Vidyasagar University

Centre for Continuing & Adult Education

DECLERATION FOR CANCELLATION OF ADMISSION

1. Name of the Candidate (in BLOCK LETTER):

2. Father’s/Guardians Name:

3. Course Admitted:

4. Fees Paid:

5. Mobile No.:

6. Email ID:

7. Admission Form ID: C-2022................

8. Account Details for refund the fees:

(a) A/C Holder Name:
(b) A/C No.:
(c) Bank Name & Branch Name:
(d) IFS Code:

I Sri/Smt. --------------------------------- s/d of Sri/Smt-------------------------------, do hereby

declare in complete alertness that I am willing to cancel my Admission in ------------------
---- (name of the course) under CCAE of Vidyasagar University. I shall have no bearing
on the candidature after such cancellation.

Date: Signature of the Candidate

Note:
1. Please attach self attested copy of Admission Payment Receipt
2. Duly signed in Application Form should be sent/submitted to the Office of the CCAE,
Vidyasagar University, Midnapore – 721102
3. Amount to be refunded as per rules of the Vidyasagar University