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Fee Refund Application Form

This document is a fee refund application form. It requests the student's contact information and reason for refund, including check boxes for course fee, project viva, application fee, examination fee, or assignment fee. The student must provide remarks on the reason for refund. Transaction details are listed, including reference number, date, payment mode, and amount. The student must sign to indemnify the school in case of any future loss from the refund. Space is provided for office remarks and signatures from the verifier, authorized signatory, accounts department, and approving authority. A note indicates the school will refund excess amounts received but not banking charges.

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Sahil R Kapoor
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77 views1 page

Fee Refund Application Form

This document is a fee refund application form. It requests the student's contact information and reason for refund, including check boxes for course fee, project viva, application fee, examination fee, or assignment fee. The student must provide remarks on the reason for refund. Transaction details are listed, including reference number, date, payment mode, and amount. The student must sign to indemnify the school in case of any future loss from the refund. Space is provided for office remarks and signatures from the verifier, authorized signatory, accounts department, and approving authority. A note indicates the school will refund excess amounts received but not banking charges.

Uploaded by

Sahil R Kapoor
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

FEE REFUND APPLICATION

Roll no./Form no. : Name of Student :


Contact No. : Mail ID :

Reason of Refund : Please () on appropriate box

1. Course Fee 4. Examination Fee

2. Project Viva 5. Assignment Fee

3. Application Fee

Remarks/ Reason for Refund : ………………………………………………………………………….

………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………

Transaction Report :
S.no.  Transaction / DD  Transaction / DD  Mode of payment  Amount (Rs.)  Program / 
Reference no.  Date  DD/Netbanking/Card  Course Code 

1    

2      

3      

4       

I indemnify IMTCDL to make good any loss occurring to IMTCDL in future on account of refund.

Signature of Student

Remarks (for office use only) : ………………………………………………………………………….

………………………………………………………………………………………………………………….

Verifier Authorized Signatory

Accounts Department Approving Authority

Note : Kindly note that Institute is liable to pay the excess received amount only and not for any charges charged by the banker.

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