1. Zone/Scrutiny Code By Registered Post/Speed Post Only
2NP GATE 2013
To
Chairman GATE
Indian Institute of Technology Bombay
Powai, Mumbai, 400076
From
Samay Deepak Kumbalwar
VII/05/02
VII TYPE 219 K 464 A
MSEB COLONY KORADI
NAGPUR
Maharashtra, 441111
90494 48851 (Mobile No.)
Cut Here
Instructions to the Applicant (GATE 2013)
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
Principal’s or HOD’s sign and seal in the last portion of the application form. Submit the whole form
to the Principal’s office without cutting it.
5. If you have opted for Challan payment, wait for 48 hours after your online submission to visit the bank’s
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.
Note: Application ID - 219 K 464 A. You should preserve this number for further correspondence.
2. Zone/Scrutiny Code GATE 2013 Applicant's recent photograph
Application Form
2NP
4.5 cm x 3.5 cm
219 K 464 A (Application ID)
Samay Deepak Kumbalwar
(Full Name of Applicant)
219 K 464 A
Do not Attest
30 Jul 1992 Male GEN Do not sign on photo
(D.O.B)
Indian National Deepak
(Name of Parent)
Communication Address GATE Exam Details
VII/05/02 EC (GATE Paper code)
VII TYPE
MSEB COLONY KORADI
Nagpur, MH
NAGPUR (Exam City 1)
Maharashtra, 441111
India Wardha, MH
(Exam City 2)
samaykumbalwar123@rediffmail.com
90494 48851 (Mobile No.) Scribe Assistance Required: No
Zonal GATE Office Contact
Qualification Details
B.E. Chairman GATE
Electronics/Comm./Telecomm Engg. Indian Institute of Technology Bombay
Graduated: No, Year of Graduation: 2012 Powai, Mumbai, 400076
NUVA COLLEGE OF ENGINEERING
NAGPUR
Maharashtra, 441501
Payment Details
Online Rs. 1200.00
MHDF2818706408
29/09/2012
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: fd5f0a68777ccc24ecd3b6edc9056f8a Date: ....../....../............ Applicant’s signature inside the box in black ink
Principal Certificate (For use as the eligibility certificate only for final year or backlog applicants)
This is to certify that Samay Deepak Kumbalwar is a student enrolled in
NUVA COLLEGE OF ENGINEERING, NAGPUR.
He is a student of the final year of B.E..
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.
Date: Signature of Principal/ HOD Seal
