GATE 2014: To Chairperson GATE Kharagpur 721302
GATE 2014: To Chairperson GATE Kharagpur 721302
GATE 2014: To Chairperson GATE Kharagpur 721302
Zone/Scrutiny
6CP
GATE 2014
Chairperson GATE
Indian Institute of Technology Kharagpur
Kharagpur 721302
A181H87
To
From
Jogeswar Prusty
C/O-PRASANTA KUMAR PRUSTY
AT/PO-KUABUDA
VIA-CHANDUA
BARIPADA
Orissa 757014
75041 36648 (Mobile Number)
A181H87
Cut Here
Note: Enrolment ID - A181H87. You should preserve this number for further correspondence.
Zone/Scrutiny
GATE 2014
6CP
A181H87
A181H87
A181H87
(Enrolment ID)
Jogeswar Prusty
(Full Name of the Applicant)
3.5 cm x 4.5 cm
A181H87
09 Jun 1987
Male
OBC
No
(D.O.B)
(Gender)
(Category)
(PD Status)
Indian National
Do not Attest
Do not sign on photo
Do not staple photo
9937328710
Communication Address
ME
Bhubaneswar, OR
(Exam City 1)
Cuttack, OR
Qualification Details
(Exam City 2)
Kolkata, WB
B.Tech
Mechanical Engg.
Graduated: No; Year of Graduation: 2014
PARALA MAHARAJA ENGG COLLEGE
BERHAMPUR
Orissa 761003
(Exam City 3)
Payment Details
Enclosure Checklist
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. The
responsibility of following the GATE 2014 website and meeting various deadlines lies with me. 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 2014. Further, if any suppression or distortion of facts is found after appearing in the
exam, any admission/degree/benefit acquired on the basis of GATE 2014 score/marks is liable to be
cancelled.
Digital
Fingerprint:
0428b1513fb769fe72b5c2a809b92fb0
Date: ....../....../.........
(For use as the eligibility certificate only for final year or backlog applicants)
Date:
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