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143 S 496 U Application
143 S 496 U Application
2ND
To
GATE 2013
Chairman GATE Indian Institute of Technology Bombay Powai, Mumbai, 400076
143 S 496 U
98901 82497
(Mobile No.)
Cut Here
Note: Application ID - 143 S 496 U. You should preserve this number for further correspondence.
Zone/Scrutiny Code
2ND
143 S 496 U
(Full Name of Applicant)
4.5 cm x 3.5 cm
(Application ID)
15 Jun 1975
(D.O.B)
Male
(Name of Parent)
OBC-NC
Indian National
M Mehmoodul Hasan
Communication Address
N-9, NAIMUDDIN STREET NEAR DAROGHA MASJID KAMPTEE Maharashtra, 441002 India
Nagpur, MH
(Exam City 1)
Wardha, MH
(Exam City 2) Scribe Assistance Required:
No
Qualification Details
B.E. Electronics/Comm./Telecomm Engg. Graduated: Yes, Year of Graduation: 2004 YESHWANTRAO COLLEGE OF ENGINEERING AND NAGPUR Maharashtra, 441110
Enclosure Checklist
Eligibility Certificate copy
Payment Details
Online
Rs. 1200.00
MSBI2819117262 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.
Date: ....../....../............