Sam Higginbottom Institute of Agriculture, Technology & Sciences

(Deemed to be University)
Allahabad 211007

NO DUES PROFORMA
ID. No. ______________________ Name____________________________________
Fathers Name __________________________ Day Scholar/ Hosteller_____________
Programme __________________________________Semester__________________
Sl. No.
1.

School / Deptt./Office/ Store etc.

HoD (For PG Students Only)

Dues/ No Dues

2.

School Deans (For UG Students Only)

3.

Central Library

4.

Departmental Library

5.

Mens / Womens Hostel*

6.

Mess*

7.

Cooperative Store

Signature

* Day scholars need not to take clearance from Hostel and Mess

To,
School Dean/ Head of the Department
SHIATS.
Certified that I have obtained No Dues from above mentioned Department/ School/ Office/
Store etc.

Date: _______________________

Signature of student: ____________________

___________________________________________________________________________
For Office Use Only
Admit Card Issued

Not Issued

Signature of verifying clerk

Office Assistant

Date: __________________

Dean / HoD Office