5NP
To
GATE 2013
Chairman GATE Indian Institute of Technology Kanpur Kanpur, 208016
157 E 280 J
72759 21099
(Mobile No.)
Cut Here
Note: Application ID - 157 E 280 J. You should preserve this number for further correspondence.
Zone/Scrutiny Code
5NP
157 E 280 J
(Full Name of Applicant)
4.5 cm x 3.5 cm
(Application ID)
03 Jul 1991
(D.O.B)
Male
(Name of Parent)
OBC-NC
Indian National
Md Zainul Abedin
Communication Address
RM-243/HALL-3 BOYS HOSTEL INTEGRAL UNIVERSITY KURSI ROAD,DASAULI LUCKNOW Uttar Pradesh, 226026 India
Lucknow, UP
(Exam City 1)
Kanpur, UP
(Exam City 2) Scribe Assistance Required:
No
Qualification Details
B.Tech Electronics/Comm./Telecomm Engg. Graduated: No, Year of Graduation: 2013 INTEGRAL UNIVERSITY LUCKNOW Uttar Pradesh, 226026
Payment Details
Online
Rs. 1200.00
MSBP2815162920 24/09/2012
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: ....../....../............
Principal Certificate
INTEGRAL UNIVERSITY, LUCKNOW.
(For use as the eligibility certificate only for final year or backlog applicants)
He is a student of the final year of B.Tech. 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:
Seal