Indira Gandhi Delhi Technical University For Women

(Established by Govt. of NCT of Delhi under Act 9 of

2012)
(Formerly known as Indira Gandhi Institute of Technology
under GGSIPU)
Kashmere Gate, Delhi-110 006

NO DUES CERTIFICATE
(For refund of Security Amount deposited at the time of Admission)
(Filling all columns is compulsory)

1 Name (In Block Letters)

___________________________________________________
2 Fathers Name (In Block Letters)
___________________________________________________
3 Mothers Name (In Block Letters)
___________________________________________________
4 Name of Programme
___________________________________________________
5 Enrollment No. ___________________________________________________
6 Correspondence Address
___________________________________________________
__________________________________________________
7 Security Amount deposited
___________________________________________________
(at the time of admission)
8 Telephone/Mobile No. ___________________________________________________
9 E-mail address ___________________________________________________
10 Year of Passing ___________________________________________________
11 Result (Passed/Awaited)
___________________________________________________
12 E-refund Details
a Complete Bank A/c No.
___________________________________________________
(Attach copy of cheque)
b Bank Name ___________________________________________________
& Complete Address
___________________________________________________
c MICR Code ___________________________________________________
d IFCS Code ___________________________________________________
UNDERTAKING
I solemnly affirm that the information furnished above is true and
correct in all respects. The security deposit may be refunded to me after
deducting the dues, (if any) as indicated below:
My Original Identity Card is enclosed

Dated:__________ (Signature of the

Student)
No Dues/ Dues (If any, may please be specified)
 Head of Department Workshop Incharge Computer Centre
Incharge

Store Keeper Librarian Hostel Warden

Net Amount to be refunded: Rs. _____________________

(as per the above undertaking)
(To be filled up by student before submitting to the Academic Branch)