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NATIONAL INSTITUTE OF TECHNOLOGY RAIPUR

(An Institute of National Importance)

APPLICATION FOR REFUND OF COLLEGE CAUTION MONEY

Full name of student: _________________________________________
Branch / Semester : _________________________________________
Fathers Name

: _________________________________________

Permanent Address : _________________________________________

_________________________________________
_________________________________________
Date of Admission : _________________________________________
Result of last exam and year : __________________________________
Reason Refund of Caution Money : _____________________________
S.B.I. Bank Name & A/c No. : _________________________________
Signature of Father : _________________________________________
I ______________________ hereby declared that I have paid all
dues of the college. There is no due against me.
Signature: ____________________
Name: _______________________
Note : 1)Enclosed Photocopy of T.C. 2) Original admission receipt of First
Semester 3) S.B.I. Passbook Photocopy.

Verification of Caution Money

Book No. /R. No.:____________________

Date: _____________________________
Amount of C.M. Rs: _________________