B219 D98 Application Form

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Zone/Scrutiny Code GATE 2021

1OB B219D98
B219D98 (Enrollment ID)

YUVASHREE S
(Full Name of the Applicant)

15 Jan 1999 Female OBC-NCL


(D.O.B) (Gender) (Category)
Indian +91-9731818853 SHANTHI S
National (Parent/Guardian's Mobile Number) (Parent/Guardian's Name)

Communication Address GATE Exam Details


#352 10TH A MAIN, 3RD STAGE, 1ST BLOCK, GATE Paper Code1 GATE Paper Code2
MANJUNATHANAGAR BANGALORE
BANGALORE
Karnataka 560010
+91-8431930872 (Mobile No.)
EC IN
(Electronics and (Instrumentation
syuvashree15@gmail.com Communication Engineering)
Engineering)
Qualification Details Exam City 1: Bengaluru North (KA)
Exam City 2: Bengaluru South (KA)
B.E.
Electronics & Communication Exam City 3: Kolar (KA)
Graduated: Yes; Year of Graduation: 2020 Exam City 4: Mysuru (Mysore KA)
MVJ COLLEGE OF ENGINEERING
Kadugodi Zonal GATE Office Contact
Karnataka 560067 Chairperson, GATE
Indian Institute of Science Bangalore
Payment Details Bengaluru 560012

Payment Mode Transaction Ref. No Transaction Date Amount Payment For


Online CPAAHTKHC0 20/9/20 6:30 PM INR 1500.00 Registration

I confirm that I fulfil the eligibility criteria to appear for the Graduate Aptitude Test in Engineering (GATE 2021)
examination and I, myself have filled up the entire form in the GOAPS portal. I have fully understood each and
every point in the form and filled up the details accordingly. I agree to strictly comply with the code of conduct
for GATE 2021 examination as detailed in Appendix B of the Information Brochure. I confirm that the
information provided by me in this form is correct in all respect. I also confirm that I am NOT filling more than
ONE form for myself.

If any of the information provided by me is found to be incorrect at any time later, my candidature for GATE
2021 will be cancelled. This cancellation of my candidature can happen either before, during or after the
examination, including the time after generation of my GATE 2021 score card, if any.

I also understand that GATE is NOT an admission ensuring examination, and qualifying in GATE examination
does NOT guarantee admission / scholarship / job. GATE 2021 committee is NOT liable for any legal
obligations related to admission / job.

I shall be liable for legal action for providing any type of false information. GATE 2021 committee's decision will
be final and legally binding on me.

e-Signature: YUVASHREE S
Digital Fingerprint: 9230aa7ec7f9f094397f3ba2932fd79d

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