T 382 D 28 Applicationform

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Application Form

Zone/Scrutiny Code

7GE T382D28

T382D28 (Enrollment ID)

SOUMIK CHAKRABORTY
(Full Name of the Applicant)

10 Jul 1991 Male GEN


(D.O.B) (Gender) (Category)

Indian +91-6289139202 SANJIB CHAKRABORTY


National (Parent/Guardian's Mobile Number) (Parent/Guardian's Name)

Communication Address GATE Exam Details


388/1 netaji colony kolkata-700090 GATE Paper Code1 GATE Paper Code2
ps baranagore, po noapara
Kolkata
West Bengal 700090
+91-6289139202 (Mobile No.)
EC DA
chakrabortysoumik86@gmail.com (Electronics and (Data Science and Artificial
Communication Intelligence)
Engineering)

Exam City 1 : Thiruvananthapuram (KL)


Qualification Details Exam City 2 : Attingal (KL)
B. Tech Exam City 3 : Kollam (KL)
Electrical & Electronics Engg.
Graduated: Yes; Year of Graduation: 2014 Zonal GATE Office Contact
Camellia Institute of Technology GATE Office
Kolkata Indian Institute of Technology Madras
West Bengal 700090
Chennai 600036
gate@iitm.ac.in, 044-22578200

DECLARATION
I confirm that I fulfil the eligibility criteria to appear for the Graduate Aptitude Test in Engineering (GATE 2024) examination. I have read the Information
Brochure and filled up the GATE 2024 Application Form myself. I agree to strictly comply with the code of conduct for GATE 2024 examination as detailed in
the Information Brochure. I confirm that the information provided by me in this form is correct. I also confirm that I am NOT filling more than one Application
Form for myself.
If any of the information provided by me is found to be incorrect later, I understand that my candidature for GATE 2024 may be cancelled, before, during, or
after the examination, including the time after generation of my GATE 2024 Score Card. Further, I understand that I may be liable for legal action for
providing false information. GATE 2024 Examination Body’s decision will be final and legally binding on me.
I also understand that GATE is NOT an admission ensuring examination, and qualifying in GATE examination does NOT guarantee admission, scholarship,
or a job. GATE 2024 Examination Body shall NOT be liable for any legal obligations arising out of this matter.
I am aware that the data provided by me during the application process as well as my GATE results may be shared for admission or recruitment purposes.

e-Signature : null
Digital Fingerprint : 75fea7560c6dd2a5f1e988d80ae20ebd

PROVISIONAL APPLICATION SUBJECT TO PAYMENT

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