRAPPALLI.
TIRUCHIRAPPALLI
Application Form
Do not Attest
Do not sign on photo