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EMICALS & FERTILIZERS, GOVT. OF INDIA) CITY CENTRE, P.O.-DEBHOG, HALDIA, DIST.-PURBA MEDINIPUR WEST BENGAL, PIN-721657 Phone : 03224 255534, Mob : 9434039466, 9547039361; E-mail : cipet.haldia.stc gmail.com,Web :www.cipet.gov.in ADMISSION FORM FOR SCHEDULED CASTE CANDIDATES (APPLICACANTS MUST BE FULL IN THE BOXES WITH REQUIRED INFORMATION IN CAPITAL LETTER) Photo COURSE APPLIED FOR (MO-IM/MO-EP/MO-BM): - NAME OF THE APPLICANT: FATHER S NAME : DATE OF BIRTH (DD: MM: YYYY) : MALE / FEMALE:.

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