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Fix
Pass Port
INDIAN INSTITUTE OF CHEMICAL ENGINEERS size
Dr. H. L. Roy Building, Raja Subodh Mullick Road, Kolkata - 700 032 Photograph
Phone : (033) 2414-6670 & 2412-9314, E-mail : iichehq@vsnl.com; iichehq@gmail.com
ASSOCIATE MEMBERSHIP EXAMINATION FORM (MARCH / SEPTEMBER 20 .....................)

Last Date of receipt of application : MARCH Exam. 31st December of the preceding year
SEPTEMBER Exam. 30th June of the same year
1. Roll No. : 13/M13/215
2. Last Registration No. : 16/S16/2054 Mobile No. : 6352740347 E-mail : vipinpatel26@gmail.com
VI P I N KUMAR
3. Name in full (in BLOCK LETTERS) as in Registration Form. ____________________________________________________
4. Father’s Name (in BLOCK LETTERS) BABU SINGH
HOUSE NO-29 WARD NO-9NAGAR PANCHAYAT GULARIABUDAUN
5. Present Address (in BLOCK LETTERS)
PIN CODE 243601
HOUSE NO-29 WARD NO-9NAGAR PANCHAYAT GULARIABUDAUN
6. Permanent Address (in BLOCK LETTERS)

PIN CODE

7. Choice of Examination Centres, any three amongst the following: [Please write in order of preference in the box provided]
Ahmedabad, Baroda, Chandigarh, Chennai, Coimbatore, Delhi, Hyderabad, Kolkata, Lucknow, Mumbai, Surat, Thrissur,
Visakhapatnam.

1. Baroda 2. Surat 3. Delhi

2850
8. Amount of examination fees remitted Rs. ..................... 520017
D/D/No. ................. STATE BANK OFDate
Bank .......................... INDIA
23/12/2021
................................
Please tick () in the appropriate box against the subjects you wish to appear. Option exercised at the time of submission of
application cannot be changed later.

Part - I Part - IIA Part – IIB (Select any one)

1. Mathematics 1. Chemical Process Principles 1. Production Management & Industrial
2. Physics 2. Fluid and Particle Mechanics Relations
3. Chemistry 3. Heat Transfer 2. Industrial Pollution Control
4. Mechanical Engineering 4. Mass Transfer 3. Petroleum Refinery Engineering and
5. Electrical Engg and Electronics 5. Chemical Engg Thermodynamics Petrochemicals
6. Engineering Drawing 6. Chemical Reaction Engineering 4. Fertilizer Technology
7. General Chemical Technology 7. Instrumentation and Process Control 5. Polymer Technology
8. Elements of Computer Programming 8. Chemical Plant and Equipment Design 6. Industrial Safety and Hazard Analysis

Part - III
N.B.: “Indian Institute of Chemical Engineers reserves the right to inform the candidate’s employer or other
1. Home Paper
appropriate authority in case of adoption of malpractice by a candidate in the examination.”

Points to Note

i) Examination fees as mentioned below must accompany the application form. Fees are to be paid by Bank Draft drawn in favour of ‘Indian Institute of
Chemical Engineers’ payable at Kolkata. Payment by money Order, Cheque or Postal Order are not acceptable. Examination fees once paid can
neither be returned nor adjusted for subsequent examinations. Fees for Parts I, IIA & IIB : Minimum fee payable is Rs. 1000/- (entitle to appear in
maximum two subjects)
Additional fee per subject is Rs. 600/-. Fees for Part - III (Home Paper) : Rs. 1800/-
ii) A self-addressed envelope. For postage of Mark sheet, add Rs. 50/- (extra) with the examination fees

I declare that all the particulars stated are true to the best of my knowledge and belief; I shall abide by the decision of the Council in all matters regarding
Associate Membership Examination.

Signature of the Applicant