INTE ‘Application for refund of the Caution Money Name of Student... Enrollment No. Course. Reason for withdraw... ¥, LUCKNOW IFSC Code. Student’s Account No. (tis compulsory to attach the Bank Passbook Photocopy with this form) Signature of Stadent No Dues. ificate (Note: Care should be taken tit dues of ail tie laboratoris/inits ec. ofthe department have been included) S.No. ‘Department [7 Dues’ Authorised Signatory | Faculty. of Engineering’ Science/’ ‘Agricultute/ ‘Architecture? Pharmacy/. Computer’ Application/ 1. | Bducation/: Law/ Commerce & Busiriess Management Health & Medical Sciences/ Humanities & Social Science/ University Polytechnic 2, | Hostel (Giris/Boys)*- Integral University Library [a Departmental Library 4 [Spain |B: Genta i 5 brary &_| Workshop 3. | Sports + 6. | Academie Section 7. | Centre for Career Guidance & Development 7 8. | Transport 9, | TF Helpdesk © 10. | Alumni Cell *Sirike of which is not applicable Prepared by: Checked & Submitted To V.C. for Approval Accountant _. Accoimt Officer ‘Approved by ‘Vice Chancellor