Professional Documents
Culture Documents
1. Your Login ID is SYED2606. 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
Page - 1
GATE IIT Bombay COPY
APPLICATION FORM FOR GATE 2011
Application No: 2119389 Payment Mode: Bank Challan (State Bank of India)
1. Name of the Candidate as in SYED KAUSARALI SYED SABERALI 11. Address NEAR RAILWAY GATE,
the 10th Class Certificate
KRANTI NAGAR,
GANGAKHED ROAD,PARBHANI.
PINCODE 431401
3. Gender MALE
Do You Require a Scribe? No 16. Name of Parent SYED SABERALI SYED YASEEN
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
2119389 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 Bombay
Page - 2
CANDIDATE COPY
APPLICATION FORM FOR GATE 2011
Application No: 2119389 Payment Mode: Bank Challan (State Bank of India)
1. Name of the Candidate as in SYED KAUSARALI SYED SABERALI 11. Address NEAR RAILWAY GATE,
the 10th Class Certificate
KRANTI NAGAR,
GANGAKHED ROAD,PARBHANI.
PINCODE 431401
3. Gender MALE
Do You Require a Scribe? No 16. Name of Parent SYED SABERALI SYED YASEEN
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
2119389 using black ball point pen only 3cm x 4cm
(do not sign in capital letters) without any
signature or
attestation
Page - 3
BY SPEED POST / REGISTERED POST
GATE 2011
GATE PAPER CODE IN To
Powai, Mumbai
From
PINCODE 4 0 0 0 7 6
SYED KAUSARALI SYED SABERALI
GANGAKHED ROAD,PARBHANI.
DIST: PARBHANI 2 1 1 9 3 8 9
PINCODE 4 3 1 4 0 1
Page - 4
CASH VOUCHER BANK'S COPY CASH VOUCHER INSTITUTE’S COPY CASH VOUCHER CANDIDATE'S COPY
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 SYED KAUSARALI SYED SABERALI Name of the SYED KAUSARALI SYED SABERALI Name of the SYED KAUSARALI SYED SABERALI
Present Address Present Address Present Address
NEAR RAILWAY GATE, KRANTI NAGAR, NEAR RAILWAY GATE, KRANTI NAGAR, NEAR RAILWAY GATE, KRANTI NAGAR,
GANGAKHED ROAD,PARBHANI. DIST: GANGAKHED ROAD,PARBHANI. DIST: GANGAKHED ROAD,PARBHANI. DIST:
PARBHANI - 431401 PARBHANI - 431401 PARBHANI - 431401
Mobile / Landline No: 08983424032 Mobile / Landline No: 08983424032 Mobile / Landline No: 08983424032
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
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.
APPLICATION NUMBER JOURNAL NUMBER APPLICATION NUMBER JOURNAL NUMBER APPLICATION NUMBER JOURNAL NUMBER
1. Please credit Rs.30/- to your Branch Commission 1. Please credit Rs.30/- to your Branch Commission 1. Please credit Rs.30/- to your Branch Commission
A/c No.98353XXXXXX A/c No.98353XXXXXX A/c No.98353XXXXXX
2. Please note to write the Journal Number in all the challans. 2. Please note to write the Journal Number in all the challans. 2. Please note to write the Journal Number in all the challans.
3. Please feed the Application No. in REG/ID/Ref No. Column 3. Please feed the Application No. in REG/ID/Ref No. Column 3. Please feed the Application No. in REG/ID/Ref No. Column
and Name of the Candidate in the menu while posting. and Name of the Candidate in the menu while posting. and Name of the Candidate in the menu while posting.
SEAL / DATE AUTHORISED SIGNATORY SEAL / DATE AUTHORISED SIGNATORY SEAL / DATE AUTHORISED SIGNATORY